back board

[FlyNdrive]

I've seen wilderness First aid and EMT classes use the MAXTRAX and ratchet straps to immobilize a patient. They used the swim noodles to put on the back side of the board to keep the gripping teeth away and ratchet straps (actually a smaller surf board strap from a roof rack) to keep the body immobilized.

I believe it was also taught at the Hollister OR event.

 

[SOFME]

A stretcher will not provide the spinal motion restriction like a backboard will. A stretcher is good for sleeping on, and transporting people who have breaks and fractures, a back board is good for everything.

For a backboard to function properly though, you also need the required straps, headblocks, and padding. I might be tempted to carry one strapped to the underside of my 1/2T canopy on long isolated trips, but other than that I don't think it would be of much use. Stokes baskets can work way better, and they even make carrying a bunch of gear easier with a couple guys.

I don't think you have carried a stokes litter vary far in uneven terrain.

There are a few big issues with carrying a backboard on an expedition type trip in addition to just the difficulty of transporting the board itself (not hard if you have a roof rack I guess).

First is having the proper training to use it.

But second, and equally as important in an expedition, back country, wilderness context (all deal with extended transport times) is the issue of back boards actually doing more harm than good. Spend much more than 30-45 minutes on a rigid back board and you'll start developing pressure ulcers (similar to a bed sore). It is extremely uncomfortable for the patient, and once they are on a back board they really shouldn't be released until they are cleared by imaging at a hospital. You also have to deal with an extended transport time in which the patient is going to have to go to the bathroom and again... once on the board they are staying on the board. What if the patient vomits? (it is pretty nauseating riding in a vehicle strapped to a board). There is a whole host of issues you need to be prepared to deal with once the person is immobilized.

You are better off doing two things (if properly trained to do so):

1) Learn the selective spinal immobilization criteria so that you can safely rule out a spinal injury in the back country setting and avoid immobilization.

2) If the patient has a positive spinal injury and immobilization is advised, use a full body vacuum splint (expensive) or use a KED type device in conjunction with a litter/stokes basket and adequate padding for patient comfort.

Otherwise, stabilize in place and wait for professional rescue (if available) or do the best you can with what you have, but in my opinion, if the transport time is more than 30-45 minutes (MAX) the backboard will probably do more harm than good. Unless you are fully equipped and prepared to conduct a self evacuation of the patient, stabilizing in place IS the best option. A spinal injury or suspected spinal injury, in and of itself, is not a life threatening condition. If it is a significant enough injury to immediately cause issues with breathing (such as an upper cervical break) then unfortunately, your patient is most likely screwed anyway without rapid transport to a hospital. If it is a lower spinal injury, or a relatively stable injury, or an unconfirmed spinal injury, then they can be stabilized and supported well until help arrives with all the necessary equipment, manpower, and training to safely conduct the evacuation, even if that takes hours.

I've conducted several rescues of patients that have fallen significant distances, and had a multitude of both internal and external traumatic injuries including later confirmed spinal injuries and they survived for several hours until we arrived and were able to reach them, evacuate them and transport them to a hospital.

Hope that helps.

If you like reading and want to know more about spinal injuries read here about the NEXUS study: http://www.sehsc.org/news/cspine.htm

Here is a great video of a rescue in Canada where the patient had all the MOI, signs and symptoms of a spinal injury (later confirmed by X-Ray) but the conditions and terrain simply didn't allow for immobilization to a board and the patient still had a positive outcome (and it's just a cool video): [ame="http://www.youtube.com/watch?v=I7_4n_4Qhu4"]http://www.youtube.com/watch?v=I7_4n_4Qhu4[/ame]

On the nose Sir


IF you are trained i would recommend a SKED litter that is hoistable over a Stokes. this gives you more options when it come to technical rescue. rolled up its abou the size of large 3 day pack.

 

[Jeff91]

I don't think you have carried a stokes litter vary far in uneven terrain.

You'd be surprised how far you can carry a stokes and in some pretty nasty terrain. It's all a matter of having the people and the technique. It's not fun but it can be done.

