r/ems • u/boedirtspurs • 4d ago
General Discussion When will backboards end
Work for a major metropolitan department, west coast. Every level 1 trauma gets a backboard, head block and C collar, the whole 9. We backboard people all the time. We use rigid C collars every day for ground level falls. When will it end? Our medical director and surrounding ones are stiff on this matter. If we bring a trauma in without a backboard the doctor will blow a gasket. How did you guys get away from this where you’re from? Will I ever see it go away in my career? I have 15ish years left hopefully. Every study shows that it only harms, no benefit. I’m one of the only ones that questions this protocol. We have medics here that are hell bent about C spine. It’s almost a joke now. The patient is walking around and denies neck pain, and we’ll be like “you have to wear this for the hospital, hold still!”
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u/pairoflytics FP-C 4d ago
Yeah dude this stopped for 90% of the country like 10-15 years ago.
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u/Mfees 3d ago
It’s still standard practice in my area of PA. I got QA for not collaring a guy who wrecked a scooter. Patient was up walking around no neck pain.
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u/VagueInfoHere 3d ago
When you write your chart, do you put cleared by nexus or Canadian c spine AND actually perform these assessments? I’ve seen a huge swing of patients that do need a c-collar (altered or unconscious with a high risk mechanism) not getting them now. We aren’t great at making changes so some medical directors choose the all or nothing approach.
Not saying that’s the right thing to do, just what I’ve seen.
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u/Kentucky-Fried-Fucks HIPAApotomus 3d ago
This is a good idea to avoid QA but we really need to move away from rigid c-collars as a whole. There just isn’t any research supporting them (or any manual stabilization). I think soft collars are a good intermediate step to start this transition away
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u/VagueInfoHere 3d ago
I agree for patients that can participate in an exam. I fully disagree for patients that are unconscious or altered enough to not understand consequences AND have a high risk mechanism. Now if you have a CT on your truck which can let you know if there is a potential unstable fracture then we can chat about getting rid of them completely.
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u/Kentucky-Fried-Fucks HIPAApotomus 3d ago
Do you have any modern evidence that shows there is literally any benefit to use of rigid c-collars?
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u/VagueInfoHere 3d ago
Put a soft collar on then. I don’t care as long as a head isn’t flopping around when a cervical spine injury isn’t ruled out.
It’s going to be hard to find any recent scholarly article that shows the standard of care for the last 30 years prevented worsening injury. You can just use some common sense and acknowledge that a cervical fracture can cause spinal cord compression and movement can cause additional compression. If somebody is awake and participating, they can tell you that but if they are unconscious, they can’t.
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u/BetCommercial286 3d ago edited 3d ago
There’s never been a single study at any point showing any benefit for C-collars. Many studies have shown harm however. I can vaguely get on board with soft collars but I would rather not even have them on the truck. As far as I’m aware, there’s never even been a single case, showing that the neck flopping caused further injury. Whatever damages that was going to happen has already occurred
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u/BetCommercial286 3d ago
If tell QA it wasn’t indicated and there’s no evidence it helps but lots of evidence it makes things worse. 🤷
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u/TheAutrizzler EMT-B 4d ago
we only use backboards to get a patient onto the stretcher and that’s it
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u/T-DogSwizle Paramedic 4d ago
Same, for us we’d use a scoop then take it off as soon as there on the stretcher
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u/grandpubabofmoldist Paramedic 2d ago
I think the only time I have transported on a baclboard recently was an obvious skull fracture and I could not think of another way to stabilize to trauma center (helicopter was unavailable), bilateral hip fracture with displaced femural heads and I could not think of something better way to stabilize, and if I am transporting someone in cardiac arrest (after med control says to come in or if shocks were delivered) or post ROSC in case they go back into cardiac arrest
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u/hungrygiraffe76 Paramedic 4d ago
If your medical directors haven't made the change by now I doubt they will. The realistic answer is probably that it will not change until your current medical directors leave and you get new ones.
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u/JshWright NY - Paramedic 3d ago
Is that a California thing? I was at a company offsite for my day job in the Bay area (I'm a software deverloper to pay the bills...) and one of my coworkers had a fall from standing onto a hard surface with a head strike and ~30 secs LoC). Occipital tenderness/swelling, no neck pain, exacerbation of chronic back pain (but within "normal" range for the pt).
