Peter Antevy explains why long spine boards were phased out: they don't fit spinal anatomy, create uneven pressure, and cause pressure sores. Scoop stretchers work better. Rigid cervical collars are poor immobilizers that can worsen airway management and raise intracranial pressure. Clinicians need to use collars or document alternatives like manual stabilization.
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I want to talk a little bit about spinal mobilization, because I know there are some questions about that ever since we changed the protocol with removing the backboards. So I just want to go the why we change the backboards? And what's the deal with the cervical collar? Do we use it, we don't use it, etc. So first, why did we get rid of the backboards? And it has to do with simple anatomy and the fact that the tool that we were using for spinal mobilization was the wrong tool. So just to backtrack a second, the principles behind spinal immobilization, who we do it on, why we do it, has not changed at all. It's just that there's been a recognition that the devices or the tools that we were using to try to accomplish spinal immobilization were absolutely the wrong tools. So let's imagine that this table here is a long spine board. Does anybody out there think that their spine is shaped like this table? The answer is obviously no, because our spine does kind of this thing. So if I were to lay down on this spine board here, my shoulders would touch the table, and my sacrum would touch the table, and then the middle of my back would sort of be floating in air here. So. So the effect of this is extra pressure by the shoulders, extra pressure on the shoulder, and then nothing immobilizing the center part. So obviously, it doesn't immobilize the spine from a vertical standpoint here. In addition, this spine board is a slippery device. So if you were to go around a corner in the rescue, there's nothing stopping the spine from moving laterally side to side. So as a tool, a spine board doesn't do a good job of immobilizing either vertically or laterally. And. And because of the way of uneven pressure allows the formation of pressure sores. So it's absolutely not a correct tool for spinal immobilization. So let's not talk about it in that terms. Let's instead talk about this long spine board as simply a patient movement device. It is not an immobilization device. It's a patient movement device. A better device would be something that's soft. So you've all seen the Tempur pedic mattress commercials, where you take your hand and they push their hand down on the mattress, and the fingers all poke in. So let's imagine that this was a tempur Pedic mattress here. If I were to lay down on the Tempur Pedic mattress, well, my shoulders would sink in, my sacrum would Sink in. And the mattress would sort of rise to meet that hollow spot on my spine. So now I've sort of sunken into the mattress and my entire spine is being stabilized from a vertical standpoint. And plus now that I've sort of sunken in, it's a soft surface. It really resists the lateral side to side motion as well. So it's actually a much better tool for mobilization as a soft surface. Unfortunately for us on the street, we can't pick somebody up off the ground with a Tempur Pedic mattress. So we have to come up with something different. The best tool we currently have out there and which is the tool that I'd like you to be using is the scoop stretcher. The reason we want to use the scoop stretcher is because the scoop is safe, sort of concave like this. Our spine would be down the same of that concave area. So there's not undue pressure on any particular portion of that spine. And it will sort of hug you. The way the scoop is shaped, it'll hug you from the sides and the pressure points will be along the sides of your body. So there's really no ability to move laterally. So it's a much better tool for mobilizing the spine, especially from the lateral standpoint. And since there's no extra pressure anywhere along the vertical plane of the aspect, it's a better tool from that standpoint. So if we don't have a soft surface, the next best is certainly the scoop. And that's the most practical for us out on the street. So that's why we went from the long spine boards, which is the wrong tool for immobilization, to the scoop stretcher, which is a better tool for spinal immobilization. Now let's talk about cervical spine. Does anybody think that the cervical collar immobilizes the cervical spine? The short answer in the literature is no. It's a very poor tool for that as well. It is still, however, considered the standard of care, unlike the long spine board. And there's a lot of good backup now to say that that is not the standard of care. The national association of EMS Physicians written position statement on it. So has the Florida association of EMS Medical Directors. So we're very comfortable saying that we can move away from the long spine board and go to the scoop for the cervical collars. However, we don't really have as much sort of large agency backup on that. There's a lot in the literature that says that really it's not the right tool. But let's just imagine the hard collar here. How often have you seen where you put the hard collar on and it's not positioned right, and the patient's neck is all the way back like this? Or even worse, they're down like this, their chin's down, and the collar comes all the way up to their nose like this? Well, you're not really immobilizing the cervical spine that way. In addition to being poor in terms of immobilization, it complicates airway management, and it also compresses the jugular veins. Well, when you compress the jugular veins, you decrease the venous return out of the brain, resulting in increased intracranial pressure. Not a good thing to do for somebody with head trauma. Head trauma is certainly one of the things that we would immobilize the neck for. So it's really not a great tool. So what do we need to do? It's still considered the standard of care. So we really have two options now. One is continue to use it, or two, put in your chart an acceptable alternative. You cannot ignore it because it's standard of care to immobilize. So you can immobilize most of the body with the scoop stretcher, and then you can immobilize the cervical spine either with a collar. Or write in your chart that you're going to immobilize the collar with inline manual stabilization or some rolls of towels and then like a soft surface under the neck. Same principle as the back. Soft surface under the neck and rolls of towels and some tape. So please make sure that you address it. What we're finding is whenever we show up to the trauma centers without a cervical collar in place, we are getting that kickback to us for cqi. So you can't just ignore it. Address it in your chart so that you either put on the collar or write in the chart some acceptable alternative, such as inline manual stabilization or soft surface with towels and tape.
