How to Use a Backboard: A Comprehensive Guide

Using a backboard effectively is a critical skill for first responders and medical professionals. It involves carefully immobilizing a patient with suspected spinal injuries to prevent further harm during transport. The process includes properly positioning the patient, securing them with straps in a specific sequence, padding natural hollows for comfort and stability, and finally, immobilizing the head. However, it’s increasingly crucial to understand when a backboard shouldn’t be used, considering the potential for adverse outcomes. Modern protocols often prioritize spinal motion restriction techniques that don’t necessarily involve a backboard in every case.

Understanding the Backboard’s Role

Backboards: More Than Just Transport Tools

Backboards were originally designed as a means to quickly and efficiently move patients from the scene of an incident to a waiting ambulance or medical facility. They provided a rigid surface to facilitate this movement, particularly in challenging environments. While their role in facilitating extraction remains valuable, their use as a primary spinal immobilization device has been significantly re-evaluated.

Shifting Paradigms in Spinal Immobilization

The medical community’s understanding of spinal injury management has evolved considerably. Research has highlighted potential drawbacks of routine backboard use, including increased pain, pressure sores, breathing difficulties, and airway compromise. As a result, current best practices emphasize a more selective approach to spinal immobilization, prioritizing patient comfort and minimizing potential harm.

The Backboarding Procedure: A Step-by-Step Guide

Even with the shifting guidelines, understanding the traditional backboarding technique remains important. Here’s a breakdown of how to properly use a backboard:

1. Preparation: Gather your equipment: backboard, cervical collar, straps (chest, hips, legs), head immobilization device (blocks or rolled towels), tape, and padding.
2. Assessment: Quickly assess the patient’s condition, noting any obvious injuries or neurological deficits. Determine if the patient meets the criteria for selective spinal immobilization or requires full backboarding.
3. Cervical Collar Application: Apply a correctly sized cervical collar to stabilize the neck.
4. Positioning:
   • Log Roll: The primary technique is the log roll. Coordinate with a team of responders. One person maintains manual stabilization of the head and neck while others gently roll the patient as a unit.
   • Backboard Placement: Slide the backboard underneath the patient, ensuring it’s centered. An alternative is the lift-and-slide if log rolling is not feasible.
5. Centering: Ensure the patient is centered on the backboard. This is critical for proper weight distribution and stability.
6. Strapping: Secure the patient to the backboard using straps. The recommended sequence is typically:
   • Chest: Secure the chest strap first, ensuring it’s snug but not overly tight to avoid restricting breathing.
   • Hips: Secure the hip straps.
   • Legs: Secure the leg straps. Some protocols may have minor variations, but the priority is secure immobilization.
7. Padding: Pad any natural hollows (e.g., behind the neck, knees, and lower back) to improve comfort and prevent pressure sores.
8. Head Immobilization:
   • Head Blocks or Rolled Towels: Place head blocks or rolled towels on either side of the patient’s head.
   • Taping: Secure the head to the backboard using tape across the forehead and chin, ensuring the airway remains unobstructed.
9. Ongoing Assessment: Continuously monitor the patient’s airway, breathing, and circulation. Reassess neurological status as appropriate.

When Not to Use a Backboard

It’s essential to recognize situations where backboarding is unnecessary and potentially harmful. According to current guidelines, consider selective spinal immobilization instead of routine backboarding for patients who meet all of the following criteria:

• Normal Level of Consciousness (GCS 15): The patient is fully alert and oriented.
• No Spine Tenderness or Anatomic Abnormality: There is no pain upon palpation of the spine, and no visible deformities.
• No Neurologic Findings or Complaints: The patient has no numbness, weakness, or other neurological symptoms.
• No Distracting Injury: There are no other injuries that would prevent the patient from accurately reporting spinal pain.
• No Intoxication: The patient is not under the influence of drugs or alcohol, which could impair their ability to assess pain.

Alternative Spinal Motion Restriction Techniques

When a backboard is not indicated, alternative techniques for spinal motion restriction can be employed. These may include:

• Manual Stabilization: Maintaining manual stabilization of the head and neck throughout assessment and transport.
• Cervical Collar Only: Applying a cervical collar and allowing the patient to self-extricate and ambulate, if appropriate.
• Vacuum Mattress: Using a vacuum mattress to conform to the patient’s body shape and provide support.

