anthann

No disagreement to the fact that anything done incorrectly or to excess can be dangerous. BUT ... I challenge any reader out there to provide reference to any published study from Australia or overseas that shows a properly padded Long Board (torso, head and lumber padding) used appropriately, does cause futher damage, especially to the spine as suggested above. I hear these claims constantly including from some Australian Ambulance Medical Directors, but no one has yet been able (or willing) to present such a paper. Unsubstantiated claims such as these are nothing more than unprofessional and unproductive. I fully agree however that there are clearly studies showing unpadded Long Boards and excessive application times (eg hours) cause problems. There is no doubt about that, and we should use such studies to improve our standard of care. Remember also that there are many things we do in our profession that when used incorrectly or to excess can have dangerous and fatal results ... eg excessive doses of morphine, adrenaline, midazolam can kill. But I don't hear anyone asking for the removal of these medication, only that they be used appropriately. And that's the professional way to do things. The problems with the use of Long Boards and immobilisation is poor teaching and poor standards of padding resulting in problems of pressure sores, headaches and lumber pain. The simple fix is use the device appropriately. Undertaking studies relating to immobilisation to unpadded Boards and then trying to present these studies as the standard of care to prove Long Boards are dangerous is, as already stated unprofessional and unproductive. In Victoria, the guideline regarding transport on Long Boards are very clear. There is no requirement to remove them after 30 minutes, but it is offered for consideration after this time. This consideration is included for situations such as Paramedics who fail to follow the Ambulance Work Instructions for immobilisation (ie fail to pad) or for patients who clearly cannot cope with being immobilised (nothing will ever work on 100% of the population). The NSW Ambulance standard of max 30 minutes and the United Kingdom standard max 40 minutes are again based on studies on flat Boards without padding. Other Australian Ambulance Services incuding Qld, WA and SA who do not to immobilise on Boards is again based on these unpadded Long Board studies. Again these studies are only useful in confirming what we already know ... that is unpadded Boards cause problems. So PAD!!! It is time to put things into perspective. If the study exist that even with correct padding and reasonable application time that the Long Board is dangerous, then let's once and for all see paper and resolve the issue here and now. Otherwise accept that fact that there is evidence that with appropriate padding and appropriate application times ( http://www.neann.com/Board%20Comfort.htm ), the Long Board is safe and reasonable, and lets do the best for our patient. Best Wishes To All Anthony

Hi Craig, If you review the 3 Australian documents: 1. Towards the Prevention of SCI - Menzies Technical Report (put out by the Australian Spinal Units including the RNS Spinal Unit) 2. Victorian Ministerial Task Force: Review Of Trauma And Emergency Services - Victorian Department Of Health Services 3. The Management Of Acute Neurotrauma In Remote And Rural Areas - Royal Australiasian College of Surgeons you will find that there is significant support in each of these documents for the immobilisation of patients to the Long Spine Board with a semi rigid collar. NSW and Victoria have already introduced protocols based on the findings and recommendations of these documents. Other states in Australia are relooking at their protocols based on recent documents. The limit of 30 minutes on a Board in NSW is based on USA studies undertaken on unpadded and flat Long Spine Boards. These studies do not reflect what we do (or should do), that is padded and curved Boards. You are correct that a poorly padded flat Long Board does cause misalignment and discomfort, and should be a message to all, not to perform a poor standard of Long Board application or complications will result. For comfort issues and a study reviewing the padded curved board, have a look at the study on the website http://www.neann.com/Board%20Comfort.htm and you will see very clearly that a well padded curved Long Board provides good comfort for at least 1 hour, and that it is actually the C-Collar that is the problem. Your idea of putting a patient on the stretcher mattress and immobilising the head to it, probably needs to be rethought. What you are doing here is immobilising the head, and so the neck becomes the pivoting point for all body rotatioin, the very thing that is trying to be avoided. The stretcher straps are not adequate to secure the patient's torso and pelvis to the stretcher to then allow immobilisation of the head. DHS (the manufacturer of the ASNSW stretcher) will not guarantee the safety of the spinal patient using this method with their stretcher. In fact no study anywhere supports this as an acceptable standard of care and nor do the 3 above Australian documents. I do accept that sometimes the patient will not accept immobilisation to a Long Board, and that the NIEJ or other form of Extrication Jacket may be an alternative, or maybe only a C Collar can be applied. And I think this would be supported in any court. However the NIEJ, nor any other jacket, is not a replacement for the Long Board unless the above or some other exceptional reasoning, and it is clearly not the teaching to the ASNSW. Studies looking at immobilisation with a jacket whilst showing excellent C-spine immobilisation, show far less immobilisation to the rest of the spine. Considering that some 48% of SCI in Australia is below the C-spine (AIHW statistics 2003-2004), the jacket clearly based on research is not adequate on it's own. Finally, for those who want an extremely detailed freely downloadable manual on all aspects of prehospital spinal care, go to http://www.neann.com/lsbmanual.pdf. Best wishes Anthony MICA Paramedic