Author: Joslyn Joseph, DO (EM Resident Physician, Morristown Medical Center) and Joshua Bucher, MD (EM Attending Physician/EMS Fellow, Morristown Medical Center) // Edited by: Jennifer Robertson, MD, MSEd and Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital)

You are the emergency department (ED) attending physician waiting in the trauma bay for emergency medical services (EMS) to bring in a patient. The box report calls in a 33-year-old obese male truck driver who rolled his vehicle on its side.  The paramedics report that the patient was ambulatory at the scene and sustained no loss of consciousness (LOC). He did complain of neck pain at the scene and a “standing takedown” was performed by basic life support (BLS) in order to maintain full cervical (C)-spine precautions.

In the ED, the patient complains of nausea and back pain that began during the transport.  You see your patient in an adjustable semi-rigid collar with his head taped down to foam head-blocks. There are also several crisscrossed, tangled seatbelts securing him to a rigid backboard.  As the paramedics slide the patient over to the ED trauma stretcher, he begins to vomit and choke. As the board is tilted on its edge with the patient’s abdomen squeezed up against the side rail, you suction your patient’s airway while he continues to vomit all over the floor.  At this point, you wonder whether full spinal immobilization was even necessary in the first place.  Are backboards of any benefit to patients?

The Problem

Almost a year ago, the American College of Emergency Physicians (ACEP) issued  a report entitled “EMS Management of Patients with Potential Spinal Injury”, which addressed the lack of evidentiary support for out-of-hospital management of potential C-spine patients.  This paper highlighted the concept that the preventing any forces from acting upon the spinal column during pre-hospital transport via “full spinal immobilization,” is technically impossible.1 Instead, the goal for EMS care of trauma patients with suspected spinal injuries should require “spinal motion restriction,” or minimizing these forces without preventing further harm to the patient.

Several EMS agencies have returned the long backboard (LBB) to its original use – as an adjunct for rapid patient extrication in a rescue scenario. Yet, many agencies are still hesitant to make the change.  For both basic and advanced providers with years of experience, it is difficult to move from using “full c-spine precautions” to doing virtually nothing.

Whether you are reading this as a first year resident or a seasoned medical director, it is important to educate the public and provide quality pre-hospital care.  In this article, we will address the many myths surrounding the backboard and how to approach them with an evidence-based perspective.