Evolution of the spineboard
How innovations in technology have shaped an essential EMS tool
Being something of an EMS dinosaur myself, I've watched the backboard evolve. For the first two thousand years of human history, backboards evolved very little. Early man used slabs of wood with straps of sinew and leather to secure the injured victim. By 1979 we advanced to slabs of wood with straps of nylon webbing. These boards were often constructed of inexpensive plywood, hastily finished and poorly sealed. They wore badly and because they were porous, also absorbed fluids. But there were notable exceptions of high quality wooden backboards.
The Parr Backboard was finely finished Baltic Birch, with many layers of sealant over a baby-smooth sanding job. It had reinforcing runners and many handholds and strap-pin locations available, and was largely a custom-made product. The Henley Board from Maryland is a regional favorite in the Mid-Atlantic, sporting a still innovative and durable head immobilizer mechanism. The company will even re-finish the board and with regular maintenance the thing can last for years.
With HIV came increased sensitivity to infection control issues. Plastic backboards quickly became the favorite backboard material. The first synthetic backboard I remember using was the Ferno folding aluminum backboard. It was all we could really carry in the Cadillac ambulances, and they worked great.
Interestingly, Ferno is one source for backboards of almost every generation. Being a leader in patient handling for so long means they have models of every type and style, all in one catalog.
The earliest plastic boards were two-piece plastic and some were one-piece acrylic with runners. Some used ABS plastic, which proved somewhat brittle when cold. Another early version was solid plastic with aluminum runners. It was awful heavy but built like a tank. But the breakthrough technology for plastic spine boards came with rotational molding.
These two-part boards initially used high-density polyethylene plastic shells, filled with polyurethane foam. This two-part structure delivered a lightweight board that was strong and could really take the abuse of EMS duty. Another version of two-part composite uses rigid fiberglass rods inside a hollow plastic board. You can get them in any color of the rainbow with graphics and almost any kind of custom artwork. They are reasonably priced and economical. But they flex more than other current types. That doesn't mean they are not an excellent alternative for MCI caches, where convenience and cost may outweigh load capacity. That brings me to share something about load or performance ratings.
The published numbers on spine boards are largely useless to the consumer. There is no standard methodology for load testing. One manufacture may suspend his board under the end handgrips, another from underneath the runners. One may put the whole load in the middle of the board when they test, another spread it evenly over the test board. So worry more about how much the boards flex with your heaviest guy on it when lifted it's off the ground. The statistics just don't mean much.
Then along came the first three-part composite boards. They employed an innovative and still favored method of construction. They use rotationally molded hollow polyethylene plastic filled with polyurethane foam reinforced with pultruded plastic or carbon plastic rods. These rods help make the structure much stronger but over time the hard rods inside the foam would displace the foam and the boards could become more flexible.
The latest evolution is placing the rods inside molded plastic channels directly, so the rods make contact with plastic itself and then the board is foamed. This creates a solid contact of rod to plastic, for a firm bonding and improved wear. This unique method is employed by a handful of the finest boards on the market.
Another favorite design feature is contoured boards. Instead of being flat, the surface is concave, providing improved lateral stability and comfort. You can get most with pins for speed clip straps. Some come with their own proven backboard strap systems. Most offer the ability to secure Pediatric patients by having vertical slots down the center to run the straps.
Some good examples are the latest models from Rapid Deployment Products and Emergency Products + Research and the elegant Laerdal BaXstrap. The BaXstrap™ is an engineering marvel, with rounded grips and graceful fluid lines. But there are many other great products out there some with unique features.
The TomCat ICID Backboard from R&B Fabrications, Inc. is a plastic backboard with a built-in head immobilizer. The CID is also plastic, easily clean and replaced. But another solution is the plastic scoop stretcher. The new Hartwell Combicarrier II is a durable, functional and versatile piece of patient handling equipment. It combines the features of an aluminum scoop stretcher and plastic spine board in one very innovative product.
As one who has taken a long trip on a backboard, these things are miserably uncomfortable. I've seen a few good attempts to produce padded backboards and more recently, special gel pads for backboards. But in other areas the solution to the comfort problems with spine boards is the vacuum mattress.
The modern vacuum mattress is the preferred method of long spine immobilization in many European countries. The rigid board is reserved for rapid extrications alone, and used far less for daily patient handling. With a vacuum mattress you actually mold the splint to the voids and form of the patient. Then you removed the air, vacuum packing the reinforcing Styrofoam beads inside. The result is a rigid litter molded to the very shape of the patient.
We have seen more evolution in long spine immobilization during the last twenty years than in the preceding two thousand. Today we have a wide range of options, some offering real enhancements to patient care. Understanding how backboards are constructed should help better inform your selection of this piece of essential EMS equipment.
- Patient Handling