Timely and Safe Removal of Backboards in a Rural Emergency Department

This study explored the need for timely and safe removal of backboards in a rural emergency department where no guidelines or protocols were currently in place for patients being brought in on backboards. Studies indicate adverse effects on patients who are allowed to have prolonged backboard time because doing so results in these individuals experiencing unnecessary pain and ineffective immobilization, as well as unnecessary use of resources. Patients were tracked over a three month period of time in order to evaluate the amount of time they remained on backboards: from the time they came through the hospital doors until the time they were removed. Patients who were included in the data collection were any trauma patients brought in by ambulance on backboards and who were eighteen years of age or older. Patients who were excluded from this measure were those in cardiac arrest and receiving CPR, dead on arrival, or under the age of eighteen. Interviews with providers were conducted to assess pre-guideline understanding of backboard use and spinal immobilization as well as apprehensions regarding patient removal from backboards. After establishing the need for a guideline, a presentation and training for providers was given including an evidence-based guideline to reduce patients' times on backboards. After implementation, patients' backboard times were tracked and times were compared from pre and post implementation for guideline effectiveness. Pre times were approximately 72 minutes as opposed to post times which were approximately 12 minutes-with a preset goal of 20 minutes or less for backboard removal. Patients' backboard times significantly decreased following provider education on current recommendations and implementation of an evidence-based guideline.