Debunking Dogma in the ED- Bridging the Knowledge Translation gap to Bring Cutting Edge Care to the Bedside

Field spinal immobilization using a backboard and cervical collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a component of field spinal immobilization despite lack of efficacy evidence. While the backboard is a useful spinal protection tool during extrication, use of backboards is not without risk, as they have been shown to cause respiratory compromise, pain, and pressure sores. Backboards also alter a patient's physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains unsubstantiated, they should only be used judiciously. Conclusion: All trauma patients should receive spinal assessment from EMS providers in the field. At a minimum, patients with potential for spine injury should be transported to the hospital using spinal precautions that include cervical collar and log roll procedures. Patients who are ambulatory or able to self-extricate without causing undue pain should be encouraged to move themselves to a supine position on the EMS cot, after application of a cervical collar. Backboards remain a valuable adjunct to spinal immobilization during patient extrication. Careful patient handling and transport of the patient with suspected spinal injury using spinal precautions remains prudent. Effects of spinal immobilization devices on pulmonary function in healthy volunteer individuals. BACKGROUND: We aimed to investigate the effects of spinal immobilization devices on pulmonary functions. CONCLUSION: We determined that both KED and long spinal backboard cause a decrease in pulmonary functions. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. BACKGROUND: To protect the (possibly) injured spine, trauma patients are immobilized on backboard or vacuum mattress, with a cervical collar, lateral headblocks, and straps. Several studies identified pressure ulcer (PU) development from these devices. The aim of this literature study was to gain insight into the occurrence and development of PUs, the risk factors, and the possible interventions to prevent PUs related to spinal immobilization with devices in adult trauma patients. CONCLUSION: The results from this systematic review show that immobilization with devices increases the risk for PU development. This risk is demonstrated in nine experimental studies with healthy volunteers and in four clinical studies. Changes in physical examination caused by use of spinal immobilization. OBJECTIVE: To determine whether spinal immobilization causes changes in physical exam findings over time. CONCLUSION: This study shows that over time, standard immobilization causes a false-positive exam for midline vertebral tenderness. In order to reduce this high false-positive rate for midline vertebral tenderness, the authors recommend that, initially on arrival to the emergency department, immediate evaluation occur of all immobilized patients. Furthermore, backboards should be modified to reduce patient discomfort to prevent the iatrogenically induced midline vertebral tenderness, thereby reducing subsequent false-positive examinations. Long backboard versus vacuum mattress splint to immobilize whole spine in trauma victims in the field: a randomized clinical trial. INTRODUCTION: Patients with possible spinal injury must be immobilized properly during transport to medical facilities. The aim of this research was comparing spinal immobilization using a long backboard (LBB) with using a vacuum mattress splint (VMS) in trauma victims transported by an Emergency Medical Services (EMS) system. CONCLUSION: The results of this study showed that immobilization using LBB was easier, faster, and more comfortable for the patient, and provided additional decrease in spinal movement when compared with a VMS.