Hooray for New Hampshire! They have come to the forefront in recognizing that the use of a long backboard for spinal immobilization has no evidence of benefit and can instead cause harm to patients.
Check out their Spinal Injury Training Video:
Here is an excerpt from the new New HampshireÂ Spinal TraumaÂ protocol:
– Apply a cervical collar.
– For ambulatory patients, allow the patient to sit on the stretcher, and then lie flat. (The â€œstanding take-downâ€ is eliminated.).
– Once the patient is moved to the stretcher, remove any hard backboard device by using log roll or lift-and-slide technique.
– Patients should only be transported to the hospital on a rigid vacuum mattress or hard backboard if it is necessary for patient safety (e.g., combative patient), or other treatment priorities (e.g., to address suspected increases in intracranial pressure associated with traumatic brain injury. See also Traumatic Brain Injury 4.5), or removal would delay transport of an unstable patient.
– Lay the patient flat on the stretcher, secure firmly with all straps, and leave the cervical collar in place. Elevate the back of the stretcher only if necessary to support respiratory function, patient compliance or other significant treatment priority.
– Instruct the patient to avoid moving their head or neck as much as possible.
– For conscious patients that poorly tolerate a rigid cervical collar (e.g., due to anxiety, shortness of breath), the cervical collar may be replaced with a towel roll and/or padding to minimize spinal motion.
– Patients with nausea or vomiting may be placed in a lateral recumbent position maintaining the head in a neutral position using manual stabilization, padding, pillows, and/or the patientâ€™s arm. See also Nausea/Vomiting Protocol 2.9.
Connecticut hopefully will be joining them soon as the state educational package is waiting final approval.