Long Spine Board – Is Less More?

Written by Clay Smith

Spoon Feed
After a national EMS statement deemphasized use of the long spine board (LSB) for spinal motion restriction (SMR), there was no associated increased risk of spinal cord injury.

Why does this matter?
Spinal motion restrictions called for rigid cervical collars and long spine board. However, use of a LSB has been deemphasized by EMS. A joint statement by NAEMSP and ACS-COT in 2014 urged more selective, judicious use of the LSB. LSB use is not harmless and is associated with respiratory compromise, pain, and pressure sores. But is decreased use safe? Has it resulted in more spinal cord injuries?

Long spine bored
This was a retrospective review of an Arizona EMS database compared with hospital discharge data over a 3-year time period. The key finding was that when comparing pre- and post-SMR changes (with less LSB use, see p39), there was no increase in relative risk of spinal cord injury in patients with possible spinal trauma, 0.40% vs. 0.45% (pā€‰=ā€‰0.436); and verified spinal trauma, 4.04% vs. 4.37% (pā€‰=ā€‰0.561). Focusing on the highest risk group, those with verified spinal injury, pre- and post-SMR changes again showed no difference, aOR 1.097 (95%CI 0.818 – 1.472). This study is encouraging but limited by the retrospective approach. A prospective study would be helpful to confirm these findings.

Source
Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury. Prehosp Emerg Care. 2019 Aug 14:1-10. doi: 10.1080/10903127.2019.1645923. [Epub ahead of print]

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Reviewed by Thomas Davis

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