Abstract:
A molded plastic spine board having specialized padding strategically located in the board and stiffing members. The specialized padding reduces patient discomfort and aids perfusion in the regions that are in contact with the board while the patient is immobilized on the board thereby helping to prevent tissue ischemia and pressure ulcer formation. The stiffening members strengthen the board eliminating deflection of the board thereby keeping the patient immobilized while eliminating artifacts (shadows and interference) in x-rays thereby ensuring good x-ray examination.

Description:
[0001]    This application claims priority from U.S. Provisional Application Serial No. 60/375,956 filed on Apr. 26, 2002. 
     
    
     
       TECHNICAL FIELD OF THE INVENTION  
         [0002]    This device relates generally to the medical community and in particular to an extraction, transportation and immobilization board for use by emergency medical personnel that helps prevent injury to the spine of an immobilized patient while allowing treatments and x-rays to be made or taken on the immobilized patient without generating interference patterns on the x-ray results. The device has strategically located padding in the board that improves the patient comfort level and helps to prevent tissue ischemia and pressure ulcer formation.  
         BACKGROUND OF THE INVENTION  
         [0003]    Extraction, transportation and immobilization boards are used in the medical community for transporting trauma victims. Emergency medical personnel will strap the victim to an immobilization board (backboard) whenever they know or suspect that the victim&#39;s spine has been injured. This technique is used to minimize the chance of further injury to the spine while the victim is being extracted or transported from the scene. In fact, the victim is often immobilized for hours on the backboard during transportation to the hospital and while awaiting diagnostic studies.  
           [0004]    The practice of strapping the victim to these immobilization boards stems from the fact that many trauma victims sustained additional neurological injuries because of undiagnosed spinal instability while the victim was being lifted or carried to ambulances and hospitals. Backboards help prevent additional injuries by keeping the vertebrae aligned so as not to further compress the spinal cord and nerves which lie within a small opening in the spine, known as the vertebral canal. The victim will be left strapped to the backboard for hours during transportation to emergency facilities and while undergoing initial examination at an emergency facility.  
           [0005]    The victim will not be taken from the backboard until the victim&#39;s spine is examined by a medical specialist (generally a neurosurgeon) who will “clear” the victim prior to the removal of the victim from the backboard. The process of “clearing” the victim involves examination of the victim (patient) and examination of x-rays. This procedure can take hours before a determination can be made of whether or not the patient can safely be removed from the backboard.  
           [0006]    The inability to move for hours on end leads to great discomfort and, quite often, great pain for the patient. Patients have complained of pain at the back of the skull (occiput), shoulder blades (scapulas), mid back area (thoracic kyphosis), tailbone (sacrum and coccyx), pelvic areas (posterior superior iliac spines) and heels (calcaneus). These areas of the body are the same areas that have the greatest contact with the backboard. The pain arises from the patient&#39;s inability to move and take pressure off of these areas (i.e., shift the body weight). In addition, the lack of movement compromises the blood flow (perfusion) in the tissues in these regions during the period of immobilization. The compromised perfusion leads to tissue ischemia that in turn causes pain. The tissue ischemia often leads to “pressure ulcers” (decubitus ulcers). The development of these ulcers often leads to an increase in the patient&#39;s morbidity, an associated increase in the length and cost of hospitalization and to increase in the possibility of surgery or similar additional treatment.  
           [0007]    The current art in backboards has undergone little change with regard to the above expressed concerns. It appears that backboards are designed, built and sold with a view toward cost and durability. Current improvements center about the use of stronger and more lightweight materials in order to increase the carrying capacity and decrease the load that ambulances, paramedics, and attendants must carry. Other improvements have focused on craniocervical stabilization, universal padding, addition of wheels to the backboard, folding backboards, floatable backboards, and the like. The art has not concentrated on improving patient comfort, reducing the chance of the formation of pressures ulcers, increasing tissue perfusion, and the like while the patient is immobilized on the backboard.  
           [0008]    For example McQueen, U.S. Pat. No. 5,560,059, discloses a patient stretcher containing inflatable supports located under the neck and torso of immobilized patient. The McQueen stretcher is formed from rigid polymeric materials that incorporate a pair of depressions that contain the inflatable pads. Close inspection of the drawings show that if x-rays are taken with the patient on the board, reflection and interference will occur due to the stiffening supports associated with the stretcher. Furthermore, the inflatable pads can cause movement of the patient thus negating the effect of the spine board, and no padding is provided for the lower extremities (legs/feet).  
