Backboards have traditionally been used for spinal immobilization in prehospital settings as part of trauma care protocols. However, recent research and evolving guidelines suggest a shift away from this practice. Studies have shown that the early removal of patients from backboards is considered best practice (Cooney et al., 2013). EMS systems have transitioned from spinal immobilization protocols to spinal motion restriction protocols, which have not been associated with an increase in disabling spinal cord injuries (Clemency et al., 2021). Implementing educational programs and policy changes has led to a significant reduction in backboard use by prehospital care practitioners (Morrissey et al., 2014).
Recommendations from systematic reviews and evidence-based guidelines suggest that patients should be transferred off spine boards as soon as feasible to reduce pressure and discomfort, with a focus on utilizing padded boards or inflatable bean bag boards (Ahn et al., 2011). Selective immobilization protocols have been proposed to reduce unnecessary immobilization and corresponding patient morbidity associated with rigid immobilization using backboards (Domeier, 2002). Clinical guidelines now recommend against the routine use of rigid cervical collars and hard backboards for stable patients, favoring the use of vacuum mattresses for patient transportation instead (Maschmann et al., 2019).
Studies have highlighted the risks associated with backboard use, emphasizing the need for judicious and selective application due to the lack of clear evidence supporting their benefit in protecting the spinal cord (White et al., 2014). The American College of Surgeons Committee on Trauma, American College of Emergency Physicians, and National Association of EMS Physicians have provided varied guidance on the role of backboards and spinal immobilization in out-of-hospital situations (Fischer et al., 2018).
In conclusion, the evidence suggests a shift towards more selective and cautious use of backboards for spinal immobilization in the prehospital environment. This change is driven by a growing recognition of the potential harm and lack of clear benefits associated with routine backboard use. Implementing spinal motion restriction protocols and utilizing alternative devices like vacuum mattresses are emerging as safer and more effective approaches to spinal care in prehospital settings.
References:
- Ahn, H., Singh, J., Nathens, A., MacDonald, R., Travers, A., Tallon, J., … & Yee, A. (2011). Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. Journal of Neurotrauma, 28(8), 1341-1361.
https://doi.org/10.1089/neu.2009.1168
- Clemency, B., Natalzia, P., Innes, J., Guarino, S., Welch, J., Haghdel, A., … & Lerner, E. (2021). A change from a spinal immobilization to a spinal motion restriction protocol was not associated with an increase in disabling spinal cord injuries. Prehospital and Disaster Medicine, 36(6), 708-712.
https://doi.org/10.1017/s1049023x21001187
- Cooney, D., Wallus, H., Asaly, M., & Wojcik, S. (2013). Backboard time for patients receiving spinal immobilization by emergency medical services. International Journal of Emergency Medicine, 6(1).
https://doi.org/10.1186/1865-1380-6-17
- Domeier, R. (2002). Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spinal clearance criteria. Academic Emergency Medicine, 9(5), 424-b-425.
https://doi.org/10.1197/aemj.9.5.424-b
- Fischer, P., Perina, D., Delbridge, T., Fallat, M., Salomone, J., Dodd, J., … & Gestring, M. (2018). Spinal motion restriction in the trauma patient – a joint position statement. Prehospital Emergency Care, 22(6), 659-661.
https://doi.org/10.1080/10903127.2018.1481476
- Maschmann, C., Jeppesen, E., Rubin, M., & Barfod, C. (2019). New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 27(1).
https://doi.org/10.1186/s13049-019-0655-x
- Morrissey, J., Kusel, E., & Sporer, K. (2014). Spinal motion restriction: an educational and implementation program to redefine prehospital spinal assessment and care. Prehospital Emergency Care, 18(3), 429-432.
https://doi.org/10.3109/10903127.2013.869643
- White, C., Domeier, R., & Millin, M. (2014). Ems spinal precautions and the use of the long backboard –resource document to the position statement of the national association of ems physicians and the american college of surgeons committee on trauma. Prehospital Emergency Care, 18(2), 306-314.
https://doi.org/10.3109/10903127.2014.884197