Question: Although not employed by a service under the SWORBHP, I have been closely following this site and your LINKS newsletter. Thank you for both of these invaluable resources. After reading the most recent question regarding spinal immobilization, I had to share a resource with you that can located here https://m.youtube.com/watch?v=eM4hxuooNN0. This is a lecture by Dr. Ryan Jacobson, a former paramedic who is now medical director of Johnson County EMS in Kansas and Assistant Professor of Emergency Medicine at University of Missouri-Kansas City School of Medicine. If you have already seen it, you are familiar with its informative value. If not, I'm confident that you will find it of value. This link is unplublished and cannot be found via YouTube search.
Something that I have been wondering after viewing the lecture and statistical evidence is as follows. Hypothetically, if the current practice of securing patients to backboards increases morbidity and mortality (particularly penetrating trauma) and that there is greater spinal movement than if secured directly to the stretcher, and that no negative effects have been observed by not securing to a backboard, is it reasonable to consider foregoing the backboard as care superior to the minimum requirement as written in the BLS? Similarly to a "letter of the law" vs. "spirit of the law" question. LBBs have been contraindicated for transport in Queensland, Australia for the past five years among numerous other jurisdictions. I've inquired with my employer but was given the old "We have standards" response.
Thank you for your time and consideration on this topic. I look forward to your reply.
Thanks for your excellent question. A similar question was initially answered on this site in Feb 2015.
You have summarized very well the current debate with the use of the long backboard when transporting trauma patients in the pre-hospital environment.
You are absolutely correct that there is a paucity of high quality data indicating that long backboards prevent secondary spinal cord injury or are effective in achieving rigid spinal immobilization.
Further, there is evidence that the use of long backboards is not a benign therapy: skin breakdown, patient agitation, and respiratory compromise are among but a few of the adverse events that are associated with this equipment.
We are very much aware of the movement away from the routine use of the long backboard across EMS agencies internationally as well as the various position statements from organizations.
The SWORBHP Medical Council supports the National Association of EMS Physicians Position Statement with regards to the use of the long backboard. A link to this can be found here:
At this time in Ontario however, paramedics are required to follow the Basic Life Support Patient Care Standards (BLS-PCS) with regards to spinal immobilization. In section III, page 35 this document states that when spinal cord injury is obvious, suspect or cannot be ruled out, paramedics are required to immobilize the cervical spine with a rigid collar and further immobilize the thoraco-lumbar spine, pelvis and legs using a long backboard.
As a reminder, spinal immobilization is not a controlled medical act requiring delegation. Therefore, the use of the long backboard as well as the other standards listed within the BLS-PCS are not under the direct oversight of the OBHG MAC. Rather, the BLS-PCS are the responsibility of the Ontario Association of Paramedic Chiefs (OAPC) as well as the MOHLTC. The OBHG MAC is however involved in an advisory capacity.
That being said, SWORBHP has been involved in paramedic research for the C-spine rule "The Out of Hospital Validation of the Canadian C-spine Rule by Paramedics" and writing letters advocating for implementation and local implementation trials of this same effort.
Also, the SWORBHP has been hard at work promoting early removal of patients from the back board and developing processes in our local emergency departments. As with many similar patient care initiatives, we work to foster and champion improvements to patient care as much as we can within our authority and mandate.
As of today, the entire BLS-PCS is under review with a new version anticipated to be released by the MOHLTC within this calendar year. This work has been underway for over 3 years. To answer your specific question, the SWORBHP Medical Council as well as the OBHG MAC endorses the incorporation of the NAEMSP Position Statement into the BLS-PCS so that paramedics in Ontario can follow best practice recommendations with regards to the use of the long backboard.
Thanks again for your question and for your insights to the changing practice of trauma patient care.