Backboards in the backcountry can be pretty tricky. I'd say that it's not really worth it in a lot of situations. The first thing is, if you're not trained in using them then don't. Next you have to have all the other bits and pieces that accompany the board. And if you're trying to move someone, and the terrain is going to be iffy it would be better to have them in a stokes or a SKED even if they are on a board.

The biggest issue like others have said is time. If you're way the hell out in the way out, the patient is likely to be spending a good amount of time on that board. This isn't really ideal for the patient, it plain sucks being on a board strapped down for a length of time. Life is going to be pretty uncomfortable for a patient on a board especially if it's a long transport off road, a major concern would be nausea. Best to get the patient safe, do no further harm and get them out in via the most rapid option possible, hopefully Air.

I realize that many like to plan for as many "what ifs" as posable, myself included, and that this could include the possibility of not being able to get EMS to extract the patient from the backcountry and being forced to transport them yourself. I'd say this is where planing comes in to play; understand where you're going, what resources you have and what resources the potential rescuers have. If you honestly feel that you may be on your own for patient evac, plan for it. Get the training, the proper tools and understand the consequences.

 

[Arclight]

I saw someone who had taken an old stokes basket, added some attachment tabs, had it power coated and then made it his roof rack. Kinda cool...


Arclight

i had a good design and sketched out in my head.
it involved taking out my passenger seat and using one of these as a bed. i have a thick sleeping back so i can basically sleep on concrete lol.

but i could sleep in security and if the need arrised i would have a backboard.

but i threw away the paper at school on accident.

 

[762X39]

Carrying a "backboard" is not so important and long term immobilization on a hard surface can have unintended consequences as mentioned above.
Im not going to get detailed here, but i think the important thing is to be educated enough to recognize when someone in an event has been exposed to and possibly has experienced cervical/spinal trauma.
Now, if your in the middle of nowhere and no-one is going to help you and your hurt friend- are you going to sit on your *** and let them die cuz you are worried abount moving them? You going to stand them up and do jumping jacks down the trail to the highway when they were unconscious a few minutes ago after a cartwheel rollover in their jeep? What if you are now exposed to environment such as wind, snow, heat? You staying there till someone helps you out of your situation?
No. Your going to take care of yourself and safely get your buddies to where they need to be. Call a heli? Great, what if its snowing. blowing, and night? Wait for SAR? Got a full day.
Learning to recognize real injury by training- CPR, 1st aid, EMT (this should be mandatory in high school), Woofer, Medic, etc..., then take the precautions needed for the circumstance.
You could very easily fashion a makeshift board out of anything- roofrack, shovels tied together, dare i say a snowboard or skiis, maxtrax, rolled in a mattress/sleep pads. Perfect, ideal, no. But could save lives. Pad it heavily and roll towels to wrap their head tightly, duck tape or tiedowns to hold them to it securely but dont cut off circulation. One could even securely pack someone into the backseat of another rig in a fashion that would provide a ton of immobilization to the spine, pelvis, chest, etc...
Most trauma care is common sense and protection from further injury.

The idea here is that if you are forced into a position to take care of yourself or others, you must rely on your abilities to think outside the box. that is what being self-sufficient is all about. You cannot prepare for all events, but must be able to overcome the obstacles in front of you.
Train to help people not harm them. Learn to assess and then treat basic injury, recognize serious life-threatening injury. Even if you dont have the skills or tools to treat. Its up to you if you think this person is too seriously injured to move them with the means you have avail., or if its too serious of a situation you are in to stay and wait for help.

Opinions only here

This reminds me of some of the "what if's" that were brought up while I was was on course for my first responder, wfa and other training. I stood up a few times to comment that sometimes, the only reasonable option is not heroic (but doomed to failure) measures but a bit of kindness and hand holding while waiting for that chopper (that is grounded due to weather). It is important to do the best you can but really, there will be times that yes, "the professionals" won't be able to get to you and despite what you think you can accomplish, the outcome will be unhappy. Remember to prepare for this scenario as well...