Are Spine Boards Safe?

Spine boards are EMS adjuncts that help to stabilize an injured patient who may have a spinal injury of some sort. They are designed not to further injure the patient while he is being transported to the medical facilities. Nevertheless, much criticism of the safety and efficiency of the use of spine boards in pre-hospital care has been drawn over the past few years. This blog article is written critically and looks into issues of safety surrounding the use of spine boards, basing it on hard data and views of experts.

Purpose and Use of Spinal Boards

Immobilization of patients with possible spinal injuries post trauma mainly involves the use of spine boards. They are, in most cases, used in cases involving vehicle injuries, falling, and sports injuries. The main reason for their use is to maintain the alignment of the spine and avoid further injury when the patient is being transported to a medical care center.

Indications for Use

1. Suspected spinal injury: High clinical suspicion of spinal injury based on the mechanism of injury or the symptoms of the patient.

2. Altered Level of Consciousness or Unconscious: To protect from undiagnosed spinal injury in the patient who cannot communicate symptoms.

3. Polytrauma: If the general patient has other multiple traumas, the injury could occur in the spinal cord.

Safety Considerations and Hazards

Despite their wide use, quite a huge number of studies have been carried out to bring out the drawbacks that spine boards have in terms of safety and efficiency. Here are some of the major ones:

Pressure Ulcers and Pain

A patient with a spine board can develop increased pain and the potential for development of pressure ulcers with prolonged immobility. For instance, pressure ulcers can occur after 30 min of immobilization according to one study in Journal of Emergency Medical Services and the immobile may be at greater risk if they are older or have existing comorbidities.

Difficulty in Breathing

The inflexibility of spine boards can affect respiration by limiting the thoracic cage's movement. Respiratory function is significantly reduced with the immobilization of patients with existing diseases, as the American Journal of Emergency Medicine has documented.

Degeneration In The

But ironically, the very device used for preventing spinal injury complications is probably the device that will worsen the neurological outcomes subconsciously. The wrong application or overmanipulation of the device during boarding may lead to neurological deterioration. The Annals of Emergency Medicine published a study in which inappropriate handling and spinal immobilization techniques caused worse neuro outcomes.

Make evidence-based recommendations

In light of this, there is a move towards evidence-based guidelines or recommendations with respect to the use of spine boards. There have been recent recommendations released by the National Association of EMS Physicians (NAEMSP) and from the American College of Surgeons Committee on Trauma (ACS-COT).

Selective Spinal Immobilization

Modern protocols use selective spinal immobilization and not the routine one and are based on factors of risk in which a patient presents and symptoms that warrant immobilization. The criteria are:

1. Mechanism of Injury: High-velocity impact, long fall, or a hit directly in the spine.

2. Clinical Symptoms: neck or back pain, neurological deficits, or change in mental status.

3. Cognizant clinical features related to the physical examination are: the spine is tender to palpation; abnormal neurological exams; or intoxication, which may mask pain.

Alternatives to Spine Board

Many times, alternatives for spine boards are prescribed. Vacuum mattresses, for example, provide patients with more comfort and prevent risks for pressure ulcers and respiratory infections. A study compared the effectiveness between keeping spinal immobilization and using vacuum mattresses and found the latter to be more effective with fewer adverse effects in a study published in Prehospital Emergency Care.

Implications for EMS Providers

The shift toward selective spinal immobilization has practical implications for EMS practitioners. Accurate assessment with good decision-making on field response will depend on proper training and education. The EMS practitioner should be skillful in employing the use of the different immobilization tools and know when each is to be taken into consideration.

Training and Protocol Changes

1. More Training: Conduct regular refresher courses for EMS regarding current protocols and evidence-based guidelines for immobilization.

2. Protocol Revision: Protocols of EMS agencies need to be upgraded according to the prevailing practices, and algorithms of decision making must be made for selective immobilization.

3. Quality Improvement: Continuous quality improvement programs can be significantly relied upon to oversee compliance with the newly set guidelines to improve patient outcomes.

Case Studies and Clinical Results

Effect of better immobilization practices on the patient outcome has been reported from several case studies: for instance, a retrospective review of trauma cases presented at a major urban trauma center showed a very significant decrease in pressure ulcers and respiratory complications following the introduction of selective immobilization protocols.

Case Study: Urban Trauma Center

Objective review within 500 trauma cases before and after implementation of selective immobilization protocols at an urban trauma center resulted in the following:

• A decrease of 30% in pressure ulcer incidence.

• A 20% reduction in respiratory complications.

• There is no increase in the number of missed spinal injuries, which shows that selective immobilization is effective.

Case Study 2: Rural EMS System

In a rural EMS system, selective immobilization protocols were implemented with a focus on education and training. Outcomes included:

• Improved patient comfort and satisfaction score.

• Enhanced assurance among EMS providers in making decisions.

• Unneeded immobilization is reduced, which is a consequence of more effective resource use.

Conclusion

The issue of using a spine board for safety is a complex issue and has to be looked at from a balanced perspective considering the benefits versus the possible risks. Although the spine board is an important tool in patient immobilization in suspicion of spinal injury, its use has to be protocol-based with better evidence to reduce the potential harms of these interventions. Selective spinal immobilization, increased training, and the use of alternatives like vacuum mattresses represent a significant progress in pre-hospital care.

Implementation of the confirmed guidelines when combined with patient-centered care may guarantee the safe and effective administration of spinal immobilization techniques by EMS providers. Continuous research and quality improvement will further enhance these practices to eventually provide patients with the highest level of care and make general improvements to emergency medical services.