I'd like to thank John Dente, MD, for his letter (“Keep the Backboard,” EMN 36;25; http://bit.ly/1unxFAP) about an article I wrote this past September. (“Screened & Examined: Soccer-Flopping and EMS Backboards More Alike than You Think,” EMN 2014;36[9A];http://bit.ly/1rENkPy.)
We all certainly appreciate the devastation of severe spinal cord injury and would try to spare 500 young adults that tragic outcome, but I would challenge the notion that the backboard is an effective preventive tool. I am actually unaware of any literature demonstrating that the backboard actually prevents the completion of an unstable spinal cord injury. There is far more evidence that the backboard can cause harm (e.g., odds ratio of death twice as high in victims of penetrating trauma than accrue benefit. J Trauma 2011;70:247.) There is also accumulating evidence that paramedics are able to safely follow prehospital protocols that require them to evaluate for and recognize hard neurological signs that represent an unstable spinal cord injury. (Prehos Emerg Care 2014;18:429.)
Finally, the argument that we should use backboards in 10,000 patients to (possibly) prevent the progression of one unstable spinal injury ignores the the number needed to treat (NNT) and number needed to harm (NNH) concepts and the Haddon Matrix, which would posit that pre-injury prevention is far more valuable than post-event immobilization. If the NNT is 10,000 and the NNH is clearly less than 10,000, is routine use of a backboard a worthy practice? Would we perform 10,000 cardiac catheterizations to find one occult coronary artery occlusion?
Backboards, or other devices like vacuum mattresses, may still have value in certain situations, such as extrication or for patients with clear neurologic deficits. Let's not give up their occasional use, but let's stop the absurdity of their routine use.
Dustin Ballard, MD
Corte Madera, CA