           [0009]    Bologovsky et al., U.S. Pat. No. 5,950,627, disclose a spine board manufactured from a molded urethane-filled polymer shell that is stiffened with a series of carbon filament tubes. The Bologovsky device makes no effort to provide padding and states that board is x-ray transparent with the exception of the stiffening elements.  
           [0010]    The prior art includes a series of design patents that attempt to meet the requirement for a lightweight stiff spine board. See for example, Pretzer, U.S. Pat. No. Des. 358,652 that shows no padding and Ott, U.S. Pat. No. Des. 328,351 that shows padding for only the feet. The inventor (Crutchfield) discloses a spine board, see U.S. Pat. No. Des. 471,634, that illustrates a padding system for the head/spine/torso and the legs/feet. Whereas the Crutchfield design provides padding and a stiff spine board, it was discovered that the board showed minor flexing and in particular caused interference in x-ray pictures due to the increased density of the stiffening members: like the Bologovsky device.  
           [0011]    Kirchgeorg et al., U.S. Pat. No. 5,771,513 discloses an x-ray compatible, partially flexible patient support. The Kirchgeorg device is essentially a flexible support that wraps from one side of the patient to the other thereby retraining the patient in a blanket like structure that is stiff from the head to the feet. Some motion is still possible (hence the title “partially flexible”) which prohibits the use of the device in a patient suffering severe spinal injury.  
           [0012]    Thus there remains a need for a carefully designed backboard that is lightweight and stiff but contains strategically located pads to reduce patient discomfort, decrease the likelihood of compromised tissue blood flow (perfusion) in pressure regions leading to an overall reduction in pain and the formation of pressure ulcers while allowing x-ray examination, without interference or shadowing.  
         SUMMARY OF THE INVENTION  
         [0013]    The instant backboard is designed to provide appropriate padding that follows the contour of the pressure points in the pattern of an immobilized supine human skeleton of average stature. It is known that the instant device cannot perfectly fit all humans because no one human is “average” and therefore there is no standard proportion. The instant device has cushioned pads at optimum locations on the board in order to meet the objectives stated above.  
           [0014]    Additional modifications included in the design of this board are openings in the undersurface railings designed to permit placement of a standard chest X-ray cassette in order to facilitate taking an anterior-posterior chest X-ray without lifting the patient. Small openings about the outer perimeter are also provided to secure intravenous poles and keep the ambulance attendants hands free of this task.  
           [0015]    The backboard is manufactured using standard molding techniques in two halves that are joined together using standard techniques. A stiffening channel is molded about the outer perimeter of the board in the upper and lower halves. Underside railings are formed in the lower half as an additional stiffening channel in a position that minimizes and/or eliminates the chance of causing artifacts on X-rays. These railings, like the current art, allow the spine board to readily slide along other surfaces (gurneys, platforms, and the like).  
           [0016]    The underside of the board, where the torso and head will lie, has a carefully designed v-groove stiffening pattern incorporated as part of the lower mold. The v-groove angles are chosen to minimize and/or eliminate x-ray interference (shadowing or causing artifacts); thereby, minimizing or eliminating x-ray interference in the most critical area of the patient—the spine which includes the neck. Thus, the thermoplastic spine board is fully stiffened by the perimeter channel (essentially a box channel), the two rail channels (a modified box channel) and the underside v-grooves.  
           [0017]    Carefully placed openings along the edges of the board allow for comfortable handgrips and for the attachment of immobilization belts, without compromising the strength of the backboard. Additional openings are provided for restraint belts in the leg area of the board. The board is easily cleaned and the cushions may be replaced to prevent transmission of pathogens transmitted by body fluids.  
           [0018]    Thus the instant device provides a lightweight stiff backboard that is compatible with hospital x-ray and other scanner-type machines (MRI, etc.) and provides padded areas thereby reducing patient discomfort, decreasing the likelihood of compromised tissue blood flow (perfusion) in pressure regions, and leading to an overall reduction in pain and formation of pressure ulcers while allowing x-ray examination without interference or shadowing. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0019]    [0019]FIG. 1 is an isometric view of the instant device incorporating specialty pads showing the head end at the left hand side of the drawing.  
         [0020]    [0020]FIG. 2 is an isometric view of the specialty pads.  
         [0021]    [0021]FIG. 3 is an exploded isometric view of the instant device showing the specialty pad design features and placement of the pads on the spine board.  