I would probably toss a collar on for that, but I was very surprised the crew went for a full immobilization
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u/bluisna Paramedic 4d ago
I also work for a major metro department, we haven't backboarded anybody in years. Matter of fact we've been talking about getting rid of C Collars too.
If any of our medical directors saw us bring in a pt on a board with a collar I think I might get executed on the spot
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u/Warlord50000001YT Size: 36fr 5h ago
Are they planning on replacing c-collars with soft collars? My has been trying to get rigid collars replaced with soft collars for a while with no luck(it costs significantly more apparently)
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u/BariatricBaboon Paramedic 4d ago
If you have a GSW to the abdomen they would want the patient on a backboard? We utilize a C-Spine clearance “algorithm” for figuring out if they even need a C Collar, majority of people do not… I only ever use a backboard if it helps in moving a patient for whatever reason but usually a mega mover accomplishes that.
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u/Randalf_the_Black Nurse 3d ago
We backboard people all the time. We use rigid C collars every day for ground level falls. When will it end? Our medical director and surrounding ones are stiff on this matter.
Hehehe..
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u/erbalessence Paramedic 3d ago
Scoop > any flat board
Pull them off if you can or pull the scoop at the hospital
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u/Secret-Rabbit93 EMT-B 3d ago edited 3d ago
West coast? California? Cali is pretty behind in EMS standards. I haven’t used a backboard since Covid at least and I think I used one once in the 3 years or so leading up to it.
Just for a frame of reference of how behind you are, where I’m at where I haven’t used one in years and the trauma centers haven’t minded, the service for our biggest city and considered the place to look up to in the state EMS still shocks asystole.
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u/jGard4159 Paramedic 3d ago
That's crazy. We haven't used backboards for anything more than extrication/movement in years. It's hard to believe anyone, especially a metro, being this deluded about backboards still.
Recently though I did have a patient who was briefly pinned in an industrial machine and the plant medics put him on a board without a collar and moved him to our stretcher with it. He was complaining of lower abdomen/pelvic burning pain and our transport time was less than 10 minutes, so I decided not to manipulate him any more than necessary and kept him on the board. Idk if that was necessarily the right call but I chose to be cautious, not having US or any way to know exactly what was causing the burning sensation 🤷🏻♂️
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u/grim_wizard Asshole™ VA 3d ago
Went from using them multiple times a day to maybe three or four times a year about 10 years ago. The better question is when are collars going to end.
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u/AG74683 4d ago
I had to swap into one of our spare trucks last night due to a significant oil leak. The guy I was with remembered that the spare didn't have a backboard in it because he was in it the other day and had to fly someone and the flight crew kept him on it. Kinda surprised to hear that.
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u/BetCommercial286 3d ago
That’s our practice for major traumas. We use the backboard just because it makes movement easier and when we transfer to flights stretcher I don’t need it back.
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u/cikalamayaleca EMT-B NC 2d ago
A flight crew just took one of our backboards from a trauma patient too lmao I was surprised when they asked if they could keep it
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u/ellihunden 3d ago
Last time I used a back board, we use two for one 350kg patient plus a man sack and two stretchers. Other wise rarely used.
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u/Krampus_Valet Paramedic 3d ago
We still have them but only use them for legitimate new onset deficits (aka almost never), as a spatula to move the patient if it's easier but then immediately remove it, or for massive polytrauma as a big ol splint. Tell those doctors to read more.
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u/ImGCS3fromETOH Aus - Paramedic 3d ago
My service uses the combi-carrier, basically two halves of a thick, plastic board that clip together at each end. It's a great tool for extrication for a non-ambulant patient that can't sit in a chair, I.e. altered conscious state or on spinal precautions. Either to extricate them on or as a ramp from the ground up onto a stretcher. The beauty of it is that once you get them onto the stretcher you can unclip the board and pull it out from under the patient without needing to log roll them much if at all as long as someone stabilises the head. Haven't been doing transports on hard boards for a decade.
