Cordell W H, Hollingsworth J C, Olinger M L, Stroman S J, Nelson D R
Emergency Medicine and Trauma Center, Methodist Hospital of Indiana, Indianapolis, USA.
Ann Emerg Med. 1995 Jul;26(1):31-6. doi: 10.1016/s0196-0644(95)70234-2.
Although spine boards are one of the main EMS means of immobilization and transportation, few studies have addressed the discomfort and potential harmful consequences of using this common EMS tool. We compared the levels of pain and tissue-interface (contact) pressures in volunteers immobilized on spine boards with and without interposed air mattresses.
Prospective crossover study.
Emergency department of Methodist Hospital of Indiana, Indianapolis, Indiana.
Twenty healthy volunteers who had not taken any analgesic drugs in the preceding 24 hours, were not experiencing any pain at the time of the study, and did not have history of chronic back pain.
To simulate prehospital transport conditions, we immobilized volunteers with hard cervical collars and single-buckle chest straps on wooden spine boards with or without commercially available medical air mattresses. The crossover order was randomized. After 80 minutes, immobilization measures were discontinued and the subjects were allowed to get off the boards for a recovery period of 60 minutes. Subjects were then studied for a second 80-minute period with the opposite intervention. At baseline and at 20-minute intervals, the level of pain was rated with a 100-mm visual analog scale. Tissue-interface pressures were measured at the occiput, sacrum, and left heel.
Mean pain on the visual analog scale was 9.7 mm at the end of the mattress period and 37.5 mm at the end of the no-mattress period (P = .0001). Although there were no significant differences in pain between the two groups at time 0, volunteers reported significantly more pain during the no-mattress period at 20 (P = .003), 40 (P = .0001), and 60 minutes (P = .0001). All 20 subjects reported that immobilization on the spine board with the mattress was "much better" (five-point scale) than that without the mattress. Interface pressure levels were significantly less in the mattress period than in the no-mattress period measured at occiput (P = .0001), sacrum (P = .0001), and heel (P = .0001).
In a simulated immobilization experiment, healthy volunteers reported significantly less pain during immobilization on a spine board with an interposed air mattress than during that on a spine board without a mattress. Tissue-interface pressures were significantly higher on spine boards without air mattresses. This and previous studies suggest that immobilization on rigid spine boards is painful and may produce tissue-interface pressure high enough to result in the development of pressure necrosis ("bedsores"). Emergency care providers should consider the use of interposed air mattresses to reduce the pain and potential tissue injury associated with immobilization on rigid spine boards.
尽管脊柱板是紧急医疗服务（EMS）中固定和转运患者的主要工具之一，但很少有研究关注使用这种常见EMS工具时的不适和潜在有害后果。我们比较了在有和没有插入气垫的脊柱板上固定的志愿者的疼痛程度和组织界面（接触）压力。
前瞻性交叉研究。
印第安纳州印第安纳波利斯市卫理公会医院急诊科。
20名健康志愿者，他们在之前24小时内未服用任何镇痛药，在研究时没有任何疼痛，也没有慢性背痛病史。
为模拟院前转运情况，我们使用硬颈托和单扣胸带将志愿者固定在有或没有市售医用气垫的木制脊柱板上。交叉顺序是随机的。80分钟后，停止固定措施，让受试者从脊柱板上下来休息60分钟。然后对受试者进行第二个80分钟的相反干预研究。在基线和每隔20分钟时，用100毫米视觉模拟量表对疼痛程度进行评分。在枕骨、骶骨和左脚跟处测量组织界面压力。
在使用气垫的阶段结束时，视觉模拟量表上的平均疼痛评分为9.7毫米，在不使用气垫的阶段结束时为37.5毫米（P = .0001）。虽然两组在0分钟时疼痛无显著差异，但志愿者在不使用气垫阶段的20分钟（P = .003）、40分钟（P = .0001）和60分钟（P = .0001）时报告的疼痛明显更多。所有20名受试者都表示，在有气垫的脊柱板上固定比没有气垫时“好得多”（五分制）。在枕骨（P = .0001）、骶骨（P = .0001）和脚跟（P = .0001）处测量的组织界面压力水平在使用气垫阶段明显低于不使用气垫阶段。
在模拟固定实验中，健康志愿者在有插入气垫的脊柱板上固定时报告的疼痛明显少于在没有气垫的脊柱板上固定时。没有气垫的脊柱板上的组织界面压力明显更高。本研究及之前的研究表明，在刚性脊柱板上固定会引起疼痛，并可能产生足够高的组织界面压力，导致压力性坏死（“褥疮”）的发生。急救人员应考虑使用插入气垫以减轻与在刚性脊柱板上固定相关的疼痛和潜在组织损伤。
