Administration and Leadership, Columns

Flush Away Your Support of Always Backboarding Patients

Issue 6 and Volume 39.

For years we’ve been saying it. No, scratch that. For decades we’ve been saying it.

“Saying what?” you ask. “Who’s saying it?”

It regards a certain questionable procedure we’ve been practicing in the trauma prehospital setting for years—a procedure never really ever seriously studied to be proven in its effectiveness. A procedure seriously lacking certifiable value. A procedure still in full use despite …

“Say it already! Jeez!”

Patience … patience my dear column reader. Fostering suspense while writing articles is an essential part of the artistic process to help advance one’s sense of curiosity while heightening the reader’s level of anticipation for a climatic finale.

“Not really. I found this article in a bathroom stall of our station and you’re running out of time at just about the time I’m running out of toilet paper.”

Steve Berry, EMS backboarding

Spinal immobilization! The ultimate body splint for which its only guarantee is that if you didn’t have back pain before, you certainly will by the time the ambulance arrives at the hospital. I sense your uneasiness. I’m already taking you out of your comfort zone—which, by the way, is also an important element of creative writing. “I’m down to my last 10 serrated pieces of TP.”

Lawyers! Not all lawyers, mind you, but when we get down to brass tacks, isn’t the fear of lawsuits one of the primary reasons we restrain spines to rigid boards outside of normal anatomical vertebral alignment? Now, don’t get me wrong. Long boards will always have a function in EMS. They’re an essential patient extrication device from the scene to the ambulance cot, but from that point on, a C-collar will suffice just fine 99.99999% of the time—the same percentage of lawyers who would like to prove otherwise. We now have the data on our side, however. In fact, if anything, current research has demonstrated a patient is more at risk for harm than benefit once strapped to the board. (By the way, how many serrated pieces are you down to?)

Stories! You’ll find many out there who’ll swear on their mother’s broken back they’ve heard of patients becoming paralyzed from the “negligent” act of not being spinal immobilized. They heard it from a friend who knew a nurse who worked with a doctor who heard a paramedic speak of a friend’s brother who spoke to a proctologist whose uncle’s aunt suffered permanent neurological damage.

Speaking of parables, several years earlier I had a patient who drove himself to an urgent care center after suffering from severe back pain secondary to a fall he’d experienced four days earlier. The urgent care center strapped the hapless man down to a backboard and requested EMS transport to a hospital 23 miles away. The patient became acutely nauseous as his metal carriage of transport wound its way down a curving mountainous road. Before Zofran could be administered, the patient had to be turned on his side to prevent aspiration as he proceeded to vomit on himself, the cot and the floor—which I slipped upon, slightly wrenching my back.

Upon arrival at the hospital, the ER staff immediately removed the patient from the backboard, but failed to free his headblocks as they rolled him onto the bed causing, you guessed it, the patient to torque his neck in a painfully unnatural manner. The patient was then re-backboarded and wheeled away for X-rays with screams of “Kill me now!” reverberating down the darkened hallway. As I slowly limped my way out of the ER holding my lower back, I had no choice but to call our unit out of service, resulting in our station becoming one paramedic short. Several days later I considered going to urgent care for my ongoing back pain, but caught myself before it was too late … you still there? “You’re lucky I found another roll of TP.”

Do no harm! Speaking of rolls, if our profession is truly on one, we need to remain committed to providing an appropriate level of patient care through evidence-based medicine while reducing costly and unnecessary emergency medical procedures. We need to flush away the act of practicing medicine through litigious intimidation. Did you note the use of clever interactive euphemisms to accentuate my concluding statement? …Hello? … Hello?

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