A couple of discussion threads on various EMS lists started me thinking about the “good old days”, which both were and were not. When I first started although we knew how to use a short spine board, long spine board, and even the never now seen narrow short board, we didn’t use them all that much. Even most patients from motor vehicle collisions didn’t get boarded. Seems strange now, but it’s true. Apparently we were doing some sort of spinal immobilization assessment, even though we didn’t call it that. I think it worked, because despite all of the horror stories, I never actually heard of anyone I knew having a patient suffer an adverse event from not being boarded.

Around about 1985 or so a nationwide panic set in amongst the EMS community. All of a sudden someone, probably a doctor or group of doctors, realized that we were putting patients at potential risk by not back boarding just about everyone who was involved in a collision, got whip lash because they heard the collision and snapped their head around to see what happened, saw the collision, or read about in the paper the next day. Whoever it was, I’d bet that when they made the decision, they KNEW that they would never have to engage in this supposedly life saving procedure. Soon in EMS systems across the fruited plain edicts were handed down and we became “people pizza” experts seemingly over night.

Back boards were called back boards because they were made of wood. Usually 3/4″ marine grade plywood, either with or without runners. Oh, the fights that would break out at EMS conferences as runner proponents and no runner advocates heatedly discussed the supposed benefits to the patients of each approach. Lives hung in the balance due to the difference in height and supposed amounts of manipulation needed to get the patient on the board. Or at least someone thought so.

For those of you who never had the “pleasure” of using a real live wooden backboard here are few fun facts. Those suckers were heavy! I never weighed one, but I’d guess that they were 10 pounds or more. They also splintered pretty quickly if you worked in a high volume system. Not that they’d be replaced right away, because they were expensive. The splinters, in addition to doing what splinters do, broke the integrity of the board and allowed yucky fluids to seep in. Lovely. This was just as we were becoming aware of HIV/AIDS, Hepatitis B and other blood borne badness. It was a constant battle to keep the stupid things serviceable.

Back then we also used sand bags, not foam or some other light weight material. Four five pound bags, two on each side of the patients head. Held in place by either tape or cravats. Not very good when we had to turn a patient on their side because they decided to yack up lunch, dinner, or whatever. We at least had real straps, pretty much the same ones we use all these years later.

So, in addition to the patient we had about 30 pounds or more of equipment on them. No wonder so many of us older seasoned veterans have bad backs.

Did I mention the soft collars we put on patients? Pretty useless, but they looked good.

As the years progressed the equipment improved. First we started using rolled up towels and sheets instead of sand bags. More from necessity than design as the Sahara would have been stripped down to bedrock if we had to buy enough sand to fill all those bags. Then someone, and I hope he got very rich, came up with the idea of using foam rubber covered with a washable cover instead of sand. Instantly our burden became lighter and I think the patients appreciated the change too.

Then one day some real genius came up with the idea of using plastic instead of wood for the backboards. The first ones weren’t very good quality and didn’t last all that long. Over time the designs improved and today you generally don’t see wood backboards outside of an EMS museum.

So now we have pretty durable and light equipment to perform our ritual torture of patients unfortunate enough to be involved in a collision or fall. There’s still not a lot of science to show that this is beneficial to the patient. Actually, what science there is shows the exact opposite. Some patients suffer serious orthopedic and soft tissue injury from being immobilized based on a questionable mechanism.

Which brings me to my point, at long last. We do a pretty fair job of performing a questionably beneficial, potentially harmful procedure on patients who probably don’t need it. Not everywhere, but I would be willing to bet that the majority of EMS systems in the country (including mine) over use back boarding because of the timidity and obstinance of system medical directors. Even some systems that have tried to modify their procedures have run into EMTs and paramedics who are too bound by the years of indoctrination reinforced with unsubstantiated horror stories.

Maybe at some point the people who set the standards and write the curricula for EMT classes will take a serious look at the whole issue of spinal immobilization and write a standard is based on medicine, not tales from the bad old days of EMS.

I’m not holding my breath though.