Spine Board

Extrication from accident scene
1. Allows for easier transfer of patient from difficult conditions by multiple rescuers
2. Wilderness rescue (e.g. mountain terrain) may make use of scoop stretcher or Stokes basket
3. Once extricated and patient on firm cot, consider alternatives to Backboard (see below)
Serious mechanism of injury (suspected or evident Spinal Injury or neurologic deficit)
1. High energy mechanism
2. Spine deformity
3. Focal neurologic deficit
Traumatic Injury and does not meet all criteria for spine clearance
1. Glasgow Coma Scale (GCS) 15
2. No spinal tenderness to palpation or anatomic deformity
3. No neurologic complaints or exam findings
4. No distracting injury
5. No Intoxication (drugs or Alcohol)
6. Age <65 years

Spine Boards are not intended for in-hospital Spine Immobilization
Avoid immobilization in penetrating head, neck or torso Trauma without spine injury findings or focal neurologic deficit
1. Haut (2010) J Trauma 68(1): 115-20 [PubMed]

Remove patients from Spine Board within 20 minutes of emergency department arrival
Patients on Spine Board must have 1:1 observation to intervene for Vomiting, change in mental status or attempts to move
Maintain full spinal precautions after Spine Board removal until spine fully cleared
1. Emergency department gurneys offer adequate firm surface for spinal support (Cervical Collar is also required)
2. Use slider boards in-hospital to transfer patient from gurney to diagnostic equipment (maintain full spinal precautions)
3. Do not leave patients on slider boards for extended periods of time
4. Consider intubation and sedation in uncooperative patients unwilling or unable to maintain spinal precautions

Pressure Sores (especially in elderly)
1. Remove patients from Spine Board within 20 minutes of emergency department arrival
Aspiration
1. Patient unable to turn head if they vomit
2. Continuous 1:1 observation until off board
Impaired respiratory function
1. Spine Board immobilization restricts pulmonary expansion
Impaired Trauma Evaluation
1. Spine Boards interfere with an adequate physical exam and lead to increased imaging

Indications
1. Patient ambulatory at the scene
2. Protracted transport time
3. Other indications for Spine Immobilization as above
Technique: Spine Immobilization
1. Rigid Cervical Collar AND
2. Supine on cot AND
3. Consider head block AND
4. Consider securing patient to gurney (e.g. via Seat Belts across chest, Abdomen, Pelvis, and legs)
Technique: Self Extrication (replaces standing takedown) for ambulatory patients with spinal tenderness
1. Rigid Cervical Collar applied first
2. Patient ambulates to cot with or without assistance
3. Patient lies in supine position
4. Patient secured to cot as above

Attempt to remove all clothing prior to Log Roll
Push Spine Board straps under patient's lateral decubtus side (side that they will lie on when Log Rolled)
Log Roll (requires 4 people)
1. Attendant at head
  1. Maintains control of head and neck and directs the Log Roll ("Roll on 3 - 1,2,3 - Roll")
2. Attendant at torso
  1. Rotates torso into lateral decubitus position
3. Attendant at Pelvis, hips and legs
  1. Rotates hips and leg into lateral decubitus position
4. Provider at back
  1. Removes the Spine Board
  2. Walks the spine from cervical through sacral examining for focal tenderness, deformity, crepitation
  3. Observes skin for wounds, Bruising
  4. Additional measures in significant Trauma
    1. Examine perineum
    2. Rectal Exam (evaluate tone, blood)
Spinal Precautions
1. Maintain spinal precautions until full spine clearance based on history, exam and imaging as indicated
2. See Precautions above