Immobilization

[fishy]

LSB are a pretty recent development here. We've only had them on the rigs now for a couple of years in our area. In general they are still very uncommon and mostly unheard of here.
I really like to have them as alternative. There's a lot of situations where they have become invaluable to me, but also there are a lot of problem ascociated with them. First and foremost the pain and discomfort they cause.

Our standard of 'splinting' possible spinal injuries used to be the vaccuum matress. We still have them, I still love them, but now we have two ways to immobilize and can decide case by case which one is more appropriate.

As to the KED, we carry that aswell and I really like it. We trained with it during medic school on pretty much every mva trauma and with a little training you can get it done in less than 5 minutes. Which to me seems very reasonable in most situations and well worth the effort.
The medics at Hockenheim Ring (German Formula 1 Grand Prix race track) can get someone out with a KED in less that 2 minutes.

[cwl3gemt]

LSB are a pretty recent development here. We've only had them on the rigs now for a couple of years in our area. In general they are still very uncommon and mostly unheard of here.
I really like to have them as alternative. There's a lot of situations where they have become invaluable to me, but also there are a lot of problem ascociated with them. First and foremost the pain and discomfort they cause.

Our standard of 'splinting' possible spinal injuries used to be the vaccuum matress. We still have them, I still love them, but now we have two ways to immobilize and can decide case by case which one is more appropriate.

As to the KED, we carry that aswell and I really like it. We trained with it during medic school on pretty much every mva trauma and with a little training you can get it done in less than 5 minutes. Which to me seems very reasonable in most situations and well worth the effort.
The medics at Hockenheim Ring (German Formula 1 Grand Prix race track) can get someone out with a KED in less that 2 minutes.

if they can do that in that amount of time, id like to see them try it with a speedboard.

[musicemt]

I must admit a bias...I really buy into Wilderness Medical Associates' ideas on spinal stabilization and immobilization. That said...

Traditional spinal immobilization with LSB is, IMO, archaic, not sufficiently supported by research, and above all, uncomfortable. Having been imobilized for a prolonged period of time personally as well as gathering all sorts of colorful feedback from "immobilized" patients, I think that the discomfort involved with putting someone on an LSB totally defeats its intended purpose. When you're uncomfortable, you fidget and move. When you move, so does your spine. Period. Going out of our way to make whatever immobilization method we choose VERY comfortable will go a long way in making immobilization more effective. Personally, no matter how much padding and effective securing methods I have used (and I've experimented with many), I have yet to find one that is very comfortable for a prolonged period of time.

I like vacuum mattresses a LOT. Haven't used one too often (not very common in my area), but they seem great in their ability to shrink-wrap to a patient's position. I've been in one for a short period of time, and it was much mroe comfortable than a LSB. Maybe that's why they're so commonly used outside the US?

One more thought...whatever shortcomings LSB immobilization has, it is still held as the "standard"; maybe the more correct term is "ideal". In any case, we all know that there is the ideal, and then there is the real. In the end, any position or system that makes the patient comfortable to the point that they don't want to move has stabilized their spine.

End soapbox.

[WEMT-I312]

I remember being taught that you can immobilize a pregnant person by placing her in Left Lateral Recumbent to avoid the mass of the fetus from impingeing on the Vena Cava, but other than that, I'm pretty sure that the commercially available forms of spinal immobilization are best.

[Ditch Doc]

I must admit a bias...I really buy into Wilderness Medical Associates' ideas on spinal stabilization and immobilization. That said...

Traditional spinal immobilization with LSB is, IMO, archaic, not sufficiently supported by research, and above all, uncomfortable. Having been imobilized for a prolonged period of time personally as well as gathering all sorts of colorful feedback from "immobilized" patients, I think that the discomfort involved with putting someone on an LSB totally defeats its intended purpose. When you're uncomfortable, you fidget and move. When you move, so does your spine. Period. Going out of our way to make whatever immobilization method we choose VERY comfortable will go a long way in making immobilization more effective. Personally, no matter how much padding and effective securing methods I have used (and I've experimented with many), I have yet to find one that is very comfortable for a prolonged period of time.

I like vacuum mattresses a LOT. Haven't used one too often (not very common in my area), but they seem great in their ability to shrink-wrap to a patient's position. I've been in one for a short period of time, and it was much mroe comfortable than a LSB. Maybe that's why they're so commonly used outside the US?

One more thought...whatever shortcomings LSB immobilization has, it is still held as the "standard"; maybe the more correct term is "ideal". In any case, we all know that there is the ideal, and then there is the real. In the end, any position or system that makes the patient comfortable to the point that they don't want to move has stabilized their spine.

End soapbox.

I wonder if the vacuum mattress would decrease the occurrence of rhabdomyolysis in patients who are immobilized for an extended period.

I remember being taught that you can immobilize a pregnant person by placing her in Left Lateral Recumbent to avoid the mass of the fetus from impingeing on the Vena Cava, but other than that, I'm pretty sure that the commercially available forms of spinal immobilization are best.

Good example. Pretty much the same method we immobilize everyone else. With that, the Pt is still immobilized supine on the LSB. Positioning is accomplished by propping the board up with blankets. The cool part is that they are no longer stressing L. lateral for pregnant Pts. You can go left or right, whichever is more comfortable for the patient. Either way, the end result is the same... the Pt is immobilized and pressure is taken off the vena cava.

[CombatMedic]

We were discussing this in class. Remember this when is comes to immobilization. The Nuetral position that everybody likes is not always obtainable. Sometimes you may need to bring someone in with their head turned to the side, because it hurts to move. Then splint is like it is. Just like the deformed are with not neuro-vascular compromise.

This career lets us get creative some times. We do our job in a non-text book setting with patients who did not read the book. so we are forced to use our minds on some of the things that we have to do.

SAFDrookie

Just remember, there is a set way to do things for the model patient. The only model patient I have ever seen is on a stretcher, in the EMS lab, with a bunch of wire hanging out of his side. And he can still be a pain in the @$$.

[lerue]

We use vacuum mattress if patient journey time is expected >30minutes. Which is pretty much all the time. I like it for it's flexibility, comfort, security and ease of handling. The main downside is leaks, although the material is pretty tough it can still be holed by debris, rough ground or glass. Every A/E vehicle in the fleet carries one, as well as a long back board and KED.

On reflection not sure if you would call it a leak, as air floods in not out.

[kojoff]

We use vacuum mattress if patient journey time is expected >30minutes. Which is pretty much all the time. I like it for it's flexibility, comfort, security and ease of handling. The main downside is leaks, although the material is pretty tough it can still be holed by debris, rough ground or glass. Every A/E vehicle in the fleet carries one, as well as a long back board and KED.

On reflection not sure if you would call it a leak, as air floods in not out.

Well, it wouldnt be a lick would it?

[medic pathetic]

Well, it wouldnt be a lick would it?

Bwahahaha!

Hey Kojoff, isn't there a pic of someone being put into a vacum backboard floating around somewhere? Taken at an EMS conference a couple years back?

[jozak78]

the air mattresses are nice if someone is going to be on them for a long time, but i've discovered since working at the hospital that for some reason x-rays don't shoot through them very well, this may be a brand issue i don't know. and since x-rays don't shoot through them very well we have to get the patients off of them and it is a royal pain in the dick to get them off of those things and maintain c-spine stability at the same time. also i was part of a study with the scoop stretcher for cervical spine stabilization and apparently it held stabilization better than the LSB and it was way more comfortable. inline stabilization was assessed during movement of the patient with some sort of motion prob in a human movement lab.