You Make the Call – Sideways

I recently had a straight forward job that got curiouser and curiouser.

Stop me if you’ve heard this one before: Fall from standing, laceration over the brow, decent mechanism with every indication for C-spine precautions given age and circumstances.

Everything is going fine until we get ready to load and he begins to vomit.

Quick thinking prevents him choking and the board is at an angle.  As we begin to do the standard tucking of blankets beneath the side of the board he begins to vomit again.  The angle of the board is not enough given our situation and the decision is made to elevate it more.  We’re comfortable with the positioning only when the board is laying almost on it’s end.  We have the head supported in line, legs as well, but keeping the board upright on it’s side was a challenge.

Using what you have in your rig, how would you secure the board to the cot?

You make the call.

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22 thoughts on “You Make the Call – Sideways”

  1. a) extra IV tubing tied to the hooks on the ceiling of the box and tie the tubing through the side of the spineboard

    b) through the top of the squad bench (using IV tubing) (Is there enough space to thread some tubing THROUGH the area at the top of the squad bench?)

  2. I don;t really like contraptions that are tied to the actual vehicle… because eventually we have to offload the patient. I would shoot for extra head blocks, blankets, heck, even chock blocks, kits, etc. under the board, and some extra board straps to attach the “top” end of the board to the corresponding stretcher rail. Doing this will likely require you to detach one or more, or perhaps adjust a stretcher strap, so I would consider adding a new one…

  3. I’ve come across this instance on a few occasions and have found the quickest and easiest way to deal with this problem (for our particular company) is to use our old backup jump kit. It’s an older style hard case jump kit which is as high as the board is wide, so it provides maximum support. Securing it is as easy as sliding it between the board and the side rail and passing the stretcher strap through the handle. Though more difficult this method is just as effective for larger patients because if we run into a larger person we can simply lower the side rail on the side we are rolling them towards (after ensuring all straps are secured first). This was something I had to come up with quick on a call one day and have used it ever since. I find it much quicker than trying to pad with blankets and layer a bunch of stuff under the board. Obviously this won’t work for everyone if they don’t carry this particular style kit, but just another way to think “outside the box”.

  4. a) extra IV tubing tied to the hooks on the ceiling of the box and tie the tubing through the side of the spineboard

    b) through the top of the squad bench (using IV tubing) (Is there enough space to thread some tubing THROUGH the area at the top of the squad bench?)

  5. I don;t really like contraptions that are tied to the actual vehicle… because eventually we have to offload the patient. I would shoot for extra head blocks, blankets, heck, even chock blocks, kits, etc. under the board, and some extra board straps to attach the “top” end of the board to the corresponding stretcher rail. Doing this will likely require you to detach one or more, or perhaps adjust a stretcher strap, so I would consider adding a new one…

  6. I've come across this instance on a few occasions and have found the quickest and easiest way to deal with this problem (for our particular company) is to use our old backup jump kit. It's an older style hard case jump kit which is as high as the board is wide, so it provides maximum support. Securing it is as easy as sliding it between the board and the side rail and passing the stretcher strap through the handle. Though more difficult this method is just as effective for larger patients because if we run into a larger person we can simply lower the side rail on the side we are rolling them towards (after ensuring all straps are secured first). This was something I had to come up with quick on a call one day and have used it ever since. I find it much quicker than trying to pad with blankets and layer a bunch of stuff under the board. Obviously this won't work for everyone if they don't carry this particular style kit, but just another way to think “outside the box”.

  7. Ive had sucess with putting the stretcher straps through the grab handles of the backboard, then buckling as normal. Has this been tried? Has anyone ever had adverse effects from this method?

