The long spine board does not reduce lateral motion during transport—a randomized healthy volunteer crossover trial

Wampler, David; Pineda, Chloe; Polk, Joan; Kidd, Emily; Leboeuf, Dale; Flores, Marti; Shown, Mike; Kharod, Chetan U.; Stewart, Ronald M.; Cooley, Craig

doi:10.1016/j.ajem.2015.12.078

Cited by 20 publications

(10 citation statements)

References 10 publications

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“…While there is concern that sitting the potentially spine injured patient too upright may induce significant downward force on the spine and exacerbate existing injuries, it is interesting to note that small movements are detected in all positions except for head of stretcher elevated to 60°, which had much higher movement. While there is no significant information on the tolerable amount of safe cervical motion, it is likely that some cervical motion is tolerable [8,15]. Our results demonstrate that the LSB had more movement of the neck to the torso when compared to a modern ambulance stretcher.…”

Section: Discussionmentioning

confidence: 75%

“…In contrast, modern ambulance stretchers have a padded mattress designed to conform to a patient's anatomy. The stretcher mattress is designed for comfort, with a higher coefficient of friction, and demonstrated superiority in reducing patient movement over the LSB [8]. To date, there have been Biomechanical Motion During Ambulance Transport J Neurol Res.…”

Section: Introductionmentioning

confidence: 99%

“…A previous publication looking at the lateral motion on and off the LSB on an EMS stretcher [8] used analog measurement to determine lateral motion. Current technology allows for the accurate three-dimensional (3D) biomechanical analysis of complex human movement.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Motion Analysis of Cervical and Thoracolumbar Spine During Ambulance Transport: A Healthy Volunteer Study

Wampler

Stewart

Summers³

et al. 2020

J Neurol Res

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Background: Recent evidence suggests that long spine board (LSB) may do little to manage spinal motion, and pose increased risk. This project sought to measure cervical and thoracolumbar motion during ambulance transport. The hypothesis was transport on a mattress with the head elevated without the LSB would allow less spinal movement than transport on an LSB. Methods: A randomized healthy volunteer crossover trial measured spinal motion using biometric sensors. Positions analyzed included 0 and 10° on LSB. Stretcher alone with head elevated to 10°, 30°, 45° and 60°, with and without head blocks. Simulated ambulance transport was on city streets at or below posted speed limits. Results: Nine subjects were included, with 66% being male. For cervical movement, there was no difference in axial, flexion/extension, or rotation (0.2 ± 0.1 mm vs. 0.2 ± 0.1 mm, 24 ± 12 mm vs. 22 ± 10 mm, and 5.1 ± 19° vs. 5.8 ± 20°, respectively). There were significant differences in lateral (3.7 ± 7 mm LSB vs. 2.0 ± 5 mm no LSB) movement and volumetric movement of the head (120 ± 172 mm 3 LSB vs. 77 ± 86 mm 3 no LSB). Positions allowing the lowest mean cervical volume of head movement were bed elevated to 30° and 45° with head blocks, (20 ± 22 mm 3 and 12 ± 6 mm 3 , respectively). For thoracolumbar movement, there was no statistical difference in threedimensional volumetric movement of the thoracolumbar spine (2 ± 0.6 mm 3 LSB vs. 4.7 ± 5 mm 3 no LSB). Conclusion: Spinal motion was small in all groups. The stretcher mattress without LSB allowed less cervical motion than the LSB. Subjects secured to a stretcher mattress with head of the bed elevated to 30° had the least spinal movement.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Biomechanical Motion Analysis of Cervical and Thoracolumbar Spine During Ambulance Transport: A Healthy Volunteer Study

Wampler

Stewart

Summers³

et al. 2020

J Neurol Res

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“…Immobilization also implies a greater use of unnecessary radiological tests, thus increasing the radiation to which the patient is exposed. This is due to the difficulty in distinguishing whether the pain is a result of the traumatic injury or is caused by the spinal panel [22,23].…”

Section: Immobilizationmentioning

confidence: 99%

Efficacy of Cervical Immobilization in Multiple Trauma Patients

Cacho¹,

Peña²,

Eguillor³

2019

Int J Crit Care Emerg Med

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Introduction: Immobilization is one of the most used procedures to prevent spinal cord injury in multiple trauma patients in prehospital setting. However, its protocolary use has historical principles rather than a scientific origin. Although this technique restricts the movement of the injured spine, there is no evidence supporting its use in all patients suffering from trauma.Objective: To contrast the effectiveness of immobilization in multiple trauma patients.Methodology: A bibliographic narrative review was carried out in databases such as PubMed, CINAHL Complete, ScienceDirect, Cochrane Plus and LILACS.Results: A total of 12 articles were obtained that met the inclusion and exclusion criteria established and answered the proposed objective. Discussion:The current literature does not clarify universal criteria about when patients should be immobilized. In addition, the great amount of harmful effects that can cause this technique to the patient are increasingly manifested. Conclusions:It is necessary to carry out more studies that provide scientific evidence of quality to know the effectiveness of cervical immobilization in multiple trauma patients, because this is still something uncertain.

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“… For extrication purposes, a trauma board can be a useful tool. It is recommended that it be used for the extrication only, to slide the patient out of vehicle and then the patient should be placed on a preferable device for transport [3] , [4] , [25] . The Kendrick Extrication Device (KED) takes a long time to apply and gives a false sense of motion restriction.…”

Section: Recommendationsmentioning

confidence: 99%

Cervical collars and immobilisation: A South African best practice recommendation

Stanton

Hardcastle

Muhlbauer

et al. 2017

African Journal of Emergency Medicine

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IntroductionThe consequences of spinal injury as a result of trauma can be devastating. Spinal immobilisation using hard trauma boards and rigid cervical collars has traditionally been the standard response to suspected spinal injury patients even though the risk may be extremely low. Recently, adverse events due to the method of immobilisation have challenged the need for motion restriction in all trauma patients. International guidelines have been published for protection of the spine during transport and this article brings those guidelines into the South African context.RecommendationsTrauma patients need to be properly assessed using both an approved list of high and low risk factors, as well as a thorough examination. They should then be managed accordingly. Internationally validated assessment strategies have been developed, and should be used as part of the patient assessment. The method of motion restriction should be selected to suit the situation. The use of a vacuum mattress is the preferable technique, with the use of a trauma board being the least desirable.ConclusionThe need for motion restriction in suspected spinal injury should be properly evaluated and appropriate action taken. Not all trauma patients require spinal motion restriction.

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The long spine board does not reduce lateral motion during transport—a randomized healthy volunteer crossover trial

Cited by 20 publications

References 10 publications

Biomechanical Motion Analysis of Cervical and Thoracolumbar Spine During Ambulance Transport: A Healthy Volunteer Study

Biomechanical Motion Analysis of Cervical and Thoracolumbar Spine During Ambulance Transport: A Healthy Volunteer Study

Efficacy of Cervical Immobilization in Multiple Trauma Patients

Cervical collars and immobilisation: A South African best practice recommendation

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