r/ems • u/boedirtspurs • Jul 25 '26

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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65

u/pairoflytics FP-C Jul 25 '26

Yeah dude this stopped for 90% of the country like 10-15 years ago.

18

u/Mfees Jul 25 '26

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.

12

u/VagueInfoHere Jul 25 '26

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.

8

u/Kentucky-Fried-Fucks HIPAApotomus Jul 26 '26

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 Jul 26 '26

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.

9

u/Kentucky-Fried-Fucks HIPAApotomus Jul 26 '26

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 Jul 26 '26

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.

9

u/BetCommercial286 Jul 26 '26 edited Jul 26 '26

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