Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study

Background Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board. Methods Medical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis. Results Under ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6–273.2 s) and 83.4 s (95 % CI 77.5–89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0–400.6 s) and 112.6 s (95 % CI 102.6–122.6 s), respectively (p < 0.01). Conclusions Spinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress. We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.

Spinal stabilisation using a polyvinilidine (Lubra) plate in a pot-bellied pig

A three-month-old pot-bellied pig presented for acute paraplegia following a presumptive fall. CT examination identified a vertebral subluxation of L1–L2 with a comminuted fracture of the L1 vertebra. Spinal stabilisation was performed with polyvinilidine (Lubra) plates. The pig improved neurologically and regained the ability to walk. Spinal radiographs six weeks following surgery revealed partial failure of the plates in the caudal aspect of the vertebral column and suspected pressure atrophy of spinous processes. Eighteen months later, the plates were piercing through the skin, so they were removed surgically and the pig did well from then on. This case report describes the feasibility of spinal stabilisation in a pot-bellied pig associated with a good outcome, but also reveals potential complications and spinal changes that can be observed after use of polyvinilidine plates in this species.