Vacuum Spine Board Paper

The follower is a research paper/letter I recently wrote regarding the use of vacuum spine boards. We have been using them at my agency for a few years, and we occasionally get them back from the ED with apparent malicious damage to them. Many ED staffers have voiced a dislike for the devices, and I think there just needs to be a little more education as to why rigid spine boards are going the way of stacked shocks, leeches, and bloodletting. Some of the formatting was lost here from copying and pasting. Feel free to email me with any questions you may have; I'll also respond to any questions in the comments section.


Use of Vacuum Spine Boards for Prehospital Spinal Immobilization
Jake Schulke, MICP

Vacuum spine boards (VSBs) were invented in France in the 1960s, and have been utilized for prehospital spinal immobilization throughout Europe and elsewhere since at least the early 1990s. However, VSBs have only gained popularity in the US over the past ten years or so. At (agency) we have been using them since 2007, primarily because they are better for the patient. Extensive research has proven that rigid spine boards, though a useful tool for extrication, cause several complications when used for spinal immobilization and are greatly inferior in their quality of immobilization. The VSB is proven to decrease complications associated with rigid boards, greatly improve the quality of immobilization, and thusly increase the quality of care.

Common relevant complications associated with spinal immobilization are:
• skin breakdown
• inadequate spinal immobilization and support
• pain and discomfort
• ventilatory compromise
• quality of radiological imaging
(Kwan & Bunn, 2005)

Research has shown that due to such complications, rigid boards placed in the prehospital environment should be removed in the ED immediately after the primary assessment and resuscitation phases (Vickery, 2001). The VSB negates this need by alleviating the complications associated with rigid boards and so allows patients to be left on the VSB much longer than on a rigid surface.

Skin complications
The human spine has natural curvature, and placing a human being on a rigid surface creates three main pressure areas: the occiput of the head, the scapular region of the thorax, and the sacral region. These areas are all associated with pressure sores, and studies show that prolonged time spent immobile on a rigid surface exacerbates longer-term skin breakdown (Mawson, Biundo, Neville, Linares, & Lopez, 1988). This is because the interface pressures created by the rigid surface impede circulation to the tissue area, and result in local hypoxia and necrosis. Other factors related to illness, trauma, and hospitalization do further complicate skin breakdown, but it is clear that time spent on a rigid board plays an integral role in the development of pressure ulcers. The VSB however conforms to the patient’s entire posterior surface area, eliminating these extreme pressure areas and decreasing the interface pressures on the skin which cause pressure sores (Main & Lovell, 1996; Sheerin & Frein, 1997).

Quality of immobilization
An experimental study proved that VSBs provide better immobilization than a rigid board and straps universally in all planes of motion, and showed a reduction of motion by about 75% on average (Luscombe & Williams, 2003). The VSB conforms to a patient’s unique anatomy and spinal curvature, reducing motion and allowing effective immobilization of patients with kyphosis and other spinal irregularities which cannot be effectively immobilized on a rigid board.

Pain
Luscombe and Williams (2003) demonstrated a 64% average reduction in pain while immobilized with a VSB versus a rigid board using a standard 0-10 numerical rating scale. Kwan and Bunn (2005) also indicated that the increased pain associated with spinal immobilization results in “multiple radiographs and unnecessary radiation exposure, longer hospital stays, and increased costs.” Further studies have concurrently supported the increased comfort of the VSB over the rigid board and the subsequent improvement in overall care (Johnson, Hauswald, & Stockhoff, 1996).

Ventilatory restriction
The VSB conforms laterally to the individual shape of a patient’s body from head to toe and restricts lateral motion as a solid unit. Equal motion restriction cannot be achieved with a rigid board and straps, and attempting such restriction requires uncomfortable tension on the straps and is proven to cause ventilatory restriction (Bauer & Kowalski,1988 ). This restriction is associated with impaired ventilation, significantly reducing forced vital capacity (FVC) and forced expiratory volume (FEV). Loosening straps to facilitate improved ventilation renders the already inferior rigid board system even less effective in immobilizing the spine than the VSB.

Radiography
The VSB contains no metal, and according to Med Tech Sweden, the manufacturer of the VSB, it is “both MRI compatible and X-Ray translucent”. There should hence be no need to remove the patient from the device during the initial assessment and resuscitation. The patient can be left on the VSB for initial radiographs taken as part of a trauma assessment and resuscitation. As aforementioned, VSBs eliminate the complications that warrant early removal from a rigid board, thus the patient can be left on the VSB much longer than on a rigid board.
When using the VSB the patient can still be log rolled with manual spinal immobilization to assess the back when necessary, just as one would with a rigid board. The VSB can be inflated (loosened) and released for the log roll, and then can be replaced and deflated (made rigid) to reinstate immobilization using standard wall suction.

Though rigid boards are useful for certain circumstances and applications, the overall conclusion, supported by medical research and field use, is that the VSB is a far superior device. It decreases complications, improves immobilization, offers unique splinting and extrication opportunities in the field, and so overall is an excellent treatment tool. Promoting its use is a benefit to quality of patient care, and so it is our hope that it will be embraced by our local emergency medicine community.

It has come to our attention that many hospital personnel have an aversion to VSBs and are perhaps uncomfortable with use of the devices. We feel that this is a result of a deficit of education and training with the devices, and we are enthusiastic to do all we can to help facilitate an understanding and appreciation of the benefits and use of VSBs. Please feel free to contact us to arrange training for your staff.

(signed)


References:
Kwan, I., & Bunn, F. (2005). Effects of prehospital spinal immobilization: A systematic review of randomized trials on healthy subjects. Prehospital and Disaster Medicine, 20(1), 47-53.

Vickery, D. (2001). The use of the spinal board after the pre-hospital phase of trauma management. Emergency Medicine, 18(1), 51-54.

Mawson, A., Biundo, J., Neville, P., Linares, , Wichester, Y., & Lopez, A. (1988). Risk factors for early occurring pressure ulcers following spinal cord injury. American Journal of Physical Medicine and Rehabilitation, 67(3), 123-127.

Main, P., & Lovell, M. (1996). A review of seven support surfaces with emphasis on their protection of the spinally injured. Journey of Accident and Emergency Medicine, 13(1), 34-37.

Sheerin, F., & Frein, R. (2007). The occipital and sacral pressures experienced by healthy volunteers under spinal immobilization: A trial of three surfaces. Journal of Emergency Nursing, 33(5), 447-450.

Luscombe, M., & Williams, J. (2003). Comparison of a long spinal board and vacuum mattress for spinal immobilization. Emergency Medicine, 20(1), 476-478.

Johnson, D., Hauswald, M., & Stockhoff, C. (1996). Comparison of a vacuum splint device to a rigid backboard for spinal immobilization. American Journal of Emergency Medicine, 14(4), 369-372.

Bauer, D., & Kowalski, R. (1988). Effects of spinal immobilization devices on pulmonary function in the healthy, non-smoking man. Annals of Emergency Medicine, 17(9), 915-918.