Original contribution
Duration of patient immobilization in the ED

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Abstract

In this article we seek to determine the duration of immobilization in patients presenting to the emergency department (ED). We conducted a 10-week prospective study of a convenience sample of patients transported to a level one trauma center immobilized with a backboard and cervical collar. Total backboard time (TBT) was measured from the time the ambulance left the scene to the time the patient was removed from the backboard, while total ED backboard time (TEDBT) was measured from the time of arrival at the ED to the time of backboard removal. There were 138 patients entered in the study. Insufficient data excluded 36 patients from further analysis. TBT was available for 92 patients and averaged 63.63 (±45.87) minutes. Dividing patients into those who were removed from the backboard prior to radiographs (n = 85), the TBT average was 53.9 minutes (±30.1), whereas the average for those who had radiographs prior to removal from the backboard (n = 7) was 181.3 minutes (±41.6). There were 102 patients for whom TEDBT was available and averaged 46.36 (±44.88) minutes. Dividing patients into those who were removed from the backboard prior to radiographs (n = 95), the TEDBT average was 37.6 minutes (±29.6), whereas the average for those who had radiographs prior to removal from the backboard (n = 7) was 165.3 minutes (±49.7). Patients are left on backboards for significant periods of time even when no radiographs are taken prior to backboard removal.

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Cited by (30)

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    These methods are considered particularly essential for unconscious trauma patients, who are unable to maintain spinal alignment by muscle tone and thus need to be protected from any subsequent spinal injury. Although there is a general consensus that the patient should be removed from the spineboard as soon as reasonably possible (American College of Surgeons Committee on Trauma, 2012; Ahn et al., 2011; Vickery, 2001), the average time they are reported to be supported on a spineboard has been estimated to be approximately one hour (Cooney et al., 2013; Lerner and Moscati, 2000; Yeung et al., 2006) but in some cases may be markedly longer (Lerner and Moscati, 2000; Schouten et al., 2012). Prolonged immobilisation on the spineboard causes significant discomfort and pain (Kwan and Bunn, 2005) and, on occasions, may cause pressure ulcers to develop adjacent to bony prominences (Schouten et al., 2012).

  • A numerical study to analyse the risk for pressure ulcer development on a spine board

    2013, Clinical Biomechanics
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    Since the spine needs to be immobilised during this period, the removal of patients from the spine board represents a low priority issue to the emergency room staff. Indeed the average time patients are reported to spend on a spine board has been estimated at 77 min (Lerner and Moscati, 2000; Sheerin and de Frein, 2007) although, in some cases it can exceed 2 h (Malik and Lovell, 2003; Yeung et al., 2006). Although stabilisation of the spine remains a critical requirement for trauma patients, it is also clear that prolonged immobilisation on the spine board causes pain and discomfort (Cordell et al., 1995; Hauswald et al., 2000; Zlupko et al., 2004) and, on occasions, may lead to the development of pressure ulcers (Baldwin and Ziegler, 1998; Cordell et al., 1995; Watts et al., 1998).

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Presented at the ACEP Research Forum, San Francisco, CA, October 18, 1997.

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