Applying Spinal Stabilization/Spinal Motion Restriction (SMR)
By Rick Garner CEP, Team Paramedic Arizona Coyotes and Arizona State University
Backboard vs. Scoop / Log Roll vs. Lift and Slide
It?s Game Time, you?re on the road, and you see your player take a big hit into the boards. He?s lying motionless on the ice, and players are waving you out. When you get to him, he?s awake, but a little disoriented. As you check him out, he?s complaining of some neck pain, with some numbness and tingling in his arms and hands. You decide he needs SMR and your fist goes in the air. As the home team?s medical staff comes on the ice to assist, you also see EMS coming with their gurney and equipment. When EMS gets to you, they remove their equipment from the gurney and lay a scoop stretcher next to your player. You see the scoop and think where?s the board? Because at home you practice using a board for these situations. Don?t worry, it?s going to be OK, take a deep breath, and trust the home team?s EAP to help you through this. Make this an educational session and learn from this experience.
SMR is designed to do no harm and create as little motion to the spine as possible during the removal of someone from their current position to a gurney and then to the next level of care.
The least amount of movement to the patient the better.
There?s currently no set standard of care for whether a board or scoop should be used to remove a player from the ice. The method used for SMR is usually determined by the City, State, Provence, Fire Department, Ambulance Company or a local Authority. As healthcare providers in sports we can still pre-plan for injuries and have what we need ready to treat them. We can also take advantage of some of the differences between treating patients in the field and treating our players on the ice.
Let?s take advantage of what we already know:
Our potential patients are hockey players. Our players are wearing helmets, pads, and skates, which adds to their height, size and weight, especially goalies. Know the challenges during treatment because of the hockey equipment.
You will get to see the mechanism of injury. Paramedics and EMT?s in the field usually don?t. The take-away, is we should be using a board/scoop that fits our patients instead of the standard 6-foot board first responders use in the field. The board we use should be larger, and if you are using a scoop it should have the ability to expand large enough to fit the player. Let?s make things easier.
Log Roll or Lift and Slide – Most EMS providers use a board with a log roll.This method has been used for decades because it?s versatile, convenient, and quick. It also allows for EMT?s/Paramedics to visualize the patient?s back for trauma/abnormalities prior to putting them on the board.This is why a board and log roll is the most preferred and commonly used method by first responders for stabilizing players on the ice. This does not mean a board and log roll is always the best or most effective way for SMR. It?s simply the most familiar to EMS providers.
The NATA recommends having a ?Time Out? meeting with EMS prior to the start of each event. It?s during this time that we should find out if a board or scoop is the preferred method used locally for SMR. If the local method is not your staff?s preferred method, then we should have the discussion on how this is going to work come game time. Another topic of discussion should be how SMR will be done if the player is in a prone position. Current recommendations support using a log roll with a board for this type of incident. How will we handle this if a scoop is this only option? Will a board also be available for this scenario? If the patient is supine and we?re using a board, we should also determine if we?re going to use the log roll or lift and slide method. Both methods work well, however, the lift and slide has recent data to support less movement of the spine, which is ideal. Both methods take practice as a team, with the lift and slide needing additional personnel in a more coordinated effort. At the end of the day we want to do both, the method that is best for the patient, and the one our group has the most confidence in using.
During the 2018 football season at Arizona State University,Gerry Garcia, ASU?s Head AT, scheduled our EMS ?Time Out? meetings 90 minutes prior to the start of each game. In attendance were the AT?s, physicians from both teams, the X-ray tech, spotters and interns. As the discussion went around the room, we always made a point to let the visiting staff know that we used a larger backboard. We would also ask which method they preferred to use if they have a player who needs SMR, the log roll or lift and slide? At the end of the season the response was split 50-50. Some teams even brought their own backboard and straps to be used on their player. In each meeting we let them know our EMS team would use whatever SMR method they were most comfortable with.
As the lift and slide method becomes more popular, we need to insure we have a solid commitment to regular training, using a consistent staff. The lift and slide works very well when you have enough staff who are familiar with the procedure and can perform it in a coordinated fashion.
While on the road if your staff prefers to use the lift and slide, then we should communicate that to the EMS crew prior to the event. It?s not the best timing when you?re meeting an EMS crew for the first time on the ice to inform them, we?re going to lift the patient and slide the board under them. Especially when the last patient they boarded in the field they used a log roll. The home team?s medical staff should also be informed of your preferred method because they?ll be needed to assist. If our staffs can get comfortable using both methods, we will have less surprises on the ice.
While at home if your staff prefers the lift and slidemethod, and your EMS providers use the log roll, then we need to practice the lift and slide with our EMS staff. This can be challenging if teams don?t have regular EMS providers covering the ice each game. With different personnel rotating through each night, the method they used on their last call in the field will be their go to method on the ice. So, only if your EMS staff uses the lift and slide method in the field, will it translate perfectly to the ice.
Game time EMS incidents are low frequency/high profile events. Knowing this we need to continue working with and developing our EMS team. The more consistency we have in our game time EMS staff, the more opportunities we have to establish a team-based EMS standard of care. The closer working relationship we have with our EMS team, the better the chance we have for a positive outcome. When it comes to EMS, we need to be Proactive instead of Reactive.