         [0022]    [0022]FIG. 4 is a top view of the instant device.  
         [0023]    [0023]FIG. 5 is a bottom view of the instant device.  
         [0024]    [0024]FIG. 6 is a side view of the instant device.  
         [0025]    [0025]FIG. 7 is an end on view of the instant device taken from the head end.  
         [0026]    [0026]FIG. 8 is an end on view of the instant device taken from the foot end.  
         [0027]    [0027]FIG. 9 is a cross-sectional view of the instant device taken at C-C in FIG. 5. Note the details A and B taken at the points shown in FIG. 9.  
         [0028]    [0028]FIG. 10 is a cross-sectional isometric view of the instant device taken at C-C in FIG. 5. Note the detail D taken at the point shown in FIG. 10.  
         [0029]    [0029]FIG. 11 is a bottom view of the initial prototype device.  
         [0030]    [0030]FIG. 12 is a side view of the initial prototype device.  
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0031]    This disclosure will first discuss the prototype device thereby tracing the development of the preferred device that will be fully disclosed.  
         [0032]    The prototype device (shown in FIGS. 11 and 12 and similar to FIG. 1) is manufactured from plastic using standard molding techniques. The outer plastic sheath is formed about a “filled interior.” In order to obtain the required stiffness (i.e., a backboard must not bend or deform with a patient in place) the plastic filled prototype interior was shaped in ridges, valleys and honeycombs; thus, when the outer plastic material was formed about the inner material the overall backboard become rigid. Wood reinforcement was used in the prototype however carbon fiber reinforcement could have been used or added to the interior.  
         [0033]    It is known that great care has to be taken to ensure that the density of the material is as constant as possible to facilitate x-rays and scanner-type equipment used in hospital diagnostic equipment. (That is, the board must be essentially transparent or of constant opaqueness so that false readings will not be taken on the patient.) Furthermore, the placement of stiffening members (be they wood, carbon fiber or the like) should be carefully made in order to minimize interference with x-ray photography.  
         [0034]    The prototype device is shown in FIGS. 11 and 12, which are an underside view and a right side view with reference to the top view of FIG. 1. FIG. 1 is a top view of the preferred device; however, FIG. 1 is very similar to the prototype device except for the shape of the rear handle slots and the front-most handle/strap slots. A plurality of openings or slots,  118  and  120  through  136 , was formed in the board. A majority of these opening are strap apertures: however, it should be apparent that the openings along the front, sides and rear also serve as handholds. That is, the openings allow hold-down straps to pass through the opening(s) and around the patient: thereby, immobilizing the patient. (Standard trauma practice.)  
         [0035]    The prototype board was further stiffened using a pair of rails running from the rear of the board toward the front,  116 A,  117 A, that terminated at approximately the mid-point of the board and continued near the head of the board,  116 B and  117 B. The rails were placed as far away from the body location in order to reduce the chance of interference with x-ray photography/examination. These rails (or skids) also facilitate the grasping of the board by elevating it above ground level.  
         [0036]    The two specialized pads, which are shown in place in FIG. 1, are also used in the prototype, and the top of the prototype board had indentions specifically molded into the board to receive and hold these pads in place. The function and purpose of these two pads will be discussed when discussing the preferred device. Additionally, a series of round IV-apertures,  4  are placed throughout the top surface. These IV-apertures,  4 , are designed to accept metal rods that in turn can hold plasma bags, electronic monitoring equipment and other required medical equipment. This leaves the medical trauma technician free to concentrate on the patient (or carrying the board) while not having to hold onto other ancillary equipment.  
         [0037]    Unfortunately it was found that the prototype device—although providing a padded system that relieved patient discomfort, decreased the likelihood of compromised tissue blood flow (perfusion) in pressure regions, and lead to an overall reduction in pain and formation of pressure ulcers)—resulted in a slightly flexible board that would not properly immobilize a patient. Further, the prototype device caused minor, but fatal, artifacts (distortions and shadows) in the x-ray image caused by variations in board density (the urethane fill) and interference by support/stiffening members that were placed within the board (not shown). Thus, the prototype device leads to a completely new form of the spine board, while incorporating the special padded features of the prototype board.  
         [0038]    The preferred device is shown in FIGS. 1 through 10 and is molded in two halves from Poly Carbonate/ABS plastic using standard molding techniques. The upper half and lower half do not quite lie on a mid point between the top and bottom of the assembled board as a result of molding and assembly techniques. (See FIGS. 9 and 10.)  
