Question: There has been a great deal written lately about the use of the long spine board (LSB) and its use in prehospital care. Many jurisdictions have eliminated or curtailed the use of the LSB due to the lack of clinical evidence supporting its benefit and the growing evidence that it actually increases morbidity and mortality in many types of patients. When is MAC going to examine this issue and hopefully revise the Standards to reflect the current knowledge base?

Thanks for your excellent question.  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:

http://naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf

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.

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.

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