EMS is very good about immobilizing the spine in trauma patients prior to transporting them to the Emergency Department. Healthcare personnel in the ED are not as good about getting people off of those rigid boards.

As always, it boils down to a risk and benefit assessment. What is the risk of keeping someone on a board, especially if they may have a spine injury? There is a well-known downside to spine immobilization: skin breakdown, which can occur in as little as 2 hours. Less appreciated is the fact that it is very uncomfortable lying on one’s back on any type of board, be it a spine board or even a simple plastic slider board.

What is the risk to the spine if it is indeed injured? In a cooperative patient, essentially zero. Think about it this way: what are spine-injured patients placed on once they are admitted to the hospital? A regular bed with a standard hospital mattress! They are kept on logroll precautions until they have an operative procedure or receive a brace.

The bottom line: All patients should be moved off the EMS spine board onto the ED cart unless they are being transferred to another hospital within an hour or less. The ED cart should have a regular mattress, but the patient must be cooperative. If they cannot or will not cooperate, and the probability of spine injury is high, they may need to be chemically restrained. A plastic slider board may be placed under the patient when they are ready to go to diagnostic studies, and should be removed immediately when they are complete. No board of any kind should ever be left under a patient for more than 2 hours.