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Use of the Spinal Board Within the Accident and Emergency Department

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Use of the Spinal Board Within the Accident and Emergency Department 108 18Accid Emerg Med 1998;15:108-113 SHORT REPORTS J Accid Emerg Med: first published as 10.1136/emj.15.2.108 on 1 March 1998. Downloaded from Use of the spinal board within the accident and emergency department Matthew W Cooke Abstract ment, with particular reference to the time A postal questionnaire was sent to all con- when the patient is removed from the board sultants and specialist trainees in the West and the primary use of boards within the Midlands about the use ofspinal boards in department. the accident and emergency (A&E) de- partment. Response rate was 70%. There Methods was widespread use of boards in A&E A postal questionnaire was sent to all A&E despite an ATLS recommendation to the consultants and specialist trainees in the West contrary. Hospitals should review their Midlands. Seventy per cent (35 of 50) returned policies on use of spinal boards within the the questionnaire. Anonymity was preserved, department, using the evidence available so there was no follow up of non-responders. to determine the best means of immobili- Respondents were asked six open questions sation. relating to their use of spinal boards within the (JAccid Emerg Med 1998;15:108-109) A&E department. Keywords: spinal boards Results Thirty one respondents (88%) had a spinal The role of the spinal board within the board in the department. accident and emergency (A&E) department If a patient was brought to the A&E depart- has been challenged recently.' It was originally ment on a spinal board he would be removed at developed as an extrication device using its a variety of stages in the resuscitation process. smooth surface to allow a person to be slid out These are listed in table 1. The majority (32, 91 %) would not be removed until at least after of a vehicle. However, it is difficult to remove http://emj.bmj.com/ him from the board in the field and therefore completion of the primary survey, initial resus- the patient is most commonly transported to citation, and first line x rays. the A&E department on the spinal board. The The preferred method of immobilisation non-conforming nature of the board means within the A&E department was the spinal that pressure points are exposed to high inter- board in conjunction with a collar and side face pressures2 and there is a risk of pressure support of the head. This was used by 15 sores developing. In addition, the shape of the respondents (43%). Eleven (31%) stated that a board does not conform to the shape of the spinal board was the preferred method but did on September 25, 2021 by guest. Protected copyright. spine. not specify use of other adjuncts. Five (14%) Alternatives include the vacuum splint, preferred immobilisation on the A&E depart- which provides better immobilisation of the ment trolley with collar and side support. trunk with less slippage on a gradual lateral tilt; In order to transfer a patient from bed to bed the backboard with head blocks, which is or from bed to scanner, various methods were slightly better at immobilising the head' ; and in use. Eighteen (51 %) stated they would use a the vacuum mattress, which has disadvantages spinal board, nine (26%) a controlled lift, three in prehospital use but may be preferable in (9%) either a lift or a board, one (3%) a Department of hospital.4 stretcher canvas, and two (6%) either a scoop Accident and The aim of this study was to determine how stretcher or board. Emergency Medicine, A patient not already on a board would be University of spinal boards are used within the A&E depart- Birmingham and City put on a board in the A&E department if there Hospital NHS Trust, Table I Stage at which patient removedfrom board was a high risk of injury (18, 51%), if they had Birmingham, UK a known spinal injury (2, 6%), or for transfer to M W Cooke No % another department or hospital (4, 12%). Nine Early in primary survey 2 6 respondents (26%) said they would never put a Correspondence to: After initial x rays 2 6 patient on a board after they had arrived in the M W Cooke, A&E After x ray and log roll 22 63 A&E department. Department, City Hospital, When spinal injury excluded 1 3 Dudley Road, Birmingham After log roll 3 9 When questioned on problems related to B18 7QH, UK; email After secondary survey 3 9 spinal boards, 18 quoted the risk of pressure [email protected] After computerised tomography 1 3 were After definitive care 1 3 sores and 20 that boards uncomfortable. Accepted date Other problems quoted included giving a false Short reports 109 sense of security (4), difficulty moving the moval before the end of the primary survey. patient on a board (4), inappropriate use of the The patient will often have been on the board board (4), the non-conforming nature of the for at least 15-30 minutes before arrival in the J Accid Emerg Med: first published as 10.1136/emj.15.2.108 on 1 March 1998. Downloaded from board (4), preventing proper examination (3), A&E department and therefore tissue damage and scaring the patient (2). may already be occurring. Many place the patient on a board after arrival in A&E. In Discussion these circumstances, the use of a vacuum mat- There is widespread use of spinal boards tress would be preferable. It may be that ATLS within the A&E department. Advanced has introduced people to the spinal board but Trauma Life Support (ATLS) clearly states has not made them sufficiently aware of their that the long board is for use "before and problems or the alternatives available. during transfer"5 and not for use within the Hospitals should review their policies on use A&E department. This survey reveals that sen- of spinal boards within the department using ior staff are well aware of the risks of spinal the evidence available to determine the best boards. However, boards remain the preferred means of immobilisation within the A&E method of immobilisation despite evidence department. that other surfaces are less hazardous and pos- sibly give better support.2 The reasons for pref- 1 Cooke MW. Spinal boards in A&E. J Accid Emerg Med erence of the spinal board are not clear. 1996;13:433. It is understandable that if a patient is 2 Main PW, Lovell ME. A review of seven support surfaces with emphasis on their protection of the spinally injured. J brought to A&E on a spinal board then initial Accid Emerg Med 1996;13:34-7. resuscitation should take priority over removal 3 Johnson DR, Hauswald M, Stockhoff C. Comparison of a vacuum splint device to a rigid backboard for spinal immo- from the board. However, many clinicians bilisation. Am J Emerg Med 1996;14:369-72. delay removal well beyond this time. Even the 4 Carney C. Support surfaces. J Accid Emerg Med 1996;13: 302. best boards will affect the quality of x rays 5 American College of Surgeons Advanced Trauma Life Sup- taken through them-another reason for re- port. Chicago: ACS, 1993. Relatives in the resuscitation room: their point of view F Barratt, D N Wallis Abstract There has been recent debate`' over the Objective-To investigate whether be- presence of relatives in the resuscitation room, reaved next of kin would like to have been not only the parents of children but also http://emj.bmj.com/ present in the resuscitation room during relatives of adult patients. Most research has attempted cardiopulmonary resuscitation concentrated on the attitudes and feelings of of their relative, and their experience or medical and nursing staff,4 and in one study4 knowledge of what is involved in cardiop- 75% of medical and nursing staff agreed with ulmonary resuscitation. the statement, "Relatives should have the Methods-The next of kin of patients who opportunity to be with a family member who is had recently died after unsuccessful car- requiring cardiopulmonary resuscitation, pro- on September 25, 2021 by guest. Protected copyright. diopulmonary resuscitation in the acci- vided appropriate professional support is avail- dent and emergency department were able." By contrast little has been published on contacted initially by telephone and then the attitude of recently bereaved relatives, sent a postal questionnaire. although the Resuscitation Council (UK) pub- Results-Four (11%) of 35 respondents lished a report in 1996 with recommendations had been asked whether they wished to be for practice and training.6 present in the resuscitation room; 24 This study had two aims: first, to determine (69%) would like to have been offered the whether bereaved next of kin felt they would like Accident and opportunity, even though not all would to have been present in the resuscitation room Emergency have accepted. The respondents had a during the attempted cardiopulmonary resusci- Department, Guy's tation of their relative; and second, to evaluate and St Thomas' Trust, wide variety of perceptions of what hap- London SE1 pens during resuscitation, few of which their knowledge and experience of what is F Barratt corresponded to clinical practice. involved in cardiopulmonary resuscitation. D N Wallis Conclusions-Most relatives of patients requiring cardiopulmonary resuscitation Methods Correspondence to: would like to be offered the of The next of kin-as stated on the accident and Dr F Barratt, Accident and possibility 16 Emergency Department, being in the resuscitation room; this could emergency card-of patients over the age of University Hospital years who had died after unsuccessful cardiop- Lewisham, Lewisham High have several benefits.
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