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40 MARCH 2015 | EMSWORLD.com caine had no impact on the hemodynamic stability of patients receiving RSI following traumatic injury and determined the drug was safe to administer dur- ing RSI. 5 However, one potential problem is that lidocaine administration is time-dependent. Some authors sug- gest that to have any potential benefit for the patient receiving RSI, lidocaine must be administered at least 2 minutes prior to laryngoscopy. 6 Waiting an addi- tional 2 minutes to intubate a patient with a head injury may be its greatest risk, as during this time patients can remain hypoxic, potentially aspirate and continue to fight, which further exacerbates an increased ICP. Lidocaine has a dose-dependent effect as well and too much lidocaine can be detrimental. While minimal arterial blood pressure changes occur when patients received 1.5 mg/kg of lidocaine prior to neurosurgery, significant blood pressure declines occur when the dose is increased to 2 mg/kg. 6 The Bottom Line Lidocaine is not proven to prevent a rise in ICP dur- ing RSI. While it may not directly harm patients, its administration does delay the completion of RSI, which puts the patient at risk for continued hypoxia. Myth #3: Backboards are Helpful The myth explained: Every year, as many as 5 mil- lion patients are immobilized with a cervical collar and backboard using the same techniques that have been taught in EMS classes for over 30 years. Three small straps are used to secure a human chest and hips to a f lat rigid board and head blocks then pre- vent head movement. This, in theory, was meant to prevent patient movement and further injury and reduce morbidity. The Evidence In any population studied, the frequency of spine injury is low. In multi-system trauma patients, rates of spine column injury range between 2%–5%, while cord injury occurs in less than 2% of patients. In minor incidents, such as falls and motor vehicle collisions with restraint use, rates are as low as 1.2%. 7 Thus, it is well understood that the majority of the time patients are immobilized there is no actual injury that the immobilization is theoretically stabilizing. This is one of the many reasons the American College of Surgeons ATLS course textbook recommends patients be removed from a backboard as quickly as possible. 8 James Morrissey and his colleagues published their 2014 paper demonstrating our current approach to immobilization does not help the overall popula- tion and provided evidence that limiting any spine immobilization to patients who cannot pass a spine examination, and then using immobilization strategies that avoid the long spine board, reduces unnecessary immobilizations and increases patient comfort. 7 One of the most significant reviews of back- board use was the 2013 joint position paper from the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma, which stated there is no proven benefit to rigid spine immobilization. This paper went on to dis- cuss that immobilization can cause pain, patient agi- tation, respiratory compromise and decreased tissue perfusion where the patient's skin presses against the board, which can potentially cause pressure ulcers. 9 It is also known that in healthy patients, full spine immobilization has been shown to cause sacral tis- sue ischemia capable of producing a pressure ulcer within 30 minutes of longboard application. 10 Further, immobilization causes a significant enough increase in pain that neurological exams become less reliable when the patient remains immobilized. 11 In the same paper, the NAEMSP identified that patients with penetrating trauma to the head, neck and torso without spine deficit do not need immobili- zation and that immobilization actually causes a delay in transport that can be significant enough to increase patient morbidity and mortality. 9 Further, even when performed properly, backboards do not provide any additional benefit. When patients in two large trauma systems were compared—one in New Mexico, where prehospital immobilization occurred, and the other in Malaysia, where no prehospital immobilization occurs—there was no difference in neurological disability between the patient groups. The authors determined that in blunt spinal injuries immobiliza- tion has little to no benefit on patient outcomes. 12 The majority of the time patients are immobilized there is no actual injury that the immobilization is theoretically stabilizing. © Jones and Bar tlet t Learning. Cour tesy of MIEMSS. CONTINUING EDUCATION