NEANN Long Spine Board Manual

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*VEHICLE EXTRACTION*



INTRODUCTION The introduction of the Long Spine Board (LSB) in prehospital setting allows for vast improvements into the standard of spinal care, and greatly eases patient removal from motor vehicles. Following extensive field trialing, the use of a curved Long Spine Board was shown to provide significant advantages over flat Board designs currently available. The shape of the curved Board allows it to slide easily into bucket seats, and when sliding the patient out of the vehicle, patients tend to stay on the curved Board better due to the side support. Much greater care and skill was also found to be required when using flat Boards. It was also shown that the thinner the Board, the easier it was to use, with the best being only a few mm’s thick. In many cases, extraction of the patient onto a LSB was found to be eased if a patient was placed into a jacket style Cervical Extrication Device (CED) such as the NIEJÔ. Not only will the CED provide extremely effective cervical and partial thoracic / lumbar spine immobilisation, it will also ease the extrication by "placing handles on the patient". If the patient does not meet the definition of an ‘Actual Time Critical’ patient; OR the patient is trapped & is classed as Actual Time Critical, but the CED will not delay on-scene time, then a CED should be applied where appropriate.



PRINCIPLES OF EXTRICATION

In determining the method of patient removal (egress) from a vehicle, the two basic principles should be applied:


	1. MAINTAIN SPINAL ALIGNMENT
		- to minimise spinal cord injury and paralysis

	2 MINIMAL BODY TWISTING
		- to reduce further injuries and reduce fracture movement & pain



SCENE SET-UP

Overcrowding and poor placement of equipment at the scene of an scene by Rescue and Ambulance Officers (causing scene cluttering & trip hazards requiring multiple movements of equipment) can result in delays in the extraction to the detriment of the patient.^2-3 By following the basic principles below, these problems can be reduced by limiting crossover work areas, as well as making a safer and more efficient working environment. Basic principles of equipment placement is to position ambulance equipment and staff in the direction the patient will be extracted, whilst placing the rescue equipment staging area at the 180º opposing position. Some basic examples include:

	Rear Extrication Ambulance equipment & staff set-up are placed at the rear of the vehicle. Rescue staging area & staff are placed at the front of the vehicle.



	Front Extrication Ambulance equipment & staff set-up are placed at the front of the vehicle. Rescue staging area & staff are placed at the rear of the vehicle.




	Side Extrication Ambulance equipment & staff set-up are placed at the side of the vehicle the patient will be extricated from. Rescue staging area & staff are placed on the opposite side of the vehicle.



	Side x 2 Extrication Ambulance equipment & staff set-up are placed at both sides of the vehicle, traveling between the two via the rear of the vehicle. Rescue staging area & staff are placed at the front of the vehicle.



Inner / Outer Circle

Officers should also maintain the principles of the INNER / OUTER CIRCLE concept to also reduce scene cluttering

	Outer Circle (5-10 Metres) Vehicles, equipment staging areas, rubbish dump & fire suppression equipment should remain outside the 5 -10 m Outer Circle. Inner Circle (2-5 Metres) Persons entering the 2-5 m Inner Circle should be strictly limited to persons actively engaged in patient care or vehicle cutting. Equipment entering the 2-5 m inner circle should also be limited equipment actually in-use.

Bibliography

1. Joint Royal Colleges Ambulance Liaison Committee: UK
Prehospital Clinical Guidelines
Procedure 14: Long Board

2. Trunkey
Sci Am 1983;249:28.
Trauma.

3. Sampalis JS
J Trauma 1993;34:252—61.
Impact of on-site care, prehospital time, and level of in hospital care on survival in severely injured patients.

4. German Trauma Surgeons Task Force on Emergency Care
Unfallchirurg 2002 · 105:1015–1021
Algorithm for extrication and medical care in vehicular trauma

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