Impact of the NAEMSP Guidelines for Spinal Immobilization and Long Backboard Application on Usage Rates between 2010 and 2014

Lauren MacNeill, BA, NREMT; Tom Dobrzynski, BS, NRP; Mark Cromer, MS, MBA, NRP; Gina Riggs, MS, NRP; Mike Mayne, BA; Joshua Salzman, MA, EMT-B

Background
Previous research has demonstrated that use of the long backboard for spinal immobilization in trauma patients may cause more harm than good, prompting the release of the 2013 NAEMSP/ACS Committee on Trauma joint position statement on long backboard and cspine immobilization usage. This study evaluated whether the release of this position statement impacted the rates of long backboard and ccollar usage.

Methods
This study was a retrospective review of prospectively collected data from paramedic, AEMT, and EMT students entering data into Fisdap, a database of prospectively reported clinical field experiences. Inclusion criteria included student consent to research, data validated by preceptor as good data, and patient encounter dates between 2010 and 2014. Change in the rate of long backboard and ccollar use per year was analyzed using logistic regression.

Results

 
A total of 1,105, 818 runs (2010 = 202, 858, 2011 = 216,980, 2012 = 265,403, 2013 = 253,718, 2014 = 166,859) met inclusion criteria. Rate of long backboard use decreased from 7.90% in 2010 to 1.73% in 2014, resulting in a 30% decrease in long backboard use year over year (OR = 0.70, 95% CI = 0.690.70).
Rate of ccollar use decreased from 8.25% in 2010 to 3.95% in 2014, which was an 18% year over year decrease. When the years were grouped into pre (2010-2012) and post (2013-2014) position statement time periods, there was a much faster year over year reduction in usage rates for long backboards (OR = 0.5899; 95% CI: 0.56480.6161) and ccollar spinal immobilization (OR: 0.7871; 95% CI: 0.76350.8114) in the post position statement time period.
 
Conclusion
The rate of long backboard and ccollar spinal immobilization has been declining since 2010, which included time prior to the release of the 2013 position statement paper. Release of the position statement appears to have accelerated the decrease in rates of long backboard and ccollar immobilization compared to the preposition paper period.