Question about defibrillation

[usmc_chris]

I know it's completely unrelated to the OP, but I LOVE your c-spine protocol! I can't wait for us to get something like that in the States (or at least where I work) - I've long thought that we are most likely doing much more harm than good by immobilizing somebody on a backboard. Glad to see somebody somewhere is slightly more forward thinking.

[chbare]

Even more sad is the fact that we utilised vacuum mattresses and scoop stretchers in Afghanistan, but not longboards.

Take care,

chbare.

[Ravemtech]

I know this is not the topic, but the removal of Boards from Ambulance should be considered very carefully.

Australia and New Zealand Services have always had a rather negative view towards Full Spine Immobilisation and Long Spine Boards. Part of this has been due to the US practice of everyone gets Boarded and both countries did not want to move down such a track. The use of Spine Boards have as a result been limited in their use, poorly taught to staff, discouraged from use, or not even as yet introduced into some Services. I have taught Board usage to 1000's of students throughout Australia, to New Zealand Paramedic students, and recently completed a 3 month study tour of the US, Europe and the UK. What was clearly evident was the lack of understanding and versatility of the Board, and research relating to it's usage. I will not enter the debate as to whether Full Spine immobilisation is necessary will go on for many years, as for every argument for it, there is a argument against. Spinal clearance protocols are clearly of benefit for reducing unnecessary immobilisation that was so passionately feared in Australia and New Zealand. But lets focus just on the Board itself.

In the Victorian Ambulance Service - Australia, Long Spine Boards were only introduced into Service in 1996. The introduction of the Board into Victoria was successful as it was a result of extensive research into current literature, looking at what was available, how it was being used, advantages and disadvantages of the device, limitations, when is should and shouldn't be used, and addressed the many shortcomings of design and application complained by so many. By teaching a true understanding of the device and the multitude of applications (spinal forms only a small part of the Boards actual uses), and introducing properly designed equipment based on research (that was also user friendly), the Board was a massive success, and even resulted in a significant reduction in back injuries amongst Ambulance Officers. The failing and/or negativity of the Board by so many is that research has progressed, but design and application of the Board is still in many Services based to practices of the 1960's.

Example: a number of Australian Ambulance Services use a curved Board rather than a flat board. A recent study from the USA (Prehosp Emerg Care. 2006 Jan-Mar;10(1):46-51. Comparison of the Ferno Scoop Stretcher with the flat long backboard for spinal immobilization) and a second study from Australia (Lee Deacon University Victoria 2007 Preparation For The Research & Development Of A New Generation Long Spine Board) finally recognised the benefit of curvature, but most of the world continues using a flat design that actually dates back to the 1800's when coffin lids were used as makeshift backboards.

Further, the biggest arguments against the Boards is pressure sores and discomfort. Multiple studies confirm an unpadded Board is uncomfortable, misaligns the spine, and leads to pressure sore development. Some of these studies include:

1. Patterson RP, et al Phys Rehabil 1988;67:123–7. Risk factors for early occurring pressure ulcers following spinal cord injury.

2. Delbridge TR, et al Prehosp Disast Med 1993;8. Discomfort in healthy volunteers immobilized on wooden backboards and vacuum mattress splints.

3. Lovell, et al Injury. 1994 Apr;25(3):179-80. A comparison of the spinal board and the vacuum stretcher, spinal stability and interface pressure.

4. Chan D, et al Ann Emerg Med 1994 Jan;23(1):48-51. The effect of spinal immobilization on healthy volunteers.

5. Chan D, et al . J Emerg Med 1996 May-Jun;14(3):293-8. Backboard versus mattress splint immobilization: a comparison of symptoms generated.

6. Hamilton RS, et al J Emerg Med 1996 Sep-Oct;14(5):553-9. The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization.

7. Lerner EB, et al Prehosp Emerg Care 1998 Apr-Jun;2(2):112-6. The effects of neutral positioning with & without padding on spinal immobilization of healthy subjects.

8. Cross DA, et al Prehosp Emerg Care 2001 Jul-Sep;5(3):270-4. Comparison of perceived pain with different immobilization techniques.

9. Vickery, et al Emerg Med J 2001;18:51-54 doi:10.1136/emj.18.1.51. The use of the spinal board after the pre-hospital phase of trauma management

As a result of these studies, many argue for the removal of the Board. But research clearly shows that these issues are resolved by the simple application of padding. Studies include:

1. Walton, et al Acad Emerg Med 1995 Aug;2(8):725-8. Padded vs unpadded spine board for cervical spine immobilization

2. Cordell, et al Ann Emerg Med 1995 Jul;26(1):31-6. Pain and tissue-interface pressures during spine-board immobilization.

3. Sheerin, et al J Emerg Nurs. 2007 Oct;33(5):447-50. The occipital and sacral pressures experienced by healthy volunteers under spinal immobilization: a trial of three surfaces.

4. Treseder, et al Ann Emer Med Vol 44 (Oct 2004). Efficiay of an inflatable Spine Board Padding device in reducing pain during simulated spinal immobilisation

5. Hann, Response Volume 33 2006. Long Spine Board: Does It Cause Discomfort

6. Lee, Deacon University Victoria 2007. Preparation For The Research & Development Of A New Generation Long Spine Board

7. Hemmes, et al The Journal of Trauma: Injury, Infection, and Critical Care: March 2010 - Volume 68 - Issue 3 - pp 593-598. Reduced Tissue-Interface Pressure and Increased Comfort on a Newly Developed Soft-Layered Long Spineboard

So before you think about removing a Board, think very carefully and research what you are really doing. The research does not support the removal of Boards, only a change in equipment design and how we use them.

And back only the topic at hand, use of a Board to rapidly move and extricate a post arrest patient, and if required perform CPR (on a soft stretcher mattress) and even Defib (rather than on a metalised Scoop), what better device is there.

Anthony

Edited March 31, 2010 by Ravemtech