2. © 2003, Tahoe Backcountry Ski Patrol. This OECTools.org document may be freely used, modified or copied for any non-profit purpose as long as this copyright notice is maintained. Not reviewed by NSP. User has responsibility for determining fitness for use. Backboard Preparation or, How to sip from a fire hose Sean Brennan & Doug Coatney

3. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Objectives: Good Spinal Exam Manual Stabilization Cervical Collar Knots

4. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Spinal Exam Work from the head down If you find pain (or deformity) confirm by going the other way Often you can scoop out snow to get to the spine Spine accessible during rolling process

5. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Manual Stabilization Married to the head -CPI If head not aligned, align one axis at a time A transfer requires 3 people. Don’t if you can avoid it Knee stabilization during Survey Semi-conscious patients can be combative

6. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Cervical Collar: Requires a second person (or more) Remove (cut away!) neck covering Size collar based on number of fingers between jaw angle and trapezius Adjustables better than 4 separate sizes

7. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Knots Most of the time, seatbelt or fastex buckles are installed on the backboard Occasionally one or more is missing, and you need to use a cravat instead. A pair of half-hitches Knots must hold a lot of weight Immobilize bone

8. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Components O2 Blanket roll & Tape C-Collar skills Axial drag alignment Backboard rolling Padding for knees Securing feet

9. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. 3 rd responder applies C-collar, supports midsectionAfter C-collar applied 3 rd responder, moves to midsection4 th responder handles backboard, clears C-spine on rollOnce O2 is in place, 2 nd moves to support shoulders/chestOnce straps secure, 4 th responder to torso to tape head with 2 nd responderStraps are applied to chest/waist, lower extremityHead is taped with two bands forming an X on the forehead (courtesy fold optional) Load & Go!Hands & feet are tied together with cravats & tank secured to patientPatient is rolled onto backboard on Lead’s callAfter roll, 3 rd responder moves to feet to clear straps1 st responder is Lead, immobilizes C-spine, married to head!2 nd responder brings O2, monitors Airway & Vitals (“Roll to” side!) Zone Movement Backboard Spine Check C-Collar Midsection Lead C-Spine 02/Airway Vitals

10. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Zone Notes C-Collar Midsection O2/Airway Vitals Lead C-Spine Backboard Spine Check Stay in your zone – know what is required in your zone. O2 always goes on the side you’ll be rolling toward. (Preference is patient’s left side) Imagine yourself in 3’ of soft snow – it’s not possible for you to trudge around the backboard from one side to the other running “errands”. Think ahead – what’s next? You should always be busy! Take vitals to establish trends every 5 minutes! Write them down on the patient on 2” tape! Be cognitive of patient injuries when reaching over patient. Go slow to go fast – Teamwork!

11. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Review: Perform a careful spinal exam Manually stabilize the patient’s head Once help arrives, apply cervical collar Know your Knots

12. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Schedule 8:00-8:15 Demonstration 8:15-9:15 Step through of issues/gotcha’s 9:15-12:30Building blocks 12:30-1:15Working Lunch 1:15- 4:15Leadership Drills 4:15-4:45Review/Wrap-up 4:45-5:00Cleanup! C-Collar Midsection Lead C-Spine Backboard Spine Check O2/Airway Vitals

13. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Effective rolling techniques –Do NOT raise arms or position legs in order to aid in rolling patients suspected of C-Spine injuries. –Position one person on torso, one on hip/femur. –Interlock hands for roll operation. –Grab bones not skin or clothes (shoulder blade, hip, femur) –Do not roll over injuries. –Minimize rolling – don’t do 2 rolls when you can do 1! –Proper lifting techniques – use your legs, not your back! –Lead/Head person always calls movement operations! Exercises 1)Start with prone patient, roll patient to their side and back down. 2)Start with supine patient, roll patient to side and then into prone position. C-Collar Midsection O2/Airway Vitals

14. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks C-Spine immobilization –Thumbs always point to nose of individual –Get comfortable, you’re going to be here awhile –Stabilize legs for surveys Exercises 1)Start with prone patient, roll patient to their side and back down. 2)Start with supine patient, roll patient to side and then into prone position. Lead C-Spine

15. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Alignment requires stabilization of hips/torso –Supine -> Aligned & Supine -> Aligned on Side -> On Backboard –On side -> Aligned on Side -> On Backboard –Prone -> Aligned on Side -> On Backboard –Movement in one plane at a time. Exercises 1)Start with unaligned supine patient, align and roll onto backboard. 2)Start with unaligned patient on side, align and roll down to backboard. 3)Start with unaligned prone patient, align them, roll on their side and then down to the backboard. C-Collar Midsection O2/Airway Vitals Lead C-Spine Backboard Spine Check

16. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Axial Dragging –Minimize movements by properly placing backboard to start. –Sometimes re-alignment is unavoidable due to extrication needs or due to sideways placement on backboard. –Move patient 6” at a time as co-ordinated by the Lead holding C- Spine in axial manner only – no sideways motion! –Grab on to skeletal structural bones, not skin. –Beware of boots hanging off the board when dragging upward.. Exercises 1)Practice forward and backward axial dragging 6” at a time on the board the goal is to align with strap placement on the backboard and proper head placement. C-Collar Midsection Lead C-Spine Backboard Spine Check O2/Airway Vitals

17. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Backboard Handling –Secure backboard from sliding downhill. –Position board as close to end position as possible to minimize axial dragging. –Put backboard at a slight angle to secure it under patient. –Have rolling individuals “transition hands” from top to bottom to help roll patient. –Gentle continuous motion lowering patient. Standing Backboard –C-collar placed on individual followed by C-Spine immobilization. –3 people required 2 to lower, one for C-Spine immobilization. –Pause at 45 degree angle to reposition C-spine immobilization. –Continuous slow decline bending with the knees to the floor. Exercises 1)Practice rolling onto backboard 2)Practice standing backboard with “good/bad” sized individuals holding C-Spine from the back and from the front. (one handed) C-Collar Midsection Lead C-Spine Backboard Spine Check

18. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Strap Management –Chest straps first. –Co-ordinate both straps at the same time. –Feed strap through buckle to tighten it, don’t pull from the end. –Waist belt next followed by femur and shin belts. –Apply padding beneath knees to avoid knee hyper extension. –Do not place straps directly over the knee. –Tie unconscious patient’s hands together w/cravat. –Tie feet together w/cravat. Exercises 1)Start with patient on backboard practice strapping in place. 2)Start with patient on backboard, practice strapping in place, but waist belt is defective. Must use cravats. C-Collar Midsection O2/Airway Vitals Backboard Spine Check

19. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks C-Collar application –C-Collar should be applied as quickly as possible, with minimum movement of patient before being place don backboard. –Sometimes this is not practical. C-Collar will be applied AFTER straps are secured when application is delayed. –Fold back velcro and use one hand to “thread” C-collar under the neck and pull through on the other side. Exercises 1)Practice applying C-Collar on supine individual. 2)Practice applying C-Collar on prone individual. 3)Practice applying C-Collar on strapped in backboard patient. C-Collar Midsection Lead C-Spine

20. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Pelvic Girdle –Used when on steep terrain where patient’s weight might cause slippage on the backboard. –Used when waist belt cannot be used due to injury. Exercises 1)Apply a pelvic girdle to a patient lying on the backboard. C-Collar Midsection Backboard Spine Check

21. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Head Roll Application –Elevate the strapped in, C-spine pre-cautioned backboard patient by lifting from the shoulder holds on the backboard with your back straight. –Backboard can either be placed on a pack, or on the knees of the person supplying C-Spine immobilization. –Create head roll by folding blanket into thirds and rolling in from the ends. –See-Saw the blanket underneath the C-Spine patient’s head. –Transition C-spine immobilization from side of head to blanket rolls. –Must use explicit terms “I have the head” when handing off the head. –Start duct tape on the corner of the board – tape must stick to itself. Perform two wraps across the forehead. Tape must be secure on blanket rolls. C- spine immobilization person must move hands out of way yet still stabilize head.Tape end must stick to itself. Exercises 1)Practice lifting backboard onto pack as well as knees with C-Spine precautions. 2)Practice inserting head roll under head with C-Spine immobilization. 3)Practice taping head in place with C-Spine immobilization. O2/Airway Vitals Lead C-Spine Backboard Spine Check

22. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Final Checks –As instructed by the lead, one individual re-checks all straps. –O2 is secured to the patients lower extremity. –Patient is loaded into the sled head (up/down) based on severity/priority of injuries. Exercises 1)Practice performing final strap check. 2)Practice securing O2 tank to patient. O2/Airway Vitals Lead C-Spine Backboard Spine Check C-Collar Midsection

23. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Putting it all together –Once more from the beginning with “feeling!”… O2/Airway Vitals Lead C-Spine Backboard Spine Check C-Collar Midsection

24. © 2003 Tahoe Back Country Ski Patrol. Not reviewed by NSP. User has responsibility for determining fitness for use. Building blocks Extrication Thoughts –Movements in one plane at a time. –Think ahead – an individual can be axially dragged onto a backboard without the need to be rolled onto it. –Avoid unnecessary rolls for alignment. It’s much better to do 1 or 2 rolls instead of 3 or 4. –Never roll over an injury. Try to avoid rolling people over their face, but that’s acceptable if there is no alternative. Exercises 1)Practice axial dragging of individual onto board. 2)Practice extracting patient from obstacle like trees or walls. O2/Airway Vitals Lead C-Spine Backboard Spine Check C-Collar Midsection