         [0039]    The upper half or section,  10 , contains indentions,  14  and  15 , for the specialized pads,  12  and  13 , which will be discussed. An upper perimeter stiffening L is molded around the entire outer perimeter of the upper section (or half) shown in FIGS. 9 and 10 as item  51  on the right side and continuing as item  61  on the left side. The L continues at the head and the foot of the board (not shown) with the same shape as shown in the FIGS. 9 and 10. As will be discussed the upper perimeter L mates with the lower perimeter L to form a perimeter stiffening channel shown in FIGS. 9 and 10 as items  50  (on the right side) and  60  (on the left side).  
         [0040]    The perimeter-stiffening channel, as stated, extends from the outer edge of the board to just inside the outer perimeter hand/strap holds,  18  through  31 . The perimeter-stiffening channel serves to stiffen the board about the outer perimeter and provide strength for the hand holds.  
         [0041]    The lower half or section,  11 , contains a plurality of V-channel stiffeners,  40 ,  41  and  42 , extending from the front-most mid strap apertures,  35  and  36 , the front hand hold,  20  and  21 . When the upper and lower sections are joined together, the V-channel stiffeners will lie more or less underneath the torso pad indention,  15 , and run parallel to a longitudinal axis (V-channel axis) extending from the head to the foot of the board.  
         [0042]    A lower perimeter stiffening L is molded around the entire outer perimeter of the lower section (or half) shown in FIGS. 9 and 10 shown as item  52  on the right side and continuing as item  62  on the left side. As with the upper section, the L continues at the head and the foot of the board (not shown) with the same shape as shown in the FIGS. 9 and 10. As will be discussed the lower perimeter L mates with the upper perimeter L to form an outer perimeter stiffening channel shown in FIGS. 9 and 10 as items  50  (on the right side) and  60  (on the left side).  
         [0043]    Two lower rail stiffening U&#39;s are molded within the inner portion of the lower section along a longitudinal axis (rail axis) extending from the head to the foot just inboard of the outer perimeter hand/strap holes,  18  through  31 , shown in FIGS. 9 and 10 as item  54  (on the right side) and  64  (on the left side).  
         [0044]    The upper and lower sections (or halves) are connected together such that the upper and lower perimeter stiffening L&#39;s join together to form the perimeter stiffening channel. Furthermore, the undersides of the lower rail channels become the spine board skids. The lower plurality of V-channel stiffeners attach at their apex to the underside of the torso indention. All joints are secured using glue, thermal techniques or sonic techniques. In addition the hand hold halves are secured using glue, thermal or sonic techniques. The net result is a very stiff plastic spine board.  
         [0045]    In designing the V-channel stiffeners, the molding engineer must assure that 45-degree angles are used throughout and that the apex of each channel be at 90-degrees to each of the sides of the channel. Thus, the width of the channel sides is set by the thickness of the plastic (set by strength of material considerations) and the requirement of the 45-degree angle. The 45-degree angle assures minimum shadowing of x-ray film. That is the x-ray passes through the channel with little or no distortion.  
         [0046]    The perimeter-stiffening channel, as stated, extends from the outer edge of the board to just inside the hand/strap holds,  18  through  31 . The perimeter-stiffening channel serves to stiffen the board about the perimeter utilizing the properties of an “open box” beam and provides strength for the perimeter handholds.  
         [0047]    The rail-stiffening channel, as stated, extends from just inboard of the hand/strap holes,  18  through  31 , about the inner perimeter. The rail-stiffening channel forms the rail (or slide) on both bottom sides of the spine board while providing additional stiffening and strength to the board also utilizing the properties of an “open box” beam. In fact, the L-shaped perimeter channels may be formed as a U-shape. Thus, when the two halves are joined together the U&#39;s with mesh to form a closed box beam.  
         [0048]    The rail stiffening channel forms an open box beam by incorporating the lower rail ( 54  and  64 ) and part of each of the outer V-channel stiffeners ( 41  and  42 ) as shown in FIG. 9. In a similar manner the V-channel stiffeners also use the principal of a box beam to provide stiffening. Two V-channel voids,  43  and  44  form a modified box beam with the underneath portion of the torso indentation as shown in FIG. 9.  