Backboards and Training

Continuous Education is Key

Protocols for spinal immobilization are constantly evolving. Medical professionals need to stay up-to-date with the latest research and guidelines to ensure they are providing the best possible care. This includes attending continuing education courses, participating in simulations, and reviewing current literature. The Games Learning Society offers resources and innovative approaches to learning that can enhance the understanding and application of these protocols. GamesLearningSociety.org

Hands-On Training

While theoretical knowledge is important, hands-on training is essential for mastering backboarding and spinal motion restriction techniques. Practice with simulated patients helps build confidence and competence in performing these skills.

FAQs: Backboarding and Spinal Immobilization

1. What is the primary goal of using a backboard?

The primary original goal was to facilitate safe and efficient patient transport. Now the main goal is to restrict spinal motion and prevent further injury in patients with suspected spinal instability.

2. What is log rolling, and why is it important?

Log rolling is a technique used to move a patient onto a backboard while maintaining spinal alignment. It’s essential because it minimizes the risk of further spinal injury during the transfer.

3. In what order should straps be applied to a backboard?

Generally, the chest straps are applied first, followed by the hip straps, and then the leg straps. This sequence helps to secure the torso and pelvis before addressing the lower extremities.

4. Why is padding important when using a backboard?

Padding improves patient comfort and prevents pressure sores. It fills natural hollows and distributes weight more evenly, reducing the risk of skin breakdown during transport.

5. How do you properly immobilize a patient’s head on a backboard?

Use head blocks or rolled towels to stabilize the head and neck. Secure the head to the backboard using tape across the forehead and chin, ensuring the airway remains unobstructed.

6. What are the potential complications of using a backboard?

Potential complications include increased pain, pressure sores, breathing difficulties, and airway compromise.

7. When should you not use a backboard?

Avoid using a backboard for patients who have a normal level of consciousness (GCS 15), no spine tenderness, no neurologic deficits, no distracting injuries, and are not intoxicated. These patients may benefit from selective spinal immobilization techniques instead.

8. What are alternative methods for spinal motion restriction?

Alternatives include manual stabilization, cervical collar only, and vacuum mattress.

9. How long can a patient safely remain on a backboard?

Ideally, a patient should not remain on a backboard for more than 30 minutes to minimize the risk of pressure sores and discomfort. Efforts should be made to transfer the patient to a more comfortable surface as soon as possible. Some protocols suggest even shorter timeframes.

10. Can CPR be performed on a backboard?

Yes, CPR can be performed on a backboard. The rigid surface provides support for effective chest compressions. However, the ERC suggests the evidence is equivocal.

11. What is the role of a cervical collar?

A cervical collar limits neck movement and provides initial stabilization of the cervical spine.

12. How do you assess a patient for spinal injury?

Assessment involves evaluating the patient’s level of consciousness, asking about pain or tenderness, checking for neurologic deficits, and palpating the spine for any abnormalities.

13. What is the lift-and-slide technique?

The lift-and-slide technique is an alternative to the log roll for transferring a patient onto a backboard. It involves lifting the patient slightly and sliding the backboard underneath.

14. How often should spinal immobilization protocols be reviewed and updated?

Spinal immobilization protocols should be reviewed and updated regularly to reflect the latest research and best practices.

15. What are the weight limitations when carrying a patient on a backboard down stairs?

Always be aware of the weight limitations of the backboard and any associated equipment. Use a sufficient number of personnel to safely and effectively carry the patient, maintaining balance and control throughout the process. Use a minimum of two people to lift, even if a one-person stretcher is being used.

Conclusion

The use of backboards in emergency medical care is an evolving field. While understanding the traditional techniques is essential, embracing current best practices for selective spinal immobilization is crucial. By prioritizing patient comfort, minimizing potential harm, and staying informed about the latest research, medical professionals can provide the best possible care for patients with suspected spinal injuries. Remember to continuously educate yourself to keep up with the latest evidence-based practices.