Spine board policy

I'm fairly certain that you need to consult the ED physicians on this. It is not within my scope of practice to remove a pt from a spine board.

I worked in an ED and we were not allowed to remove a patient from back board unless they had been cleared by an MD or PA. I know patients are uncomfortable and I cant say I blame them for complaining but I always tell them that if we remove them before we are certain they are alirght, they could become paralyzed for life and usually they understand that it is for their benefit and were not just being mean. When a pt comes in on a backboard or is placed on one, we inform a Dr or PA and they try and come clear them or send them ASAP, even if they cant do a full exam until later. Hope this helps.

This is not an uncommon nursing intervention. Trauma trained registered nurses initiate spine board removal frequently, all over the world. The original poster is correct to be writing a policy on this. The harm of immobilization is serious, often EMS must immobilize based on mechanism. Nurses need to apply some critical thinking, a risk assessment and treat appropriately. Early board removal is advocated for in the research knowledge base, PHTLS, ITLS, ATLS and newer materials by ENA.

Original poster, email me at matthewjdouma (at) gmail.com and I'll share what I can.

Matt

Can I add that there is a fundamental difference between removing a patient from a spinal board and clearing a spine.

Spinal boards are well known for being uncomfortable and compromise tissue viablity. Most emergency departments have nursing staff that are more than competent in safely log rolling and removing a patient from a spinal board however this never negates the need for a full spinal examination.

Good thought! I agree, we were able to remove them from the board, not clear them. Sorry if I caused any confusion.

i think snoopy29 has a point, is the op asking for a policy for nurses to clear c-spine for backboard removal or just policy on how to remove a patient from a backboard? as far as clearing, i can tell you all the er's i work at (1 fulltime and 2 partime) only erp's clear the c-spine.

there's evidence that rn's and medics can apply the canadian c-spine rules:

[color=dimgray]podichetty, v. k, morisue, h. (2009). prediction rules in cervical spine injury. bmj 339: b4139-b4139

stiell, i. g, clement, c. m, grimshaw, j., brison, r. j, rowe, b. h, schull, m. j, lee, j. s, brehaut, j., mcknight, r d., eisenhauer, m. a, dreyer, j., letovsky, e., rutledge, t., macphail, i., ross, s., shah, a., perry, j. j, holroyd, b. r, ip, u., lesiuk, h., wells, g. a (2009). implementation of the canadian c-spine rule: prospective 12 centre cluster randomised trial. bmj 339: b4146-b4146

wiese, m. f, allen, j., pillai, v. (2008). facilitating the canadian rule. bmj 336: 233-233

wee, b., reynolds, j. h, bleetman, a. (2008). imaging after trauma to the neck. bmj 336: 154-157

armstrong, b p, simpson, h k, crouch, r, deakin, c d (2007). prehospital clearance of the cervical spine: does it need to be a pain in the neck?. emerg. med. j. 24: 501-503

pitt, e, pedley, d k, nelson, a, cumming, m, johnston, m (2006). removal of c-spine protection by a&e triage nurses: a prospective trial of a clinical decision making instrument. emerg. med. j. 23: 214-215

mower, w. r., wolfson, a. b., hoffman, j. r., todd, k. h., hall, f. m., stiell, i. g., rowe, b. h., lee, j. (2004). the canadian c-spine rule. nejm 350: 1467-1469

(2004). testing for c-spine injury: nexus criteria vs. canadian c-spine rule. jwatch emergency med. 2004: 5-5

yealy, d. m., auble, t. e. (2003). choosing between clinical prediction rules. nejm 349: 2553-2555

there's no evidence immobilization on a spineboard is more effective for preventing injury in the cooperative, alert and oriented patient.

nurses can empower themselves with evidence and practice accordingly. this works in the other direction too. through careful history taking you may advocate that the cervical spine is not cleared clinically but by ct.

there are a number of threads on these boards on this topic , usually hijacked by those who

0. cannot identify the difference between changing the method of immobilisation and 'clinical clearance'

1. cannot see beyond the end of their own facilities policies ,

2. refuse to accept the evidence base for CCR or

3. for iatrogenic harm from even relatively modest periods of unnecessary immobilisation ,

4. claim it is 'illegal' for anyone other than physician to make the 'order' or perform the clinical exam required by CCR and similar decision support tools ( despite never providing evidence of the statute which states this)

5. believe that possession of an MD magically makes people's hands different and that the examination required for CCR is magically safer if performed by a physician rather than any other health professional.

Well said ZippyGBR, very eloquent.

I concur.

Thank you.