Proper Strap Tightness for Immobilization - @

Proper Strap Tightness for Immobilization

Street Science



Keith Wesley | | Saturday, August 4, 2007

The Science

This study from the University of North Carolina Hospitals Emergency Department was undertaken in an attempt to define adequate spinal immobilization and the frequency with which it s applied to patients transported to the ED on backboards.

They defined an adequate strap to be one that has less than 2 cm of slack measured at the point where the strap contacts the patient. Quality of immobilization was measured by determining the number of straps used to immobilize both the head and body, including proper placement of head blocks and padding.

They evaluated 50 consecutive patients who were triaged as having low acuity injuries. They report that 15 (30%) had at least one unattached strap or piece of tape that should have attached their head to the board. Forty-four (88%) were found to have greater than 2 cm of slack between their body and at least one strap with the average strap tightness being 4.2 cm. Among those with any straps looser than 2 cm, the average number of loose straps was 3.4.

This study suggests that many patients are not well immobilized on arrival at the emergency department.

The Street

This is the first prospective study analyzing the quality of spinal immobilization on actual patients delivered to an emergency department. The authors readily agree that there are some limitations to the study, including the fact that only low acuity patients were evaluated and, more importantly, no one has defined precisely how tight immobilization straps should be to inure minimal movement without interfering with respirations or circulation.

Despite these limitations, the study is eye-opening in the fact that a significant number of patients had clearly inadequate immobilization. This raises the question as to why these patients were on backboards at all. Sometimes, it s more convenient for rescuers to place the patient on a backboard on scene to aid in extrication and then attach the backboard to the cot, when in fact the patient is not felt to be at significant risk for spinal injury. I suspect that this was the case for the majority of these low acuity patients.

What s clearly needed is a definition of proper strap tightness. I further suspect that straps that were adequately tightened on scene had loosened during transport as the patient assumed different positions and the weight dispersed. Perhaps we should make it routine to periodically readjust the straps during transport and before unloading the patient form the ambulance.

I m looking forward to the authors' attempts to recreate this study on high and moderate acuity patients. They may also want to obtain more information regarding the patient s complaints and the rescuers reasoning for immobilization.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Management

What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox


Fire EMS Blogs

Blogger Browser

Today's Featured Posts


EMS Airway Clinic

Improving Survival from Cardiac Arrest Using ACD-CPR + ITD

Using active compression-decompression CPR with an ITD has been shown to improve 1-year survival from cardiac arrest by 33%.
More >

Multimedia Thumb

Philadelphia Fire Department Apologizes for Medic’s Jab at Police

Union head calls photos a slap in the face of officers.
Watch It >

Multimedia Thumb

D.C. Fire and EMS Crews Blame New Technology for Patient’s Death

Delayed response blamed on recurring dispatch problems.
Watch It >

Multimedia Thumb

Suspect Steals, Crashes Maryland Ambulance

One killed, others injured in Prince George’s County crash.
Watch It >

Multimedia Thumb

Truck Strikes Pedestrians in Scotland

Six killed in downtown Glasgow.
More >

Multimedia Thumb

Tennessee Trench Rescue

Worker pulled from Roane County worksite.
More >

Multimedia Thumb

Time’s Ebola Firefighters

Doctors, nurses and others saluted for fighting virus.
More >

Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >

Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >

Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >

More Product Videos >