  8. I’m what some would call a “knot fairy” (I like the rescue tech stuff and I’m pretty good at it, sorry), so I would go for some long backboard straps and start with 2 half hitches on one stretcher side rail, then a half hitch with a twist, then finish it off on the other rail with a half hitch and a slip loop in case we have to change something quickly. So I agree with John and EMT Dan. Mr. Broyles had a good basic idea, but there are 2 problems: 1) the tubing stretches too much and would be very insecure, and 2) tying to the rig causes the patient to sway or swing as we move down the road. The idea was a good one, just need a little refining.
    I’m quite certain when we see CAPTAIN Justin’s piece on “What Happened” he will have a totally different and amazing solution.
    UnlimitedUnscheduledHours

    1. Easy with the Captain stuff…don’t jinx me ;P
      The straps were the easy part, keeping the board from sliding at the bottom was our trouble. Mainly this was a quick, you’re in the back, what will work” thinking scenario.

      1. Sorry HM, it slipped out. I have a Chief who introduces me as “The next Chief” all the time and it drives me nuts. I guess it slipped out.
        I’m not understanding the mechanics of the problem here, am I? Are you saying that the backboard is on it’s side, or the stretcher, essentialy putting the patient in a left lateral recumbant position? Is the backboard shifting from the back of the rig toward the front of the rig? Or is something else going on that I’m not getting?
        UU

  9. Ive had sucess with putting the stretcher straps through the grab handles of the backboard, then buckling as normal. Has this been tried? Has anyone ever had adverse effects from this method?

  10. I'm what some would call a “knot fairy” (I like the rescue tech stuff and I'm pretty good at it, sorry), so I would go for some long backboard straps and start with 2 half hitches on one stretcher side rail, then a half hitch with a twist, then finish it off on the other rail with a half hitch and a slip loop in case we have to change something quickly. So I agree with John and EMT Dan. Mr. Broyles had a good basic idea, but there are 2 problems: 1) the tubing stretches too much and would be very insecure, and 2) tying to the rig causes the patient to sway or swing as we move down the road. The idea was a good one, just need a little refining.
    I'm quite certain when we see CAPTAIN Justin's piece on “What Happened” he will have a totally different and amazing solution.
    UnlimitedUnscheduledHours

  11. Easy with the Captain stuff…don't jinx me ;P
    The straps were the easy part, keeping the board from sliding at the bottom was our trouble. Mainly this was a quick, you're in the back, what will work” thinking scenario.

  12. Did the patient continue with the nausea and if so I would start a line and give Zofran and fluid, most head injuries once they vomit will no longer be nauseated therefore it would be unnecessary to lace the patient in any other position but supine.

  13. Did the patient continue with the nausea and if so I would start a line and give Zofran and fluid, most head injuries once they vomit will no longer be nauseated therefore it would be unnecessary to lace the patient in any other position but supine.

  14. Sorry HM, it slipped out. I have a Chief who introduces me as “The next Chief” all the time and it drives me nuts. I guess it slipped out.
    I'm not understanding the mechanics of the problem here, am I? Are you saying that the backboard is on it's side, or the stretcher, essentialy putting the patient in a left lateral recumbant position? Is the backboard shifting from the back of the rig toward the front of the rig? Or is something else going on that I'm not getting?
    UU

  15. Scoop or longboard straps. Put board in position, then alternate between strapping the upper edge of the board to the left side of the stretcher and to the right of the stretcher. No straps would travel from the left side of the stretcher to the right side, although the seatbelts would do this. If you fasten the straps tightly enough, you would be pulling the top of the board in both directions, and therefore they will counter one another enough to hold the board in place. Blanket between the patient’s flank and the stretcher in order to prevent lateral displacement of the spine

  16. Scoop or longboard straps. Put board in position, then alternate between strapping the upper edge of the board to the left side of the stretcher and to the right of the stretcher. No straps would travel from the left side of the stretcher to the right side, although the seatbelts would do this. If you fasten the straps tightly enough, you would be pulling the top of the board in both directions, and therefore they will counter one another enough to hold the board in place. Blanket between the patient's flank and the stretcher in order to prevent lateral displacement of the spine

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