trauma

1. A B D A L M O H S E N A B A B T A I N
EMERGENCY MEDICINE
PHYSICIAN
Prehospital Spinal
Immobilization

2. Spinal Injuries
 Primary:
Injury due to the accident
 Secondary:
Injury Caused by manibulation after the injury

4. Is the backboard good ?
 Substantial evidence now exists to show that long
back boards may cause harm to patients, and no
literature has yet shown a benefit of their use

5. Backboarding :
 Doesn’t Immobilize the spine.
 Increases mortality in certain trauma patients.
 Doesn’t Prevent neurological complications from
spinal injury.
 Restricts respiration, which some patients can not
tolerate
 Leads to skin breakdown and pressure ulcers, even
after a short period of time, and is particularly hard
on the elderly.

6. How would you transfer the pt to the stretcher ?
 Long spine board
 Scoop stretcher
 Vacuum mattress
 short board
 Kendrick Extrication Device (KED)

7. Use Backboard selectively for
 The safety of the patient (Patients who are markedly
agitated and confused from head injury may not be
able to follow commands with regard to minimizing
spinal movement, and combativeness may also be a
factor)

8. Don’t Apply Backboard for
1.Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma,
2010; 68: 115–20, discussion 120–1.
 Penetrating trauma such as a gunshot wound
or stab wound (1)
 Ambulatory Patients : Patients who are
ambulatory and able to follow commands do a better
job of preventing movement of an injured spine than
rescuers do.

9. NAEMSP believesoct 2012:
 There is no evidence that the use of backboards reduces spinal
injury or effectively provides anatomically appropriate spinal
immobilization or protection.
 There is evidence that backboards result in harm by causing
pain, changing the normal anatomic lordosis of the spine,
inducing patient agitation, causing pressure ulcers and
compromising respiratory function.
 The only practical value of backboards is for extrication to a
transport vehicle. Once extricated, patients should be taken
off the backboard.
 Backboards should not be used for spinal immobilization.
Placing ambulatory patients on backboards is unacceptable.
 In general, patients should not be transported or otherwise
kept on backboards for any length of time.

10.  Backboards should not be used for spinal
immobilization. Placing ambulatory patients on
backboards is unacceptable.
 In general, patients should not be transported or
otherwise kept on backboards for any length of time.
 The debate now is not whether EMTs can effectively
determine which patients do not require
immobilization in the field, it is whether we should
immobilize at all.

11. C-Collar
 High risk injury (high speed MVC, axial loading
injury)
 Focal neurological deficits such as paralysis
 Intoxication or altered mental status
 Age >65
 Presence of midline bony tenderness of the spine
 Midline spinal pain with movement of the neck

12. The new protocol will:
 Reduce pain and suffering
 Reduce complications
 Decrease on scene times
 Reduce injuries to crews who are attempting to carry
immobilized patients
 Reduce unnecessary imaging costs and radiation
exposure