By Jim Sideras
RN, MSN, CFO, CMO, MIFireE
Spinal immobilization is vital when treating trauma patients — including patients who have fallen. The simple and often overlooked straps that hold the patient to the backboard play an important role in spinal immobilization. With the many various straps on the market, some may not work well for your situation. With the changes that have taken place, you may want to take these tips into consideration when you are purchasing straps for your backboards.
There are two key ways to use straps to secure a patient to a backboard. In the first method, there are several single straps that secure the patient by wrapping over the patient and then securing themselves to the board. These are often similar to seatbelts and may or may not have a swivel to attach to the board. Single straps offer a great deal of versatility when accompanying various lengths and sizes of patients.
The second type is an integrated system, often called a "strap system" or a "spider strap." These have several straps sewn together and this system secures the patient to the board. Usually these incorporate several straps — shoulder, chest, hip, thigh and ankle — attached to a strap that runs the length of the patient’s body. Some of these strap systems are color-coded to facilitate use, however some do not have this feature.
2. Usage level
If your crews secure patients to backboards on a daily basis, their familiarity with style — either single or spider — will not be a major issue. However, if crews package patients less often, they may find spider-type systems more complicated when used in high-stress and low-light situations.
Most straps are constructed of nylon strapping in a variety of colors. This strapping is very durable and long lasting. One concern is how to decontaminate straps. Many companies are now offering straps that are covered with an impervious barrier so the straps can be easily cleaned. Others are made from polypropylene to allow for ease of cleaning, but are not as durable as nylon. These covered straps may be slightly more expensive, but worth the cost considering the infectious disease and cross-contamination concerns.
Most straps use a buckle to secure the straps, while others use Velcro. The cleaning and decontamination of Velcro soaked in blood can be a challenge. When looking at buckles, there are seatbelt styles and also plastic slide buckles. The seat belt style is more durable and less prone to breakage.
4. Pins or No Pins
Prior to any purchase of straps, look at the boards you are using. If they have pins, then the straps with quick release swivel clip ends will work best with your board. If your boards do not have pins, then the swivel ends will not work with your board.
For a setup fee, some manufacturers will put your organization's name on the strap. These can be very useful if your straps remain at a hospital. Straps can be accidentally taken by other organizations, especially if the straps are not marked. An inexpensive option is to mark your straps with a permanent marker. However, the do-it-yourself method does not present a professional appearance to either your patients or the hospital staff.
Cervical collars are also crucially important to immobilize the cervical — or neck — area of the spine. There are various types on the market, so here are some tips to consider when planning the purchase of collars.
There are two basic styles of collars. The first style is an individually sized collar to fit the patient. Once it is determined which size the patient should have, that particular collar is then applied. This will require a crew to have several of the various sizes to ensure each patient has a properly sized collar.
The second style is a collar that is adjustable to fit a wide range of patients. This requires the provider to manually adjust the collar to the proper fit, and also secure the collar into that position. Usually, there are regular adjustable and smaller adjustable sizes. Adjustments allow the regular size of collars to fit adults and the smaller size to fit small adults, pediatric and geriatric patients. The collars will vary in their adjustments from 4 to 16 different increments, based on the manufacturer. The adjustable collars are usually slightly more expensive.
2. Supply / storage issues
One advantage to the adjustable collars is that there is the ability to decrease the number of collars that need to be kept in the supply system. The adjustable collar ensures that there will always be a properly sized collar available. In the event of multiple patients, the adjustable fit collar will ensure there are properly sized collars to fit all patients.
Most collars will lay completely flat for storage. That is not the case will all collars —some will take up more storage area because they do not lay flat and may occupy an inch more of space. This amount of space can quickly add up when carrying several collars, especially in the tight confines of an ambulance or fire truck. Order some sample collars to test storage concerns.
One important consideration is the collar’s translucence properties. This refers to the ability to take an X-ray through the collar without obscuring the image. Many collars are X-ray translucent, and some are also compatible with MRI and CT scans. This is an important consideration since many of the patients will be wearing a collar while getting X-rays or other imaging. Not all collars are advertised as being translucent.
4. System-wide compatibility
Prior to any purchase, it is important to check with other healthcare providers who may operate in your system. It is useful to have all agencies within a system using the same collar — especially when units from differing organizations are operating together. It eliminates on-scene questions such as, "which collar is better." Compatibility allows the crews to focus on patient care.
5. Meet with your medical director
Your department needs to work closely with your medical director on purchases of medical equipment. In addition to the considerations for your cervical collar purchase, the medical director may cover additional issues like training. Finally, involving your medical director will establish an ongoing dialogue to ensure care in the best interest of the patient is always considered.
It is also very important to immobilize the head of the patient to prevent movement and potential further injury. Using some type of head immobilizer will help prevent head movement. There are various types on the market, prompting these considerations for the purchase of a head immobilizer.
There are several basic designs on the market. Some are made of foam in the shape of blocks that are placed on each side of the head. The patient's head is then secured to the board with straps or tape. Some of these blocks even attach to the board with Velcro.
Another style is constructed of plastic or cardboard and usually taped to the board. This style is then folded or manipulated into a shape that will securely hold the patient's head in place.
2. Disposable or reusable
One concern with the purchase of a head immobilizer is if the device will be thrown away after each use, or decontaminated and reused. If you plan to decontaminate your head immobilizers, you will need to determine where the process will take place — at the hospital or back at your station — and have a plan in place for how it will be done. Since some of the devices use Velcro, that can be another concern for decontamination. As a personal preference, disposable items put your staff at less risk for contamination and can decrease crew turnaround time.
Regardless of style, your agency will need to have a stockpile of head immobilizers since they may remain at the hospital with the patient for some time. Cost may be an issue since disposable is less expensive at $5 each and some of the reusable ones can be more costly at over $80 each.
3. System-wide compatibility
As with cervical collars, it is important to check with other healthcare providers who may operate in your system prior to purchasing. All agencies within a system should use the same head immobilizer — especially when units from differing organizations are operating together. This will eliminate on-scene questions like, "which is better," and how to use some of the devices. Compatibility allows the crews to focus on patient care.
4. Meet with your Medical Director
Again, working closely with your medical director on purchases of medical equipment is crucial. In addition to the considerations for your head immobilizer purchase, the medical director may bring up additional issues like training. Finally, involving your medical director will establish an ongoing dialogue to ensure care in the best interest of the patient.
- Any other suggestions? Anything we missed in the list above? Leave a comment below or e-mail firstname.lastname@example.org with your feedback.
James Sideras is a Division Chief for Sioux Falls Fire Rescue and has received both the Chief Fire Officer (CFO) and Chief Medical Officer (CMO) designations. He is a 25-year veteran of SFFR and a registered nurse with a Master of Science degree in nursing as a Clinical Nurse Specialist.
He received the Harvard University Fire Executive Fellowship, completed a Human Resources program through Cornell University, and the National Fire Academy's Executive Fire Officer program. He has spoken on various topics concerning fire and EMS at national and international conferences, including the World Conference on Disaster Management. He has written more than 20 articles on the fire service and EMS.
Jim is a member of the National Association of EMS Physicians, International Association of Fire Chiefs, the South Dakota Nurses Association, and the South Dakota EMT Association.
He can be contacted at: Sideras@post.harvard.edu