Long Spine Board

Comfort Studies 

Long Spine Board: Does It Cause Discomfort
 

Response   Volume 33  2006

Anthony Hann - MICA Paramedic
Ambulance Officers Training Centre      Victoria       Australia

INTRODUCTION

In recent times, the flat Long Spine Board (FLSB) has come under increasing scrutiny due to the potential discomfort and pressure area  development of the FLSB to the patient when the patient is immobilised without body, head or lumbar padding.^1-6  Additionally respiratory  compromise due to the strapping techniques in use have also been quoted.^7-8  It has been suggested by some studies however that the  addition of appropriate padding under the patient can improve comfort and reduce tissue interface pressures.^2-6   

The Victorian Ambulance Service introduced the curved Long Spine Board (CLSB) into use in 1995, and since then, there have been no  studies within the Service to support or discredit previous overseas studies on the FLSB discomfort, pressure area development or respiratory compromise.^1-8  To resolve this question, a study was carried out at the  Ambulance Officers Training College in Victoria to determine if the CLSB and methods being taught by the Victorian Ambulance Service⁹ resolved previous discomfort findings.

METHOD

Sixteen healthy subjects (Stage 1 Ambulance Students) without a previous history of back injury and no current back pain were placed onto the  fiberglass CLSB for a period of 1 hour with padding as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions  5.1.11⁹ using a blanket between the patient and CLSB, occipital padding with a bath towel, and lumber support using an Airsplint (Hand & Wrist).  Fourteen of the subjects were then immobilised to the CLSB as per the Victorian Ambulance Service’s teaching standards using Worksheet  Instructions 5.1.11⁹  with chest crossover straps, pelvic strap ,femur strap, and figure of eight foot strap.  Two subjects received no immobilisation. All patients had a cervical collar applied using either Stifneck, Veribrace or Wizloc collars.  Nine of the subjects received  head blocks with forehead and collar taping padding again as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11,⁹ and 6 subjects received no additional head immobilization.

Subjects were checked every 15 minutes by fellow students and asked to rate discomfort in numerous areas of the immobilisation,  which was measured using the 10 point numerical rating scale (NRS) of 0 (no pain) to 10 (significant pain).  Overall discomfort and comfort were also measured.

RESULTS

The following are the recorded results of the 16 subjects.

Cervical Collar Discomfort

All 16 subjects were fitted cervical collars using one of the following brands - Laerdal Stifneck (4), Zimmer Vertibrace (3) or Ferno Wizloc (1) cervical collars. Eight of the subjects failed to state on the evaluation form what brand of cervical collar was used.   During the 1 hour session,   1 subject required the removal of the cervical collar due to significant discomfort.    Subjects were asked to rate cervical collar discomfort  during immobilisation, measured with the NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 1 below.

*R = Collar     * R = Removed

The         The cervical collar was state by the majority of subjects to be the major cause of pain during the study.

 

Long S Spine Board Discomfort

Previous studies have shown pain and discomfort when lying on the FLSB for periods of greater than 30 minutes when inadequate or no padding is applied.^1-5 All 16 subjects were placed on the CLSB for a period of 1 hour.  As per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11,⁹ patients were placed on the CLSB using a folded blanket between the patient and CLSB, occipital padding with a bath towel, and lumber support using an Airsplint (Hand & Wrist). Subjects were asked to rate discomfort during immobilisation, measured with the NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 2 below.

Head Occiput Discomfort

Failure to pad under the occiput has been shown to cause pain and discomfort when lying on  the FLSB for periods of greater than 30 minutes,¹  and may result in misalignment of the cervical spine.^11-12  To maintain neutral inline positioning of the cervical spine, padding was placed under  the occiput of the patient’s head as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹  Subjects  were asked to rate head occiput discomfort during immobilisation, measured with the NRS  of 0 (no pain) to 10 (significant pain), with results
shown in Table 3 below.