Prehospital Spinal Immobilization andthe Backboard Quality Assessment Study

Abstract

Introduction. Prehospital spinal immobilization (PSI) for patients with suspected spinal injury has been the universal standard of practice for emergency medical services (EMS) in the United States since the early 1970s. PSI research has faced numerous methodological difficulties, including an inability to evaluate whether the immobilizations being studied were carried out appropriately. The purpose of this study was to assess the quality of spinal immobilization to a long spine board in patients presenting via EMS to an emergency department (ED). Methods. All noncritically ill patients presenting to a tertiary care academic trauma center who had been immobilized on a long spine board for EMS transport were approached for enrollment. Each subject was evaluated for the number andlocation of restraining straps andtheir degree of tightness. Results. Of 50 consenting subjects, 15 (30%) had at least one unattached strap or piece of tape that should have attached their head to the board. Of 50 subjects, 44 (88%) were found to have greater than 2 cm of slack between their body andat least one strap. Among those with any straps looser than 2 cm, the average number of loose straps was 3.4. Conclusions. This study suggests that many patients are not well immobilized on arrival at the Emergency department.

Key words:

• spinal immobilization
• backboard
• c spine
• trauma
• prehospital

Notes

¹The American Academy of Neurology provides the following definitions of Class I andClass II evidence for a therapeutic intervention on their website.³¹ “Class I: Prospective, randomized, controlled clinical trial with masked outcome assessment, in a representative population. The following are required: a) Primary outcome(s) is/are clearly defined. b) Exclusion/inclusion criteria are clearly defined. c) Adequate accounting for drop-outs andcross-overs with numbers sufficiently low to have minimal potential for bias. d) Relevant baseline characteristics are presented andsubstantially equivalent among treatment groups or there is appropriate statistical adjustment for differences. Class II: Prospective matched group cohort study in a representative population with masked outcome assessment that meets a-d above OR a RCT in a representative population that lacks one criteria a-d.”