Factors Associated with Appropriate Spinal Immobilization and Long Backboard Use

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

Background
The 2013 NAEMSP/ACS Committee on Trauma joint position statement on long backboard and cspine immobilization included criteria defining appropriate use of these treatments. This study sought to identify factors associated with the appropriate use of long backboard immobilization following release of these guidelines.

Methods
This was a retrospective review of collected data from Fisdap, a database of prospectively reported clinical field experiences for paramedic, AEMT, and EMT students. Inclusion criteria included student consent to research, data validated by preceptor as good data, and patient encounter date of 2013 and 2014. The association of US geographic region where the encounter ocurred (West, North, South, East), student training level (EMT/AMET vs. paramedic), patient race/ethnicity (African American, Caucasian, Other, Hispanic), patient gender (male vs. female), and patient age (≤ 18; 1964; ≥65) with appropriate backboard use was evaluated using logistic regression. Appropriate use was defined according to the 2013 position statement criteria and derived from data elements from Fisdap.

Results
A total of 24,020 runs (2013 = 15,417; 2014 = 8,603) met inclusion criteria and were analyzed (Table 1). Overall, 82.4% of patients were appropriately long backboarded, 13.9% had inappropriate placement, and appropriateness could not be determined in 3.7% of patients (Table 2).

Encounter year (2013 = 77.9%; 2014 = 90.3%), geographic location [Midwest (OR = 1.54; 95% CI 1.31.8); South (OR = 1.24; 95% CI 1.101.40); reference = West], and race (African American; OR = 1.22; 95% CI = 1.101.36; reference = Caucasian) were all significant factors associated with higher levels of appropriate placement. Encounters with an AEMT student (OR = 0.81; 85% CI 0.710.92) and encounters with a patient ≤ 18 (OR = 0.74; 95% CI 0.66 0.82) or ≥65 (OR = 0.75; 95% CI 0.69 0.82) were associated with a lower likelihood of appropriate placement.
 
Conclusion
Factors associated with higher likelihood of appropriate long backboard use include patient encounter in 2014, encounters in the Midwest or South, and African American patient race. Encounters with an AEMT students and encounters with patients ≤ 18 or ≥65 were associated with a lower likelihood of appropriate long backboard use.