© 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.

© 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

© 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


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


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


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


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


Components

• O2

• Blanket roll & Tape

• C-Collar skills

• Axial drag alignment

• Backboard rolling

• Padding for knees

• Securing feet


3rd responder applies C-collar, supports midsectionAfter C-collar applied 3rd responder, moves to midsection4th responder handles backboard, clears C-spine on rollOnce O2 is in place, 2nd moves to support shoulders/chest Once straps secure, 4th responder to torso to tape head with 2nd 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, 3rd responder moves to feet to clear straps1st responder is Lead, immobilizes C-spine, married to head!2nd responder brings O2, monitors Airway & Vitals (“Roll to” side!)

Zone MovementBackboardSpine Check

C-CollarMidsection

LeadC-Spine

02/AirwayVitals


Zone Notes C-CollarMidsection

O2/AirwayVitals

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!


Review:

• Perform a careful spinal exam

• Manually stabilize the patient’s head

• Once help arrives, apply cervical collar

• Know your Knots


Schedule

• 8:00-8:15 Demonstration• 8:15-9:15 Step through of issues/gotcha’s• 9:15-12:30 Building blocks• 12:30-1:15 Working Lunch• 1:15- 4:15 Leadership Drills• 4:15-4:45 Review/Wrap-up• 4:45-5:00 Cleanup!

C-CollarMidsection

Lead C-Spine


O2/AirwayVitals


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!

Exercises1) 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-CollarMidsection

O2/AirwayVitals


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


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-CollarMidsection

O2/AirwayVitals

Lead C-Spine



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-CollarMidsection

Lead C-Spine


O2/AirwayVitals


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. Exercises1) Practice rolling onto backboard2) Practice standing backboard with “good/bad” sized individuals holding C-Spine from the

back and from the front. (one handed)

C-CollarMidsection

Lead C-Spine



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.

Exercises1) 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-CollarMidsection

O2/AirwayVitals



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.

Exercises1) 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-CollarMidsection

Lead C-Spine


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-CollarMidsection



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.

Exercises1) 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/AirwayVitals

Lead C-Spine



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/AirwayVitals

Lead C-Spine


C-CollarMidsection


Building blocks• Putting it all together

– Once more from the beginning with “feeling!”…

O2/AirwayVitals

Lead C-Spine


C-CollarMidsection


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.

Exercises1) Practice axial dragging of individual onto board.2) Practice extracting patient from obstacle like trees or walls.

O2/AirwayVitals

Lead C-Spine


C-CollarMidsection

© 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.

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