Providers Analyze Immobilization Techniques for Spinal Injuries

Study evaluates the use of scoop stretchers.

 

 
 
 

Keith Wesley, MD, FACEP | Marshall J. Washick, BAS, NREMT-P | | Tuesday, November 23, 2010


Review Of: Del Rossi G, Rechtine GR, Conrad BP, et al. Are Scoop stretchers suitable for use on spine-injured patients? Am J Emerg Med. 2010;28(7):751–757.

The Science

This is a study on the effectiveness of using scoop stretchers in decreasing spinal movement compared with using long backboard techniques. Five lightly embalmed cadavers had surgically induced "worst case scenario" spinal injuries at C5–C6 vertebrae. Sensors were implanted around the vertebrae and spinal column to detect angular motions in six directions when placing the patients onto a long backboard using two techniques: log roll and lift and slide. These results were then compared with the scoop stretcher. After analysis, the investigators found no "statistical significance" of the movement created by the log-roll technique, but they did find that it created more motion in all directions when compared with the lift and slide and the scoop stretcher.

The Street

Medic Marshall: This is an interesting study, and it seems to reinforce some of the current literature out there on backboarding patients. For me, it's really starting to beg the question: What’s the value of placing a significant population of our “trauma” patients on a backboard when we could potentially be doing more harm than good?

I've never used a scoop stretcher in my short career (although I hope to someday), but clearly, as demonstrated by this original research, it appears to be slightly more beneficial than the long backboard (LBB).

The study requires five rescuers to place a patient on an LBB using the lift-and-slide technique. The scoop stretcher method only requires three. How often is it that first responders, and EMS providers have sufficient room to properly place these patients on a board using a lift-and-slide technique? The answer: not very often, if ever. The majority of the time they use the log-roll method. It's fast, easy, and it gets the job done with as little as three people.

It's also worth mentioning a few of the study's limitations. First, the average age of the cadavers was 81. Even though they were free of any type of spinal pathologies, their age is still significant because of the decreased mobility. Prehospital providers aren't always going to be boarding "grandma" and "grandpa." The investigators note that younger cadavers could have potentially produced more movement. Secondly, the rescue team that was used for the study consisted of physicians and athletic trainers. I think first responders, EMTs and paramedics would have yielded a more accurate depiction of prehospital care.

Personally, I'd also like to see an alternative to those "torture racks" called long backboards. If the scoop stretcher is the answer, then by all means, we should be further evaluating its place in the prehospital realm.

Doc Wesley:
I enjoy articles like this for the simple fact that they challenge our conventional training and education. Since the first National Highway Traffic Safety Administration (NHTSA) curriculum, the flat longboard has been the mainstay of traumatic injury stabilization and transport. Many studies have challenged the value of the longboard—with several demonstrating the amount of pain they induce, which often results in unnecessary X-rays. When the NEXUS studies demonstrated that physicians and EMS can selectively determine who should undergo spinal immobilization, the door was opened to examine what, if any, immobilization techniques actually protect the potentially injured spine.
This is one of two recent studies that used fresh cadavers with surgically induced spinal instability to measure the motion of the spine during immobilization. The neurosurgical literature attests that this is a valid reproduction of reality associated with acute injury. What both studies have shown is that standard C-collars and log-rolling of patients results in clinically significant spinal movement, which could worsen existing spinal trauma.

This study specifically examined the effects of log-rolling and the lift-and- slide technique, which is routinely used with longboarding as compared with simply applying a scoop stretcher to the supine patient. What about not being able to examine the back? Well, that's a great question that should be investigated. What are you going to find that may change your treatment? If there's bleeding, it can be assessed without rolling the patient, and leaving the patient supine would keep pressure on the wound. If it's a penetrating wound, such as a gunshot wound or stab wound, data show that the likelihood of spinal trauma is low, and log rolling might be indicated.

There's no question that the scoop stretcher is more comfortable and is certainly easier to apply. I commend the authors for this thought-provoking study, which I hope will cause us to reconsider the value of the old flat spine board.
 




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Related Topics: Patient Care, Trauma, “immobilization”, scoop stretchers, Marshall Washick, Keith Wesley

 
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Keith Wesley, MD, FACEP

Keith Wesley, MD, FACEP, is the Minnesota State EMS medical director and the EMS medical director for HealthEast Ambulance in St. Paul, Minn. and and can be reached at drwesley@emsconsulting.net.

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Marshall J. Washick, BAS, NREMT-Pis a paramedic and the peer-review/research coordinator for HealthEast Medical Transportation. He can be contacted at MjWashick@HealthEast.org.

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