A number of recent studies are forcing us to rethink the way we understand and use spine boards. These studies have shown us that there are actually a lot of disadvantages to using spine boards in a general ‘fix-all’ kind of way.
In the spirit of constantly evolving our techniques for the better, even where something has been the accepted ‘norm’ for a very long time, let’s take a closer look at the practicality of spine boards.
For a start, it pays to remember that spine boards don’t really do what we want them to — namely fully immobilise the patient (even though they do restrict movement a lot).
In addition, immobilisation on a spine board can actually cause extra problems for the patient, such as restricted respiration, further discomfort and pain, cervical and lumbar midline tenderness where none was previously experienced, and the development of pressure ulcers from more prolonged immobilisation.
Researchers from the University of New Mexico have actually compared patient outcomes regarding blunt spinal cord injuries in a region that always immobilises patients (New Mexico) with one that doesn’t (Malaysia).
What the researchers surprisingly found was that the patients who hadn’t been immobilised tended to have less neurological disability than those who had.
In order to avoid putting your patients (and yourself) at a disadvantage, here are some guidelines for adjusting your protocols regarding spine boards:
Patients who show signs and symptoms of spinal injury should still be immobilised on a spine board. But their routine use for patients with any type of blunt trauma should be re-evaluated in patients who show no signs and symptoms of a spinal injury. Mechanism of injury alone is no longer appropriate as a sole reason to immobilise a patient on a spine board.
Pressure ulcers should ideally be avoided by not exceeding a maximum duration of two hours when immobilising a patient on a spine board.
Whenever possible, a spine board should only be used as an extrication device, whereafter the patient should be immobilised with a vacuum mattress. Vacuum mattresses are now believed to offer greater levels of comfort and better immobilisation of the spinal column than spine boards. In fact, whenever prolonged spinal immobilisation is required, a vacuum mattress should be the preferred method.