From EMS World Expo: Ditch the Backboards

Evidence continues to mount that challenges the use of backboards in EMS transports.

Salim Rezaie, MD, host of the RebelEM Podcast and an internal medicine and emergency physician at GSEP Emergency Medicine in San Antonio, highlighted recent research that further validates the clinical decision not to immobilize patients during emergency transports Oct. 7, 2021 during EMS World Expo in Atlanta.

Rezaie’s presentation “Throw Away the Backboards” reviewed the evidence that debunks the use of spinal immobilization in trauma patients.

Potential problems with backboard immobilizations include:

• Difficulty of airway management. For every 16 intubations, you are potentially causing harm to one patient during intubation if they are wearing a rigid collar, said Rezaie, citing a recent study.
• Pressure ulcers. For longer transports and patients with ischemic skin, rigid collars can cause ulcerations of the occiput, chin, and upper back.
• Pulmonary function. Ventilation can be compromised when a patient is strapped to a board.
• Intracranial pressure. A swollen traumatic brain can suffer secondary injury in the case of cervical immobilization.

Vacuum mattresses, scoop stretchers, and Reeves litters are somewhat better choices and can seem more comfortable for patients, but the bottom line is that spinal immobilization in any form worsens pulmonary functional tests and does not prevent spinal injury, said Rezaie. Further, it can potentially increase intracranial pressure.

Recent statements by the NAEMSP and the American College of Surgeons conclude that immobilization is not necessary in these cases:

• Normal GCS
• No spine tenderness
• No neurologic findings
• No distracting injury
• No intoxication.

Backboards can still prove useful as an extrication device, concluded Rezaie, but the bottom line is that they should be selectively used and removed as quickly and safely as possible.

While clinical habits die hard and there is an ongoing sense of “this is the way we’ve always done it,” Rezaie’s hope is that evidence continues to mount in order to change established protocols surrounding spinal immobilization for all but a very select subset of cases.