The Lengthy Spine Board Isn't Going Away And Shouldn’t

Across the nation we are shifting additional away from spinal immobilization with a spine board.
The rationale for this is the chance of a spinal cord injury could be very low. A National Spinal Cord Injury Statistical Center’s report revealed the U.S. has 54 instances of spinal cord harm per 1 million people annually. The brand new England Journal of Medicine article, “The Canadian C-Spine Rule Versus the Nexus Low-Threat Criteria in Patients with Trauma,” states there are about thirteen million individuals per yr who are at risk of a spinal cord damage. That signifies that fewer than 1% of trauma patients will endure a spinal cord harm. Because of this information, lengthy spine board immobilization is slowly being phased out nationwide for patients involved in a traumatic event who meet particular standards established by the National Emergency X-Radiography Utilization Study (NEXUS).

This is applicable as long as the affected person is categorised as falling into the Nexus Low-Danger Criteria, which consists of the next five items:

1. The affected person doesn't have mid-line cervical spine tenderness in the posterior area. 2. There isn't any evidence of intoxication. Keep in thoughts, alcohol is a analysis of exclusion, which means alcohol ought to be the final rule out you should consider. 3. The patient is alert and oriented x 4 - particular person, place, time and event. 4. The patient does not have a focal neurologic deficit. 5. There aren't any distracting accidents.

We all know the alert patient does a greater job of defending themselves from further harm because of the inflammatory response. This would be the one-time histamines are a great thing.

Do you flip your head to look at somebody when you've gotten a “kink” in your neck? No, you know your limitations and also you flip your whole body to reduce the pain.


Different uses for the long spine board
Simpler CPR

I used to be instructing a category a few months ago and a scholar stated his agency had fully eliminated lengthy spine boards from service. I used to be floored.

What’s the issue? First, as we are able to see above, NEXUS lays out very particular criteria by which spinal immobilization is required. But we produce other makes use of for long spine boards.

spine board with head immobilizer can't do CPR immediately on a gurney mattress. We know doing chest compression on a mattress decreases the effectiveness. And, considering we obtain 30% of the patient’s normal cardiac output at greatest, that’s huge. But, how many of you could have witnessed or allowed chest compression to be performed instantly on the gurney? I have seen it more instances than I can count.


Stopping tube displacement
What about the causes of a lost endotracheal tube? Our new mnemonic is DOPER - displacement of the tube, obstruction, pneumothorax, extubation and the most recent edition is rigidity - because of the growing pre-hospital use of fentanyl.

The most typical challenge is tube displacement, which is especially true among the many pediatric inhabitants.

A neck motion examine sponsored by the Beijing Tsinghua Chang Gung Hospital found that flexing the patient’s head resulted in transferring the endotracheal tube towards the patient’s carina and extending the top resulted in the other.

These movements resulted in both endobronchial intubation or unintentional extubation. Both issues are life-threatening if they go uncorrected.

If there is a return of spontaneous circulation the patient is moved a minimum of two instances, floor to gurney and gurney to hospital mattress.

If we take ninety seconds and place the affected person in spinal immobilization and remember to apply padding accurately, we decrease the danger of an endotracheal tube displacement.

I can’t even guess on the variety of times I have been on a cardiac arrest affected person and was questioned as to why I used to be putting a non-trauma affected person into spinal immobilization. My response: “We are going to do this, and we can discuss it after the call is over.”


It’s better for you, too
We additionally need long spine boards to assist with lifting and to protect our backs. Have you ever lifted lifeless weight? It’s awkward and can throw us off stability very simply.


Again injury danger grows
We even have an obesity downside within the U.S. In 2016, the Centers for Illness Control and Prevention reported that 93.3 million people classified as obese. That’s 39.8% of the population.

We spend $20 billion on healthcare-related again accidents, in line with the Occupational Security and Health Administration (OSHA). These prices embrace visits to the emergency division, workman’s comp, bodily therapy, misplaced wages, paying extra time for somebody to backfill your shift, and potentially back surgical procedure and retraining.

In keeping with OSHA, in 2012 nursing and residential care workers have been two instances extra likely to suffer a again harm than a building worker. I feel it's protected to say that these of us working in EMS have an equal, if not higher threat of damage, than those working in a facility.


OSHA recommends six parts to minimizing again injuries:
1. Input from staff who work with patients 2. A management workforce that commits to a secure-lifting program 3. Hazard assessment 4. Know-how 5. Training 6. Gear

The long spine board is the gear you possibly can and needs to be utilizing to maneuver the patient. And never just obese patients, but all patients.

We all know lifting an obese affected person can lead to an damage, however we could be injured transferring smaller patients too. When you are taking the time to immobilize the patient correctly you guarantee there just isn't an unexpected shift in the patient’s weight. You also make lifting a extra formal process as a result of you need to squat down and keep your again straight.

To the companies which have eliminated lengthy spine boards from service, please put them back on the models. Your budgets and, extra importantly, your crew’s backs, will thank you.