NEANN Long Spine Board Comfort Research

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.

TIME	SUBJECT																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	2	2	5	2	1	1	0	2	2	0	2	0	3	0	5	1.8
30 Min	0	1	2	5	3	1	1	0	2	2	0	2	2	3	0	4	1.8
45 Min	0	1	2	9	3	*R	1	0	1	2	0	3	4	2	0	3	2.4
60 Min	0	1	2	9	2	*R	1	0	3	2	0	3	4	3	0	3	2.6
Table 1

*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.

TIME	OFFICER																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	2	0	0	0	0	0	0	0	0	0	0	0	3	0	1	0.4
30 Min	0	2	0	0	0	0	0	0	0	0	0	0	0	3	0	1	0.4
45 Min	0	2	0	0	2	1	1	0	0	0	0	0	0	2	0	0	0.5
60 Min	0	2	0	0	2	1	1	0	0	0	0	0	0	2	0	0	0.5
Table 2

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.

TIME	OFFICER																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	3	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0.3
30 Min	0	4	0	0	1	1	0	0	0	0	0	1	0	1	0	0	0.5
45 Min	0	1	0	0	0	3	0	0	0	2	0	1	0	0	2	2	0.7
60 Min	0	1	0	0	0	3	0	0	1	4	0	1	0	1	3	2	1.0
Table 3

The The majority of the subjects complaining of pain stated this to be due to the cervical collar.

Lumbar Discomfort

Previous studies have shown that inadequate or no padding under the lumbar spine can lead to pain and discomfort when lying on the FLSB for periods of greater than 30 minutes.^1,6 To maintain anatomical alignment of the lumbar spine, padding was placed under the lumbar spine using
an airsplint (hand and wrist) as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate lumbar spine discomfort during immobilisation, measured with the NRS of 0 (no pain) to 10 (significant pain), with results shown
in Table 4 below.

TIME	SUBJECT																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	0	0	1	0	1	2	0	0	0	0	2	0	4	0	5	0.9
30 Min	0	0	0	1	2	1	1	0	0	0	0	1	0	2	0	5	0.8
45 Min	0	0	0	1	2	1	2	0	0	0	1	0	0	1	0	2	0.6
60 Min	0	0	0	0	4	1	2	0	0	0	1	0	0	2	0	6	1.0
Table 4

Chest Cross Strap Discomfort

Previous studies have recommended the use of cross over shoulder straps in preventing upward sliding as well as limiting lateral movement of the torso of the patient during transport.¹⁰ Fourteen of the 16 subjects were immobilised to the CLSB using cross over straps as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate chest cross strap discomfort during immobilisation, measured on a NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 5 below.

TIME	SUBJECT																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	1			0.0
30 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	1			0.0
45 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0.0
60 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0.0
Table 5

Respiratory Compromise

Previous studies have demonstrated respiratory restrictions when applying chest straps.^7-8 Subjects were asked to rate respiratory restrictions during immobilisation, measured on a NRS of 0 (no restriction) to 10 (significant restriction), with results shown in Table 6 below.

TIME	SUBJECT																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	1			0.0
30 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	1			0.0
45 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0.0
60 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0.0
Table 6

Pelvic Strap Discomfort

The pelvic strap is applied to assist in preventing lateral movement of the spinal column. Fourteen of the 16 subjects had pelvic straps applied as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate pelvic strap discomfort during immobilisation, measured on a NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 7 below.

TIME	SUBJECT																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	0	0	0	0	0	0	0	0	0	0	0	1	0			0.0
30 Min	0	0	0	0	0	0	0	0	0	0	0	0	1	0			0.0
45 Min	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0			0.0
60 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0.0
Table 7

Femur Strap Discomfort

The femur strap is applied to assist in preventing lateral movement of the spinal column. Fourteen of the 16 subjects had femur straps applied as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate femur strap discomfort during immobilisation measured on a NRS of 0 (no pain) to 10 (significant pain) with results shown in Table 8 below.

TIME	SUBJECT																RESUL MEAN RESUL RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESUL RESULT
15 Min	0	0	0	0	0	0	0	0	0	0	0	0	1	0			0.0
30 Min	0	0	0	0	0	0	0	0	0	0	0	0	1	0			0.0
45 Min	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0			0.0
60 Min	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0.0
Table 8

Ankle Strap Discomfort

The use of the figure of eight ankle strap prevents downward sliding of the patient and assists in limiting lateral movement of the spinal column during transport.¹⁴ Fourteen of the 16 subjects had a figure of eight ankle strap applied as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate ankle strap discomfort during immobilisation, measured on a NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 9 below.

TIME	SUBJECT																RESUL MEAN RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESULT
15 Min	0	0	2	0	0	0	0	2	0	0	0	0	1	2			0.5
30 Min	0	0	2	0	0	0	0	2	0	0	0	0	0	0			0.4
45 Min	0	0	3	0	0	0	0	1	0	0	0	0	0	0			0.3
60 Min	0	0	3	0	0	0	0	1	0	0	0	0	0	0			0.3
Table 9

No padding was placed between the patients legs in this study. This needs to be evaluated to determine if this would reduce discomfort.

Head Block Discomfort

The use of head blocks and tape has shown significant improvement of cervical spine immobilisation over cervical collar alone.^15-17Nine of the 16 subjects received head immobilisation using foam head blocks and tape applied as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate head block discomfort during
immobilisation, measured on a NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 10 below.

TIME	SUBJECT																RESUL MEAN RESU RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESU RESULT
15 Min						0	0	0	0	0	0	0	1.5	0			0.2
30 Min						1	0	0	0	0	0	0	1.5	0			0.3
45 Min						0	0	0	0	0	0	0	0.5	0			0.2
60 Min						0	0	0	0	0	0	0	0.5	0			0.2
Table 10

Head Tape Discomfort

As stated above, the use of head blocks and tape has shown significant improvement of cervical spine immobilisation over cervical collar alone.^15-17 Ten of the 16 subjects received head immobilisation using tape applied as per the Victorian Ambulance Service’s teaching standards using Worksheet Instructions 5.1.11.⁹ Subjects were asked to rate head tape discomfort during immobilisation, measured on a NRS of 0 (no pain) to 10 (significant pain), with results shown in Table 11 below.

TIME	SUBJECT																RESUL MEAN RESULT
TIME	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	RESUL MEAN RESULT
15 Min						0	1	2	2	1	0	1	0	2	0		0.9
30 Min						0	0	3	2	1	0	1	0	2	0		0.9