Patients Don’t Buy Backboards

I have a Labrador named Eddie (pictured below). He eats only Eukanuba dog food. That’s because we buy it for him. If we bought him a different brand, I’m sure he would eat that as well. He might need to get a little hungry before he agreed to the switch, but my gut tells me that he would eventually concede.

Knowing my dog, probably sooner than later.

    

I want to quote from the Eukanuba web site:

Satisfy your dog’s taste buds with the succulent flavors of beef and rice. Your dog is sure to enjoy every bite with real beef as a key ingredient.

Reading this, one thing is clear. Dogs don’t by dog food. This product was clearly not formulated for dogs and it isn’t marketed to dogs. This product is designed to make people feel good about what they’re feeding their dogs. If dog food was made for dogs it would be cat flavored or rodent flavored or bird flavored … or maybe even other dogs butt flavored. My dog doesn’t care about succulent beef and rice. He cares about feeling full. Nobody is going to convince me that rice tastes succulent to a dog.

So what about backboards? Patients don’t buy the backboards they ride to the hospital on do they? Patients are the end users of the product, but EMS organizations make the decision which backboards to buy. It stands to reason that the backboards are probably designed more for the people who buy them than the people who use them.

You see where I’m going with this right?

If patients bougt their own backboards I suspect the design priorities would be different. I imagine the specifications might look something like this. #1) Make it comfortable to lie on for three hours. #2) Shape it like my spine. #3) Make it effective and safe. That would probably be about all.

Take a glance at your backboard and you’ll likely see a different animal (especially if you practice in the USA.) The specs for your backboard looked something like this. #1) Make it inexpensive. #2) Make it easy to clean off blood. #3) Make it light. #4) Make it easy to carry. #5) Make it in colors that are different than the other local EMS agencies.

I got to thinking about Eddie and his dog food and my patients and their backboards recently. One thing that got me rolling on the subject was an article by Dr. Brian Bledsoe about stuff they use in other countries that we don’t typically have (or use) in the US. On his list of wants … vacuum mattresses for spinal immobilization.

When you leave the friendly confines of the U.S., you rarely see a backboard. In all other industrialized countries, EMTs and paramedics don’t provide spinal immobilization unless there is a high index of suspicion. When spinal immobilization  is applied, the vacuum mattress is commonly used.

                                                                                                        – Dr. Bryan Bledsoe

Then I ran across a new study that reported just 5 cm of padding on a standard backboard almost completely redistributes the pressure from the scapula and sacrum to the whole of the posterior. I’m sure most of us didn’t need a study to tell us that but if you want to argue the point, at least now you have a leg to stand on.

But why should we have to argue the point? Shouldn’t we have been designing backboards with the patients comfort in mind from the start? I think a large part of that answer lies in Eddie’s dog food and who makes the decision to buy a thing. Like succulent rice and beef … or backboards.

I pad my backboards with a few hospital blankets when I have the chance. Sometimes it makes the ride more comfortable. Other times it doesn’t work so great. It’s a band-aid (so to speak) for now. But let’s face it, we’re not just talking about backboards here. There is a “purchasing agent” focus in most of our medical equipment design.

If patients bought their own oxygen masks would they still be smothering pieces of stinky plastic held to the head with rubber-bands? Would nasopharyngeal airways still be made of the same hard rubber used for racquetballs? What about IV tape, tourniquets, ET tubes, blood pressure cuffs, ecg patches and limb splints? I suspect all of these devices would undergo some design makeovers if the patient were in charge of equipment purchasing.

For now we have to make do with what’s available, make accommodations when we can and advocate for patient comfort. But I still think the idea of rabbit flavored dog food has merit.

  

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Comments

  1. Excellent post.

    I think that my cat enjoys the taste of sweet, sweet victory. So the best food for her would be one that she was able to steal and chew through the bag every time to get.

    Then she would throw it up.

    We have the vacuum matresses. I use them often for hip fractures. The patient’s are no longer in pain once secured in the matress and given 100mcg of Fentanyl. Unfortunately, they’re not in the protocol for spinal immobilization and I can only use it when it’s justified by severe kyphosis or other like reason.

    We should start a medical device company. I’ll get the VC funding if you pay for all of the product lawyers and FDA approval.

  2. Excellent words about how purchasing controls patient care. It really is in the hands of the care giver to alter the equipment to make it people friendly. A quick word on the vacuum splints though. About 8-10 years ago we tested one and were told it was the greatest thing ever, the salesman had answers for everything. We just loved the versatility and ability to put frail little Erma Fishbiscuit in the position we found her.

    Then we got a call from St Farthest from a very upset physician who wanted to know why we didn’t tell them the splint was not x-ray luscent. “The manufacturer says it is” “My x-rays say otherwise.”

    Turns out the filler was blocking their machines and they had to unpackage her.

    That one encounter ruined the experience and the tool disappeared. Imagine the cost to make a spine board that actually did what it is designed to do!

    HM

  3. 40lizard says:

    I agree 100%! Even before taking the jump off into the world of EMS I agree that most devices are not patient friendly! I speak from personal experience after being involved in monster MVA several years ago- I was “packaged” on a long board and collar for almost 5 very long hours because of an inexperienced ER doc! I still recall that experience with dread!

  4. Brilliant!

    My dogs will eat pretty much anything. The little one is lucky to be alive after eating a cord(plugged in, mind you) to a dehumidifier. Damn circuit breaker saved her life.

    I bet if patients bought backboards… we’d use a lot less of them too! I’ll not walk down that street right now though…

  5. We have had full body vac splints over in our service for quite some time. They are a great bit of kit, however, they do take a bit more effort to apply than just log rolling someone onto a spinal board, hence most people dont use them!
    I personally love them for the multi trauma patient as you can actually do a full bosy immobilisation and put a bit of compression on the ? fractured pelvis.

  6. Steve, best thing I did was teach my lab to sit while I fill his food bowl and set it on the floor. Thus I still have 10 fingers for padding backboards before immobilization. I get a lot of strange looks and “whatever” shoulder shrugs whenever I add hospital blankets to the backboard.

    Another post on backboarding today caught my eye, http://brownems.org/2009/06/introducing/

  7. Stuart Crutchfield,MD says:

    I developed the InnovaBoard several years ago. It was a padded backboard. I am a neurosurgeon and got tired of having patients complain of pain. Unfortunately it was not a commercial success at that time. I’d be willing to help anyone who thinks they could make this idea a success.

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