II. Indications: Maintenance of spinal immobilization for emergency vehicle transport

  1. Extrication from accident scene
    1. Allows for easier transfer of patient from difficult conditions by multiple rescuers
    2. Wilderness rescue (e.g. mountain terrain) may make use of scoop stretcher or Stokes basket
    3. Once extricated and patient on firm cot, consider alternatives to Backboard (see below)
  2. Serious Mechanism of injury (suspected or evident spinal injury or neurologic deficit)
    1. High energy Mechanism
    2. Spine deformity
    3. Focal neurologic deficit
  3. Traumatic Injury and does not meet all criteria for spine clearance
    1. Glasgow Coma Scale (GCS) 15
    2. No spinal tenderness to palpation or anatomic deformity
    3. No neurologic complaints or exam findings
    4. No distracting injury
    5. No Intoxication (drugs or Alcohol)
    6. Age <65 years

III. Contraindications

  1. Spine Boards are not intended for in-hospital Spine Immobilization
  2. Avoid immobilization in penetrating head, neck or torso Trauma without spine injury findings or focal neurologic deficit
    1. Haut (2010) J Trauma 68(1): 115-20 [PubMed]

IV. Precautions

  1. Remove patients from Spine Board within 20 minutes of emergency department arrival
  2. Patients on Spine Board must have 1:1 observation to intervene for Vomiting, change in mental status or attempts to move
  3. Maintain full spinal precautions after Spine Board removal until spine fully cleared
    1. Emergency department gurneys offer adequate firm surface for spinal support (Cervical Collar is also required)
    2. Use slider boards in-hospital to transfer patient from gurney to diagnostic equipment (maintain full spinal precautions)
    3. Do not leave patients on slider boards for extended periods of time
    4. Consider intubation and Sedation in uncooperative patients unwilling or unable to maintain spinal precautions

V. Adverse Effects

  1. Pressure Sores (especially in elderly)
    1. Remove patients from Spine Board within 20 minutes of emergency department arrival
  2. Aspiration
    1. Patient unable to turn head if they vomit
    2. Continuous 1:1 observation until off board

VI. Management: Alternatives to Backboard for spinal immobilization (for EMS)

  1. Indications
    1. Patient ambulatory at the scene
    2. Protracted transport time
    3. Other indications for Spine Immobilization as above
  2. Technique: Spine Immobilization
    1. Rigid Cervical Collar AND
    2. Supine on cot AND
    3. Consider head block AND
    4. Consider securing patient to gurney (e.g. via Seat Belts across chest, Abdomen, Pelvis, and legs)
  3. Technique: Self Extrication (replaces standing takedown) for ambulatory patients with spinal tenderness
    1. Rigid Cervical Collar applied first
    2. Patient ambulates to cot with or without assistance
    3. Patient lies in supine position
    4. Patient secured to cot as above

VII. Technique: Spine Board Clearance

  1. Attempt to remove all clothing prior to Log Roll
  2. Push Spine Board straps under patient's lateral decubtus side (side that they will lie on when Log Rolled)
  3. Log Roll (requires 4 people)
    1. Attendant at head
      1. Maintains control of head and neck and directs the Log Roll ("Roll on 3 - 1,2,3 - Roll")
    2. Attendant at torso
      1. Rotates torso into lateral decubitus position
    3. Attendant at Pelvis, hips and legs
      1. Rotates hips and leg into lateral decubitus position
    4. Provider at back
      1. Removes the Spine Board
      2. Walks the spine from cervical through sacral examining for focal tenderness, deformity, crepitation
      3. Observes skin for wounds, Bruising
      4. Additional measures in significant Trauma
        1. Examine perineum
        2. Rectal exam (evaluate tone, blood)
  4. Spinal Precautions
    1. Maintain spinal precautions until full spine clearance based on history, exam and imaging as indicated
    2. See Precautions above

VIII. References

  1. (2008) ATLS, American College Surgeons, Chicago, p. 184-5
  2. White (2014) Prehosp Emerg Care 18(2): 306-14 [PubMed]

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Ontology: Spine board (C0183440)

Concepts Medical Device (T074)
SnomedCT 156009
English Back Boards, Spine board, device, board spine, spine board, boarding spine, spine boards, Boards, Spine, Spine board, Spine board, device (physical object)
Spanish tabla espinal (objeto fĂ­sico), tabla espinal