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March 12, 2017
Wash. responders resort to backboard alternative for spinal injuries
By Robert Mittendorf
WHATCOM COUNTY, Wash. — You’ve seen it in the movies and on TV: Someone hurt in a car wreck is strapped to a rigid backboard and rushed to the hospital by ambulance or aboard a rescue helicopter. That’s how firefighters, paramedics and others have approached patients with suspected spinal injury since the nation’s modern fire-based EMS system began some 50 years ago.
But that doesn’t happen in Whatcom County, where EMS workers are among the first in the nation to reject traditional spinal immobilization techniques – a neck brace and backboard – in favor of a device called a vacuum mattress or full-body vacuum splint.
It’s a growing trend in U.S. pre-hospital emergency care as more studies show that vacuum mattresses work better than backboards. Even the traditional cervical collar or neck brace is falling by the wayside as unnecessary.
Backboards are notoriously uncomfortable for patients, and – especially with long transport times to a specialized trauma center – further injury can result.
“There’s a lot of data that lying on a board for more than 30 minutes causes tissue death. It doesn’t do any good, and it’s more likely to cause harm,” said Dr. Marvin Wayne, Whatcom County medical program director and the supervising physician for Whatcom Medic One, which provides paramedic ambulance service countywide.
“Medic One was one of the early adopters” of the vacuum mattress, Wayne said.
A vacuum mattress is a thick vinyl or nylon-coated fabric blanket stuffed with small plastic beads like a bean-bag chair. An injured person is wrapped in the mattress and air is sucked out with a pump. As the air is sucked out and the device becomes rigid, rescuers mold the mattress to the patient, providing a more comfortable and ultimately safer way to protect a patient – especially someone who might have multiple injuries, such as a broken spine, pelvis and femur.
Wayne points to clinical research conducted over the past several years, including a 2003 World Health Organization study, that shows some 5 million patients are backboarded in the U.S. annually, but only 2 to 3 percent actually have spinal injuries. A five-year Society for Academic Emergency Medicine study published in 1998 compared patients at the University of Malaya (Malaysia) and the University of New Mexico hospitals, finding that the patients in Malaya who were not immobilized fared better neurologically than the U.S. patients who were immobilized.
“It’s a kinder, gentler method of immobilization,” said Rick Lipke of Bellingham, whose local company Conterra makes EMS and rescue supplies, including two kinds of vacuum mattresses.
“The first time I saw a vacuum mattress was on Ski Patrol in the 1990s,” Lipke said. “It’s been the standard of care in Europe for 35 years.”
Early vacuum mattresses for spinal immobilization were developed from vacuum splints that stabilized a broken arm or leg. But they are expensive, costing $400 to $800 for a vacuum mattress vs. $80 for a backboard. Further, backboards were interchangeable and could be shared among various fire agencies in a geographic area. When firefighters left a patient on a backboard at the ER, they just took one from ER storage. But fire and EMS agencies were reluctant to leave an expensive vacuum mattress at a hospital.
Some fire departments around the nation tell their staff to gently lift an injured patient to an ambulance cot, also called a stretcher or gurney, to avoid having to invest in vacuum mattresses, Wayne said.
“A lot of people are just using the cot,” Wayne said.
But many local fire departments, including South Whatcom Fire Authority, have been using vacuum mattresses for more than a decade on a case-by-case basis. Firefighters in Whatcom County now use backboards mostly just for extrication purposes, such as moving a patient from a car wreck to a vacuum mattress or ambulance cot.
“Vacuum mattresses have been in use since at least 2005,” said Assistant Chief Rod Topel of South Whatcom Fire Authority, which serves the communities of Sudden Valley, Geneva, Yew Street Road, Chuckanut Drive and Lake Samish. “It’s just more comfortable for the patient, and still provides the same stability or better. (But) that long ago, backboards were still the primary method of patient immobilization.”
Then, firefighters were taught to backboard a patient who suffered severe “mechanism of injury,” such as a rollover car wreck or long fall. Now, patients generally are immobilized if a physical exam shows they might have suffered such an injury, or if patients say that they have neck pain or back pain.
About that time, Conterra loaned its mattresses to Bellingham Fire Department for testing and evaluation, Topel said. Widespread countywide use of the mattresses began in 2013, and the mattresses were put into service officially with an EMS protocol change and bulk purchase in 2015.
All fire departments in Whatcom County now share their vacuum mattresses, thanks to an $18,245 Chuckanut Health Foundation matching grant in 2015 that helped buy 60 vacuum mattresses, said Gary Barr, chief of the Lynden Fire Department.
“That put one on every gurney that we have in Whatcom County,” Barr said. “We use them – I don’t know if daily – but for broken hips, pelvises, back injuries in an auto accident.”
Vacuum mattresses aren’t just for injured people, said Chief Jerry DeBruin of Whatcom County Fire District 14, which serves the rural Sumas, Kendall and Welcome areas, and provides ambulance transport for people injured at Mt. Baker Ski Area.
“It makes it easy to move a frail patient. Moving can be painful. It’s a great, great piece of equipment. I can’t say enough about them,” DeBruin said.
District 14 firefighters see lengthy ambulance transport times: 30 minutes to St. Joseph hospital from Sumas, 45 minutes from Kendall, and more than an hour from the ski area.
“I can’t imgine being on a backboard for that long,” DeBruin said.
District 14 firefighters don’t even use the cervical collar anymore, opting instead to protect a patient’s neck with padding or a rolled blanket.
“It’s been wonderful and we’re using them 100 percent of the time. We haven’t transported a patient on a backboard in a long time. The only time we use one is if we’re getting someone out of a vehicle,” DeBruin said.
The Bellingham Herald reporter Robert Mittendorf is a volunteer firefighter with South Whatcom Fire Authority, and has used vacuum mattresses in the field.