Is a backboard for transport only, or immobilization while in the ER?

[vampireslayer]

I posted this question in another thread about a nurse getting an MVC patient who had not been immobilized on a back board for transport to her ER, but I wanted to move it to it's own thread so I can get my question answered without hijacking that other post:

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Ok, I've looked through my TNCC book and my Emergency Nursing book, because I just hate to ask this question and risk looking like a total MORON! I've been in ER for a year now and SHOULD KNOW the answer to this question...but I've actually asked it of several people at work, and gotten different answers! (and the books just say HOW to immobilize using the backboard, not why).

So here goes: is the purpose of the backboard to immobilize the spine for transport only, or the entire time they're in the ER, until their spine is cleared via xray or CT?

I've had docs immediately take the pt off the backboard, based on their conversation and physical assessment, although they were pending results of xrays/CTs. I've had other docs insist that the pt stay on the backboard until the L-spine film is taken (but not read, just xrays have been shot) because the board helps get a better picture. But once the xray's been taken, they'll have the pt off the board, before the xrays have been read. And then I've got another doc who won't let us take the pt off the board until all films have been read and their spine has been cleared (could be an hour or two in the minor MVCs!).

We also have been told that one of the very important issues in the traumas is getting the pt off the board as quickly as possibly, because of the issue of skin breakdown.

So...what's the purpose of the board IN THE ER?

Oh, by the way, until their spine is cleared via xrays/CT, we do keep them lying flat, with the c-collar on, we log roll them off if we're taking them off the board, etc. But we very often put the pt on a soft bed before any xray/ct results have come back.

VS

[traumaRUs, MSN, APRN]

We did it the same way - roll the person off the board as soon as possible - frequently before any xrays. C-collar left in place as long as no c-spine tenderness or deficits. When you consider that even if the pt has a t-spine or L-S spone injury - you still would not keep them on a spineboard for prolonged period of time, it seems logical to me.

[TazziRN, RN]

Once the pt is place in full precautions, only the ERMD can d/c it. If you roll the pt off the board, you are d/c-ing precautions. Leaving the collar on is fine and dandy, but if there truly is a spinal fx, would you want to risk movement before an MD exam? Logrolling is good.....but what happens when the x-rays are done? Not all ER gurneys are set up to hold x-ray plates underneath and the pt must be rolled repeatedly for plate placement.

[vampireslayer]

We never take the pt off the backboard until the ER doc orders it, but the thing is that some ER docs order it immediately, some wait until xrays are shot but not read, and others won't let us take the pt off the board until all xrays have been read.

VS

[vamedic4, EMT-P]

So here goes: is the purpose of the backboard to immobilize the spine for transport only, or the entire time they're in the ER, until their spine is cleared via xray or CT?

The purpose of the backboard, C collar, and all associated immobilization devices is to protect the integrity of the head/c spine/ spine and prevent it from further injury until it is determined that no "serious" injury or deficit exists.

That means...if you have a patient on a backboard/collar/KED, whatever, they are supposed to STAY immobilized on it until cleared by X rays which have been read and a thorough neuro exam by ED physician.

That's it in a nutshell.

Hope that helps.

vamedic4

[Larry77, RN]

In my ED the docs always assist in the log rolling so they themselves can examine the underside and chose to keep the Pt on the backboard or DC it at the time of the log roll.

[JMBM]

Its not a question of immobilization vs transport. As vamedic said, the purpose of a backboard is to "splint" the spine - to immobilize the spinal column and so prevent further injury due to movement. If that were the end of the story, we'd leave backboards on for days - which we don't.

Backboards are also incredibly uncomfortable, can cause excruciating pain and can quickly cause pressure sores, especially in older patients. If that were the end of the story, we'd take backboards off immediately - which we don't.

The decision of when to remove a backboard is one of medical judgment. Since movement, and therefore injury, is a distinct possibility during transport, backboards stay on during transport. Now, once in the ED, what do we do? The short answer is to wait for the doctor to decide. HOw scary is the injury? How well can we maintain spinal integrity without the board? What is the patient's LOC, neuro status? How old are they? Is the patient intoxicated? How uncomfortable is the patient/what is the danger of ulcers? In winter, the cold board can help induce hypothermia. In some facilities, under some circumstances, "spine clearing" protocols are in place that don't even use x-rays. In some cases, xrays don't even find the fractures. This is why MD's get the honorific title before their names, the preferred parking spaces, the big bucks, and the horrific malpractice premiums. They get to decide.

[tridil2000, MSN, RN]

our docs log roll them off the board and assess for pain while pressing down the spine. i always document which dr removed the backboard.

the c collar remains and the pt remains flat until xrays are cleared.

[Altra, BSN, RN]

The decision of when to remove a backboard is one of medical judgment. Since movement, and therefore injury, is a distinct possibility during transport, backboards stay on during transport. Now, once in the ED, what do we do? The short answer is to wait for the doctor to decide. HOw scary is the injury? How well can we maintain spinal integrity without the board? What is the patient's LOC, neuro status? How old are they? Is the patient intoxicated? How uncomfortable is the patient/what is the danger of ulcers? In winter, the cold board can help induce hypothermia. In some facilities, under some circumstances, "spine clearing" protocols are in place that don't even use x-rays. In some cases, xrays don't even find the fractures. This is why MD's get the honorific title before their names, the preferred parking spaces, the big bucks, and the horrific malpractice premiums. They get to decide.

Thought-provoking post.

Related question: any tips for managing the the intoxicated, unruly or just plain uncooperative patient who refuses to remain flat? Other than documenting my butt off, which I do ...

I went in to a patient room last weekend to find my MVA patient who had multiple injuries standing at the bedside.

[NurseWilliam]

As a general rule in my ER, we keep C/S trauma patients on the board until we see a negative CT/MRI result. It's really better to be safe than sorry, and while it is uncomfortable for the patient, it sure as shootin' beats being paralyzed from the neck down.

[debbyed]

Removing a patient from a backboard is a physician call and should be documented as such. In the case of an uncooperative patient I would strongly suggest to the doc that the patient remain "restrained" on the backboard until films are read.

Backboards are not just for transport. We've had many a patient who have walked into triage post MVC who refused medic transport who we have immediately boarded and collared due to severe neck pain and neuro deficits. Several of those were eventually shipped out to a trauma unit with C-spine fractures.

Also do careful evaluation of those patients who come in by Medic post MVC or fall that are not B+C'd.(The reason is always that they were up walking at the scene or patient refused) We have had more that one of those who ended up with fractures and were shipped out to a trauma unit.

For those patients who complain, usually once you remind them that the choice maybe being unconfortable for an hour or so vrs wheelchair for life they will usually settle down..

[twentyfourseven]

I am a CT tech at night in a trauma center, and our docs are pulling patients off the boards right away, even when obvious damage is in the spine area. We have complained repeatedly about this, and are now being told that this is a "National Protocol." Anyone know anything about this? Being an ex-EMT, I have a huge problem with this, if this is the case, why have a backboard at all? Shouldn't the patient stay on the board until at least the x-rays/CT is done? Our standard answer to this is "the damage has already been done" ????????????????????

Would welcome any and all info for an upcoming meeting.

Thanks much:banghead: