Does a scoop stretcher provide spinal immobilization?
Show Previously considered the standard of care, there’s no evidence to support routine use of backboards. Photo Vu Banh THE RESEARCH EMS SCIENCE KEITH WESLEY’S COMMENTS Throughout the past several years, since the NEXUS and Canadian C-spine rules were published, EMS has slowly but steadily adopted selective spinal immobilization protocols. This alone has significantly reduced the number of patients needlessly strapped to backboards and placed in C-collars. But the question now before us is: Once it’s determined a patient may require spinal immobilization, what’s the most appropriate method? The C-collar is very similar in design to the devices used to provide long and short-term immobilization for patients who have suffered significant injury to their neck. Therefore, despite there being no documented evidence to support their use in the emergency situation, their use after diagnosis supports their emergency use as a standard of care. On the other hand, there’s no evidence that the long backboard provides clinically appropriate support and immobilization of the injured spine. In fact, there’s a large and growing body of evidence that the backboard causes pain, promotes skin ulcers and harms patients by restricting their ability to breath. Unlike the C-collar, physicians treating the injured spine in the hospital don’t use the backboard in any form. In fact, the original use of the backboard was as an extrication device only. Over time, the decision was made to simply keep the patient on the board and this was incorporated into the Department of Transportation curriculum without any scientific evidence to support it. Many medical directors, myself included, supported an earlier draft of this position statement that clearly stated backboards should only be used for extrication, and then the patient should be lifted onto the stretcher. This position statement essentially states that the relative risks and benefits of using the backboard must be evaluated with every patient. If the risks outweigh the benefits, it’s completely appropriate to place the patient on the stretcher, securing and padding them to limit spinal movement. It doesn’t require the use of the traditional backboard but instead states that for patients suspected of a spinal injury, appropriate methods to reduce potentially harmful movement of the spine should be used. There’s growing literature to support the use of the scoop stretcher or vacuum mattresses for spinal immobilization. Patients placed on a backboard should be removed from it as soon as practical in the emergency department. Of particular note, the position statement clearly admonishes that ambulatory patients don’t need spinal immobilization. Oh my God! No more standing take-downs while trying to hold a patient’s head still! The biggest question is whether medical directors and services have the courage to modify their current guidelines to permit EMS providers to use their best judgment of who requires spinal immobilization and the best method to accomplish that safely. KAREN WESLEY’S COMMENTS Selective spinal immobilization provides a clear tool for providers to determine the degree of stabilization needed for each patient. However, the movement of patients to the stretcher is not defined. A standing patient can be coached to sit on the stretcher. A three-person assist to the supine position with head stabilization is then an easy maneuver, but removal of patients either from a vehicle or other situation may not be as easy. The long spine board provides a safe method of movement. Aggressive training on how to move the patient to the stretcher sans long board will have to be developed. Further, instruction and emphasis on the scoop stretcher for this purpose is needed. Along with this, methods for limiting spinal movement once on the stretcher need to be made part of the National Standard Curriculum for EMS providers. Provider fear of legal repercussions when utilizing new techniques has always been a topic during training. I anticipate some hesitation to adopt selective spinal immobilization until the information has been widely distributed. So Doc? You have my vote. Let’s “Do no harm.” Let’s make patients comfortable, and ensure that the mechanism of injury is the only source of pain. Does a scoop stretcher immobilize the spine?Scoop stretchers are one of the latest innovations in immobilization for spine-injured patients. A scoop stretcher, like the Ferno Scoop Stretcher, or the Hartwell Medical Combicarrier II Backboard, is designed to separate into two halves which are placed on either side of the patient.
What is the purpose of a scoop stretcher?Scoop stretchers (preferred over longboards) allow you to scoop the patient off of the floor – without having to roll them – and carry them to wherever your cot may be located.
What do you use to spinal immobilize a patient?The traditional ATLS teaching for adequate spinal immobilization of a patient in a major trauma situation is a well fitted hard collar with blocks and tape to secure the cervical spine in addition to a backboard to protect the rest of the spine. other devices currently in use are scoop stretcher and vacuum splint.
How do you do spinal immobilization?Center the patient on the board while maintaining cervical alignment. Secure the upper torso with straps first. Secure the chest, pelvis, and upper legs with straps. Secure the patient's head by using a commercial immobilization device or rolled towels.
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