The Back of the Bus - The End of the Backboard?


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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Lisa Chavez, RN, and Kathy Garvin, RN

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Kevin G. -

if the 'spine board' is fading out in usefulness, as this says, what about fading in of the idea of preventing heat loss,beyond blankets over the scooped patient.

Bean bag beds with vacuum pumps, heated mattresses, whatever.
Does anybody at a receiving institution ever raise this with the sender?

Just because the All Blacks are going to wallop the Wallabies tonight because they are tougher better men, does not mean that rural Kiwis should put up with lesser care than rural Australians (go the real champions, the RFDS)

Kevin G. -

Hmmm. Mel, I wonder if you did not publish the above because of a cultural misunderstanding about the last paragraph.
New Zealanders might say what I did before the first of the 3 game series for the Bledisloe Cup, as I did, but never after winning. Which Australians would, if they had won. I love Australia, its almost as good as New Zealand.
Perhaps if I had inserted a smiley face?
Or is it that since you now live in the US where every second person 'packs heat', Kiwi style humour is necessarily unknown. I prefer to think that you are now American in outlook and just ca'nt see the funny side, rather than residual Aussie and won't.

Sean G., M.D. -

Lol the dreaded take down.....My favorite was when I worked in residency in a major urban trauma center....the poor hapless passenger who was ambulatory at the scene on cell phone, but fell victim to the takedown, due to another associated victim who was ejected or dead at the they came all treated exactly the same....the takedown victim, the one with essentially no complaints, guilty by association was the best...they panicked, they squirmed against the restraints, they pleaded with the trauma team that they were "OK" at the foot of the bed stood the poker faced trauma attending, arms folded drinking in the chaos....the takedown victim pleads...."no not my boots!!!! They are real snakeskin!!! They cost me 500!!! Please Nooooooo!!!!! " The surgical intern hesitates, stares back at said trauma attending who gives the slightest nod..."Off with the boots!" is the silent communicae and the intern commences with the trauma shears, shredding a perfectly good pair of snakeskin boots....but even better, the hapless restrained "victim by association" has yet to meet Mr happy finger followed by Mr Foley.....all in the essence of proper trauma care......sorry but i used to laugh my ass off at this.....

Marc K. -

I have always thought that backboards where unnecessary devices of torture and am glad there is evidence of this and other like minded individuals. I am also now a new EMS director and would like to incorporate this into my protocols. Has someone already invented these so I can plagiarize them?

Clinton K. -

Good on you Chelsea and Darren. This is the kind of work that needs to get more press

John P. -

What are your thoughts on how to properly transfer someone with known cervical spine pathology to a tertiary care center from a small community hospital? For instance, awhile back I cared for a ruby player with no neuro deficits who had sustained a bad C2 fracture in the scrum pile. Ground transport from my center takes 2.5 hours if the air is black. Is it necessary to keep a patient such as this immobilized on a backboard for the transfer due to the severity of the fracture and its potential complications, or do you think they can be safely transported in a c-collar without the board to avoid pressure ulcers and other complications?

Darren B., M.D. -

This is a fantastic question. I do not believe boards should be used at all in the inter-facility setting and we stopped using them at our flight program about 10 years ago. It has been a bit of an uphill fight with some sending physicians who understandably have been confused and mislead into thinking that a board was part of immobilization when it is just an extrication tool. When that patient with the C2 fracture gets to the receiving facility they will be taken off the board and kept in spinal precautions with a cervical collar and firm mattress so there's no reason we can't do the same during transport. I think you are way ahead of the curve in recognizing the potential complications not to mention torture involved with being on a board for 2.5 hours. Just say no!


I'm a prehospital physician from the UK and we don't use rigid back boards. They can be used as an extrication device but really backboards have been dead for a long time. As discussed people can get out of the vehicle or walk up the stairs etc if they are fully conscious and have neck pain. Hopefully the widespread use of rigid cervical collars will be the next thing to go. The evidence is mounting and in 10 years time we will be looking back at what we did to trauma patients to 'protect' their spine and laugh.

rebecca l. -

can I get a copy of your protocol for completeness? I have a protocol that I can share also which I believe is following your protocol that you described. I believe if we share, then we all have a new "standard". i'm having difficulties w/ one of my ems agencies who want to see more like our new one. They believe me more when I can show them that other places are using these same protocols and doing ok.

Darren B., M.D. -

I would be happy to share our protocol and would love to see what you have put together. Contact me directly at

Howard M. -


The ACEP Board just passed a new spinal immobilization policy in line with what Darren and other have been saying for years. Press release and education should be rolling out soon. But email me at and I can get you a protocol copy too.


Stefanie F. -

I just think of how we treat patients after we have confirmed c-spine fracture: Aspen collar, see the spine surgeon in follow up in a week or so, meanwhile going to the mall etc. Or if more severe: firm mattress and c-collar if going to OR. No need to immobilize the whole patient if the problem is the neck.
Thanks for this! It's long overdue that we get rid of this medieval torture device. Can you tackle traction splints next please?

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Episode 155 Full episode audio for MD edition 275:00 min - 131 MB - M4AEM:RAP 2014 août Résumé en Francais Français 65:33 min - 60 MB - MP3EM:RAP 2014 August Aussie Edition Australian 73:57 min - 102 MB - MP3EM:RAP 2014 August Canadian Edition Canadian 30:52 min - 43 MB - MP3EM:RAP 2014 Augusto Resumen Español Español 83:27 min - 77 MB - MP3EM:RAP 2014 August MP3 359 MB - ZIPEM:RAP 2014 August - Summary 1 MB - PDFEM:RAP 2014 August Board Review Questions 379 KB - PDFEM:RAP 2014 August Board Review Answers 421 KB - PDF