By Raul A. Angulo
The N gates have a long set of stairs that go up to the main terminal. Thank goodness for escalators. Even climbing the stairs on the escalator is a workout. I always choose to ride it up. As I was gliding up the escalator, I thought, “Too bad Ladder 6 doesn’t have an escalator instead of a ladder. That would make ladder rescues fast and easy!” Alan Petrillo wrote “Alternative Lift Systems Proposed for Rescue Aerials” in the September 2011 issue of Fire Apparatus & Emergency Equipment. Inventor Orville Douglas Denison started studying fire-rescue technology after the extensive television coverage of the September 11th attack on the World Trade Center.
|1 The SpineBoard is a wedge-shaped backboard that uses conveyor-belt technology to smoothly and effortlessly load a patient safely onto the backboard. The upper board and lower carriage are attached. The wedge automatically keeps the patient in a semi “shock position.” This has its advantages for hypotensive patients. (Photos by author.)|
Denison came up with a rescue conveyor ladder design that was actually an “escalator for firefighters.” It was a 113-foot aerial ladder with a conveyor system of rungs that could operate at 200 feet per minute, carrying a firefighter up to the tip in about 30 seconds. He also claimed his ladder could rescue four victims and have them down in four minutes. Although this conveyor-belt technology has not been implemented on fire apparatus yet, a company serving the emergency medical services (EMS) market is adapting it.
EMS is about 80 percent of our emergency work. Patient packaging and transport are the most time-consuming and physically demanding parts of it, so I’m always looking for something that is quicker, easier, and safer to accomplish this task. On the average, the fire service sustains approximately 100,000 on-duty injuries per year. Of those, my guess is that 50 percent of them are back injuries from heavy lifting and twisting.
|2 Once the patient is loaded on to the SpineBoard, connect the the side rails and head rail. They slide on very easily.|
In 1999, John Spanton was watching his son play high school football. Over the seasons he witnessed numerous sports injuries on the field. He watched from the stands time and time again as local emergency medical technicians (EMTs) responded with aid kits, backboard, and gurney to tend to an injured player. Knowing something about emergency medicine, Spanton knew it was paramount to immobilize the neck and keep the back straight to prevent cervical spinal injuries. Although the EMTs were doing their best, it was obvious that the football helmet, pads, and gear made it difficult to examine the patient and log roll the injured player onto the backboard for spinal immobilization and transport. Even from the bleachers, Spanton could see the player’s spine being twisted and bent while EMTs packaged the patient. As he cringed, he thought there had to be a better way.
He shared his concern and idea with his friend, Jason Viebrock. Together they started designing a wedge-type backboard that would incorporate conveyor-belt technology. Unfortunately, Spanton died in 2005, but Viebrock, the Spanton family, and the other investors wanted to keep his vision and idea alive. It took them another eight years to finish developing it, but they finally made it happen. Jason partnered with Ben Rice and formed InMotion SpineBoard, LLC. The SpineBoard™ hit the market in June 2014.
|3 With all the hand rails attached, the SpineBoard is leveled out at zero degrees. This model, the EMT Standard, weighs 60.3 pounds. The unit can be carried by two, four, or six EMTs, depending on the patient’s weight. It has a rated carrying capacity of 700 pounds.|
The SpineBoard is a backboard using conveyor-belt technology to backboard a patient. This motorized board “crawls” under the injured patient while one EMT maintains head and neck stabilization. The patient can remain motionless in the supine position while the upper belt moves in one direction and the undercarriage belt moves in the opposite direction. This facilitates smooth loading of the patient onto the SpineBoard. EMTs can place the board at the head or the foot position. But, to maintain cervical stabilization without the EMT following the patient along the board, it’s best to start at the foot end of the patient.
The backboard’s body, with an inner honeycombed design and thin outer skin, is made of lightweight, stain-resistant aluminum. It won’t flex under weight and provides a weight-bearing capacity in excess of 700 pounds.
The SpineBoard comes in two models: the EMT Standard and the Sports Professional.
The EMT Standard upper board is 71.46 inches long, 18.31 inches wide, and 3.15 inches high and weighs 32.54 pounds. The lower carriage is 40.55 inches long, 18.35 inches wide, and 3.86 inches high and weighs 27.76 pounds. The EMT Standard’s total weight is 60.30 pounds.
|5 The conveyor belts do all the work so there is no lifting or log rolling the patient. The second EMT simply controls the head to immobilize the cervical spine.
Click picture to view video.
The Sports Professional upper board is 81.30 inches long and 28.98 inches wide. The total weight on this model is 93.30 pounds. This unit is designed more for professional sports, which can easily handle an NFL linebacker with all his gear. At this type of sports venue, there will be no shortage of hands to help lift the 94-pound unit plus the weight of the patient. The EMT Standard model is better suited for fire departments and EMS.
The SpineBoard’s heavy-duty lithium battery has no memory for short charges, so ambulances can be fitted with an AC power receptacle and the unit can stay plugged in while the ambulance is in the station on shore power. During field tests, the unit has run without a load for longer than eight hours. During repeated patient-loaded demonstrations, the SpineBoard operated for longer than four hours with full power on a single charge. Without a single use of the SpineBoard, the battery stayed fully charged for an entire month. Charging time is one to two hours.
|6, 7 Once the head and neck are on the SpineBoard, the EMT releases the button and the conveyor belts stop. The EMT Standard model has a six-foot-long board.|
Using the SpineBoard
To use the SpineBoard, lay it inline at the feet of the supine patient. One EMT holds and controls the head. The second EMT turns on the motor with the forward-reverse switch. That’s it. The patient glides up the conveyor belt into position with no movement or effort. The SpineBoard is wide enough that it will track in a straight line. Once the patient is completely on the SpineBoard, turn the switch to the off position. The SpineBoard will track over asphalt, ice, grass, mud, and interior floor surfaces. It will work in all types of weather.
The handles, which attach at the head position, slide on and level the board, which is at a slight negative angle because it is a wedge, to zero degrees (floor level). Round lugs run around the edge of the SpineBoard where the metal ends of the safety straps can securely snap on. This allows for numerous variations of safety strap crisscross configurations to secure the patient to the SpineBoard.
|8, 9 The head rail is attached to the SpineBoard. The bracket removes the negative angle of the wedge so the SpineBoard is now level at zero degrees.|
As stated, the EMT Standard is 60.3 pounds-much heavier than standard backboards. If there are only two EMTs, they need to place the gurney adjacent to the SpineBoard and lower the gurney all the way down because they will be lifting the entire weight of the patient plus the SpineBoard’s additional 60 pounds. Anticipate if you will need help lifting the patient so you can request an additional unit early. If fire and police personnel are on scene, they will be more than willing to assist with lifting the patient. Even bystanders may be willing to help. Remember to coach them with clear instructions on using their leg muscles and not their backs. Give a ready and lift count. If the gurney does not have a motorized lift, everyone involved will have to lift the gurney to the up position and help load it into the ambulance. This is the biggest drawback to the SpineBoard because now you’re lifting the weight of the patient, the SpineBoard, and the gurney. However, motorized gurneys are becoming a common feature. Besides, there are usually sufficient EMS and fire personnel on scene to overcome this drawback.
I know you’re asking if the unit will pick up gravel and shattered glass along with the patient-I did! Shattered safety glass is everywhere at a motor vehicle accident. The answer is yes. It will pick up some. But the lip has a 1⁄8- to ¼-inch clearance before the pad makes contact with the ground. As the conveyor belt comes around, brush glass off with a gloved hand. This isn’t a problem, but use common sense and brush away excess debris from your work area.
|10, 11 Ten round lugs or grommets are anchored along the edge of the SpineBoard for the safety straps. The safety straps can attach to any of the grommets for a variety of crisscross restraint configurations. The green button is the power switch. The toggle has the forward, reverse, and off position.|
Arriving At ER
Once the patient is loaded into the ambulance, you’re ready for transport. On arrival at the ER, call for assistance from hospital staff if you’ll need help unloading the patient from the ambulance. Unloading a heavy gurney is not nearly as hard as loading one. Two EMTs should easily be able to handle this task, even with a heavy patient, because the gurney wheels quickly release to the ground after clearing the floorboard, taking the load of the patient.
Again, two EMTs will have to lift the weight of the SpineBoard and the patient from the ambulance gurney on to the hospital gurney. This may take a group of four or six people, depending on the situation and the height of the hospital bed, but this is the last lift. A patient may be X-rayed while still lying on the SpineBoard; however, the patient will have to be moved off the board if the ER physician calls for an MRI. Simply make sure the foot of the bed is clear and flip the power switch to the reverse position. The SpineBoard conveyor belt will reverse direction and “crawl” out from under the patient with the patient remaining on the hospital bed.
The SpineBoard is easy to clean and decontaminate. Cover the two electrical ports with the attached rubber caps and hose it down. Use your local decon protocols.
|12 With the side and head rails attached and the patient strapped to the SpineBoard, the unit is ready to lift onto the gurney using a crew of two, four, or six depending on the patient’s weight.|
The SpineBoard isn’t a one-stop, all-in-one appliance. Obviously, it cannot be used for every rescue and extrication. Like everything else on your rig, it is a tool. Every tool has pros and cons. The SpineBoard is no different. It has its place and purpose.
I’ve been an EMT since joining the fire service more than 35 years ago. I can remember the instructor from my very first class emphatically stressing the importance of maintaining cervical and spinal immobilization. It was the cardinal rule and remains so to this day. But, we all know that standard backboards make this technique easier said than done and often we just do the best we can, knowing full well we are far away from “textbook.” That’s what impressed me about the SpineBoard when I first saw it-it slid effortlessly and automatically underneath the patient while he remained perfectly still. I know if I were the patient with a spinal injury, I would want the SpineBoard instead of being log rolled. How do you put a price on your health and safety?
When you come across patients with suspected or actual spinal injuries, sports injuries, trauma patients, burn victims, rehab patients, and elderly and bariatric patients who are injured, any movement is painful. There is nothing firefighters and EMTs hate more than knowing they’re causing a patient unavoidable additional pain because they have to move them.
I believe there is a market for this invention. I probably won’t be around to see an escalator or conveyor-belt aerial ladder, but I’m glad I got to see this innovation before I retired. I only wish I could have an opportunity to use it-just not as a patient!
RAUL A. ANGULO, a veteran of the Seattle (WA) Fire Department and captain of Ladder Company 6, has more than 35 years in the fire service. He is a member of the Fire Apparatus & Emergency Equipment editorial advisory board. He lectures on fire service leadership, company officer development, and fireground strategy and accountability throughout the United States, Canada, and Mexico.