Removing a patient from the spine board: is the lift and slide safer than the log roll?

ABSTRACT

BACKGROUND: After spine board immobilization of the trauma victim and transport to the hospital, the patient is removed from the spine board as soon as practical. Current Advanced Trauma Life Support's recommendations are to log roll the patient 90 degrees, remove the spine board, inspect and palpate the back, and then log roll back to supine position. There are several publications showing unacceptable motion in an unstable spine when log rolling. METHODS: Cervical spine motion was evaluated during spine board removal. A C5 to C6 instability was surgically created in cadavers. A three-dimensional electromagnetic tracking system was used to assess motion between C5 and C6. The log roll was compared with a lift-and-slide technique. Throughout the log roll procedure, manual inline cervical stabilization was provided by a trained individual in a series of trials. In other trials, the lift-and-slide technique was used. In the final stage, the amount of motion generated was assessed when the spine board removal techniques were completed by experienced and novice persons in maintaining inline stabilization of the head and neck. RESULTS: Motion between C5 and C6 was reduced during the lift-and-slide technique in five of six parameters. The reduction was statistically significant in four parameters. When performing the log roll, motion was not reduced with increased head holder experience. CONCLUSIONS: Spine boards can be removed using a lift-and-slide maneuver with less motion and potentially less risk to the patient's long-term neurologic function than expected using the log roll.