When Immobilizing A Patient On A Long Backboard You Should

When Immobilizing a Patient on a Long Backboard: A Comprehensive Guide for Emergency Responders

Immobilizing a patient on a long backboard is a critical skill for emergency medical responders. It's a procedure used to stabilize the spine and prevent further injury in patients suspected of spinal trauma. However, improper techniques can worsen existing injuries or even cause new ones. This comprehensive guide details the essential steps, considerations, and potential pitfalls involved in safely and effectively immobilizing a patient on a long backboard.

Assessing the Situation: Prioritizing Patient Safety

Before even considering immobilization, a thorough assessment is paramount. This involves several key steps:

1. Scene Safety:

• Environment: Is the scene safe for you and your team? Are there hazards like traffic, downed power lines, or unstable structures? Addressing these hazards before approaching the patient is crucial.
• Mechanism of Injury (MOI): Understanding how the injury occurred provides valuable clues about the potential for spinal injury. High-impact collisions, falls from significant heights, penetrating trauma, and significant forces are all red flags.

2. Primary Assessment:

• Airway, Breathing, Circulation (ABCs): Always prioritize the immediate life threats. Address any airway obstructions, breathing difficulties, or circulatory compromise before immobilization.
• Rapid Trauma Assessment: Quickly assess the patient for any life-threatening injuries, including those beyond the spine.

3. Secondary Assessment:

• Neurological Examination: A detailed neurological examination is crucial. Assess the patient's level of consciousness (Glasgow Coma Scale), motor function in all four extremities, sensation, and pupillary response. Document your findings clearly. Any neurological deficit warrants immediate attention.
• Palpation of the Spine: Gently palpate the spine for tenderness, deformity, or step-offs. However, avoid excessive manipulation.
• Patient History: Gather information about the mechanism of injury, pre-existing conditions, and any medications the patient is taking.

The Immobilization Process: A Step-by-Step Guide

Once the primary and secondary assessments are complete and you've determined the need for spinal immobilization, follow these steps:

1. Manual Cervical Spine Stabilization (MCSS):

• Head and Neck Support: Before moving the patient, manually stabilize the cervical spine. This involves using your hands to support the head and neck, preventing any movement. This should be maintained throughout the entire process.
• Teamwork: At least two people should be involved in MCSS. One person maintains manual stabilization while the other prepares the equipment.

2. Preparing the Backboard:

• Positioning: Place the backboard as close to the patient as possible.
• Equipment Check: Ensure all straps and other equipment are functioning correctly.

3. Log-Roll Technique:

The log-roll technique is the preferred method for moving a patient onto a backboard. It minimizes spinal movement and requires a coordinated team effort:

• Team Briefing: Brief the team to ensure everyone understands their role and the process.
• Personnel: Ideally, four to six people should participate for optimal control and safety.
• Positioning: Team members position themselves on one side of the patient, aligning their bodies along the spine for synchronized movement.
• Lifting and Rotation: Working in unison, the team lifts the patient as one unit, while maintaining manual stabilization of the head and neck, rotating to place them onto the backboard.
• Gentle Movement: The movement should be slow, controlled, and synchronized to avoid any jarring.

4. Securing the Patient to the Backboard:

Once the patient is on the backboard, secure them using appropriate straps:

• Head Immobilization: Secure the head using a head immobilizer or appropriately placed straps. This is vital for preventing head movement.
• Chest and Pelvis Straps: Apply chest and pelvis straps snugly, but not too tightly to avoid compressing the chest or abdomen, which can impair breathing or circulation.
• Torso Straps: Add torso straps to provide additional stability.

5. Continuous Monitoring and Reassessment:

Throughout the entire process and during transport, continuously monitor the patient’s vital signs, neurological status, and overall condition. Reassess the patient regularly. Any changes should be noted and addressed immediately.

6. Documentation:

Meticulously document the entire procedure, including:

• Mechanism of Injury: How the injury occurred.
• Initial Assessment Findings: Including vital signs, neurological examination, and any other pertinent information.
• Immobilization Procedure: Step-by-step details of the immobilization process.
• Post-Immobilization Assessment: Findings after securing the patient.
• Any complications: Any difficulties encountered during the procedure.

Special Considerations and Potential Complications

Several factors can influence the immobilization process and require special attention:

1. Pregnant Patients:

Pregnant patients require additional care due to the physiological changes and the potential risk to both mother and fetus. The backboard should be tilted to the left to relieve pressure on the vena cava.

2. Obese Patients:

Immobilizing obese patients requires more personnel and may necessitate the use of specialized equipment. Extra care must be taken to avoid causing injury to the rescuers or the patient.

3. Patients with Pre-existing Conditions:

Patients with pre-existing conditions, such as spinal stenosis or osteoporosis, may be more susceptible to further injury. Extreme caution is necessary.

4. Potential Complications:

Improper immobilization can lead to:

• Worsening of existing spinal injuries: Incorrect techniques can cause further damage to the spine.
• New injuries: Improper handling can cause new injuries to the patient.
• Compromised circulation or breathing: Tight straps can restrict blood flow or breathing.
• Pressure sores: Prolonged immobilization can lead to the development of pressure sores.

Beyond the Backboard: Alternative Immobilization Techniques

While the long backboard remains a standard, situations may necessitate alternative immobilization methods:

• Short Spine Boards: Useful for extrication in confined spaces.
• Vacuum Mattresses: Provide a more comfortable and conforming immobilization for patients with suspected spinal injuries.
• Kendrick Extrication Device: Used for extricating patients from difficult positions.

Ongoing Education and Training

Mastering spinal immobilization requires continuous training and practice. Regular refresher courses, scenario-based training, and adherence to established protocols are crucial for maintaining proficiency and ensuring patient safety. Staying current with best practices and advancements in pre-hospital care is essential for all emergency medical responders.

Conclusion

Immobilizing a patient on a long backboard is a critical skill in emergency medicine, demanding precision, teamwork, and continuous assessment. Prioritizing patient safety, performing a thorough assessment, and employing proper techniques are paramount in preventing further injury and optimizing patient outcomes. Remember, consistent training and adherence to protocols are key to providing safe and effective care. This comprehensive guide provides a foundation for safe practice, but hands-on training under the guidance of experienced professionals is indispensable.