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Why Are we Still Using Spineboards?

It’s a great question, one that many of my fellow emergency care colleagues sometimes scoff at, but the truth is, there is little to no evidence that spineboards do any good. In fact, there is much more evidence that they actually cause further harm.

The idea behind the spineboard is quite simple, a large splint meant to immobilize the entire spine. Unfortunately, spineboards don’t really do a great job of actually immobilizing a patient.

Spineboards also don’t necessarily restrict movement. Have you ever seen an awake patient on a board? They tend to constantly squirm and reposition themselves, complain of pain and whine to be taken off immediately. The hard surface also can be a problem with pressure points and make pressure ulcers easier to contract. In fact, studies have also shown that spineboards actually are causing injury that wasn’t even present prior to being placed on it. Patients who had no back pain prior, arrive at the hospital with complaints of pain and then receive unnecessary imaging. Boards are also great at creating respiratory compromise, even in completely healthy patients. Laying flat and strapped to a rigid board is not exactly conducive for respiration, especially those with SOA, rib fractures, COPD, pulmonary contusions, and obesity. Also, if RSI is needed enroute, it is much more difficult to obtain an airway.

There are now numerous states, counties, regions and agencies that have done away with the use of spineboards completely or use them for extrication only. It’s been found that EMS gurneys and ER beds actually act similarly to a spineboard, and thus placing a patient on both the board and the gurney is redundant and less comfortable.

Regions that have not eliminated boards altogether limit their use to the following:

  • patients with blunt trauma AND altered mental status

  • patients complaining of spinal pain or numbness

  • patients with a visible deformity of the spine

  • patients that sustained a high energy injury AND are intoxicated/unable to communicate.

***Even patients with penetrating trauma to the head, neck, or torso and no evidence of spinal injury should not be immobilized on a spineboard as studies show it increases mortality! So why are we still using them? Because we always have…