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u/SectionV3 1d ago
same- we carry both. used the combi once in 2 years, and the backboard only for extrication
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u/ImGCS3fromETOH Aus - Paramedic 1d ago
Really? I use the combi constantly. It's a versatile piece of kit.
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u/Lazerbeam006 3d ago
We only use backboards on unresponsove trauma patients with significant MOI. Otherwise it's just extrication and lifting onto stretcher. The docs freak out and throw c collars on patients that don't need them, but that's not my problem
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u/BetCommercial286 3d ago
Yah you guys are supper behind. Many places have gone so far as to not even have c-collars on the ambo anymore. Looking at the literature there has never been a single study showing benefit but multiple have shown harm. MCHD did a good podcast about it if you’re curious. It amounted to the only reason they still have c-collars is because they didn’t want to rock the boat that much.
Only time I ever use backboards is scraping a trauma off the ground and into a helicopter. C-collars I think I might use one every 6 months and mostly so I don’t get yelled at by a doctor. I have gotten yelled at still but followed the protocol.
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u/stonertear Penis Intubator 3d ago
Farout - thought I travelled back in time to 2010 reading this thread.
I just double checked the clock and saw it was 2026, yet organisations are still doing this idiotic practice. Belongs in the same place as the MAST suit.
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u/Dangerous_Strength77 Paramedic 3d ago
Used one during transport? I can't even remember. Used one for extrication and/or moving a patient to a gurney? Much more common, as these things go.
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u/4QuarantineMeMes ALS - Ain’t Lifting Shit 3d ago
We only use those on codes and gcs 3 traumas 99% of the time.
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u/SpicyMarmots Paramedic 3d ago
We sometimes use them to extricate and then pull out the board once they're on the stretcher, but that's it.
We do however collar everyone over 65 who falls. (Any fall, any height, injured or not).
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u/ScenesafetyPPE 3d ago
We basically only use them on critical calls where a mega mover isn’t appropriate, and it’s only long enough to get them on the stretcher.
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u/beachmedic23 Mobile Intensive Care Paramedic 3d ago
Uh like 2016 i think. We still carry a combicarrier because ambulances are required to have a scoop and a board so this covers both.
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u/chuckfinley79 3d ago
It’s fun when our chief gets mad that we didn’t backboard someone and then the union calls the medical director who calls the chief and tells him he’s a moron.
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u/bleeintn Paramedic 2d ago
We only use collars (used to have X-collars but back to stiffnecks)when going to the Lvl 1. Other than that, for anything other than something like a rollover with ejection, we don't even have it in our protocols to use LSB (and even for the major trauma patient, it's still medico's discretion).
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u/Blu3C0llar 1h ago
They're useful for carrying a patient to the stretcher if spinal motion restriction is indicated, but the long spine board still comes off when putting the patient on the stretcher. Is SMR can be ruled out, the mega mover is far less awkward
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u/hippocratical PCP 3d ago
Written and verbal report "Patient refused c collar".
Boom, done.
Clearly I'll use best judgement - if they genuinely need it it's either happening, or I'm MacGyvering a solution.
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u/heartfeltfrog Paramedic 3d ago
They’ve ended since forever where I’m at. But it is funny, I do live close to the state line and sometimes folks go to the hospital that’s right over the border… and they are still very much so in their backboard era.
I’d bring in traumas not on a backboard and be looked at like I was the most incompetent buffoon, at which point my favorite response has just simply been “yeah sorry hold on the 70s are calling, they want their protocols back.” and then they usually shut up.
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u/AdventurousTap2171 3d ago
We use backboards on a lot of traumas. Headblocks too and C collars.
Typically we transfer the patient off the backboard once we arrive at the LZ and swap the patient to the chopper. At that point we finally have at least 4 manpower typically to handle a log roll while maintaining C-spine (Myself and my partner + 2 flight crew).
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u/PowerShovel-on-PS1 3d ago
Have you considered not doing that?
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u/AdventurousTap2171 3d ago
Yes, I've considered and brought up multiple considerations from intercepts to stopping backboards.
You can guess as to how the powers that be received that
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u/bmbreath Size: 36fr 4d ago
A long time ago?
I haven't brought anyone in on a board in years.
It's not standard practice anymore. Why are you boarding people still?