         [0049]    The pads, shown in FIGS. 2 and 3, are manufactured from almost incompressible cushion material such as urethane. The pads must be sufficiently compressible so that a comfort level is attained, but sufficiently incompressible so that the patient&#39;s spine is appropriately supported. The ideal material would be one that conforms to the body&#39;s natural shape and remains in that state while the patient is immobilized. This material would ensure that the pressure exerted by the patient&#39;s body weight would be spread out over as large an area as possible; thereby reducing the pressure in any one area. A modification of the “visco-elastic foam” developed by the National Aeronautics and Space Administration and used in certain commercial mattresses would be ideal, providing the material is made to be almost incompressible, i.e. a dense visco-elastic material.  
         [0050]    The heel/foot pad takes the shape of a quadrilateral and is designed to accept the heels of the patient. The strange shape allows for the accommodation of a variety of human sizes and serves to cushion the heels (calcaneus). The hourglass like torso pad serves to cushion the skull (occiput), shoulder blades (scapulas), mid back area (thoracic kyphosis), tailbone (sacrum and coccyx), and pelvic areas (posterior superior iliac spines).  
         [0051]    The hourglass shape has been chosen to support the shoulders and other parts of the body, as described above, while keeping as much of the surface area of the board clear of padding. The “clear” area allows the medical technician space to place equipment, run straps, and generally perform emergency procedures. A fully padded board will not function as well as the disclosed pad shape. Again the strange shape has been chosen to accommodate the greatest variety of human sizes and shapes.  
         [0052]    Finally, the device provides a series of IV-apertures,  4 , which are placed at strategic intervals about the outer perimeter of the upper half of the board. These apertures accept IV-stands that will hold IV-bags, other medical fluid distribution equipment or medical monitoring equipment. The IV-stands (not shown) when properly used will relieve the emergency medical provider of the additional duty of hold such items while attempting the carry the board.  
         [0053]    A manufacturer will mostly likely provide varying sized boards. A standard board for most adults, a small board for small adults and a child board for children. The boards are lightweight and will take up little space in an emergency vehicle.  
         [0054]    Additional stiffening materials such as carbon fiber may be incorporated in the perimeter channel during the molding process for the upper and lower halves of the board. And the perimeter channel may be filled with urethane foam. Similarly the rail channel may be reinforced using foam and/or carbon fiber. The area under the torso, neck spine and other body parts (arms, legs, etc) should be kept clear of material that could cause artifacts in x-rays.  
         [0055]    Although the disclosure describes the rail stiffener as forming an open box beam by incorporating the lower rail ( 54  and  64 ) and part of each of the outer V-channel stiffeners ( 41  and  42 ) as shown in FIG. 9, it would be possible to bring the lower rail directly upwards and connect to the underside of the upper section. As claimed in the claims, the rail channel “box” structure can be omitted and regular stiff skids attached to the lower section. In a similar manner the disclosure describes the two V-channel voids,  43  and  44  as forming a modified box beam by connecting with the underneath portion of the torso indentation as shown in FIG. 9.  
         [0056]    The inventor envisions an alternate embodiment without the torso and heel pads: under these circumstances the two channel voids would connect directly with the underside of the upper section. Furthermore, although the disclosure shows three V-channels, the number of channels will be set by the width of the board, the 45-degree requirement, the thickness of the plastic and the thickness of the final board. Such changes are within the disclosure.  
         [0057]    There has been disclosed the best and preferred modes of the invention. The foregoing discussion is meant to provide a general explanation of the purpose and concepts of the instant device. The disclosure and drawings are meant to be explanatory of the invention; however, they are not meant to be restrictive. Slight variations in shape and position of the pads, the openings, ridges or v-grooves, perimeter or rail channels and material are anticipated and would fall within the spirit of this disclosure.  
         [0058]    Item Listing  
         [0059]    This list is provided as an aid to examination and may be included as part of the application at the discretion of the Examiner.  
                                                        1.   Generally the Instant Device            2.   Generally the Hand Holds            3.            4.   Generally the IV Support Aperture            5.            10.   Upper Section            11.   Lower Section            12.   Foot/Heel Pad            13.   Torso Pad            14.   Foot/Heel Pad Indention            15.   Torso Pad Indention            16.   Left Side Skid            17.   Right Side Skid            18.   Right Rear Hand Hold            19.   Left Rear Hand Hold            20    Right Front Hand Hold            21.   Left Front Hand Hold            22.   Right Side Hand Hold-1            23.   Left Side Hand Hold-1            24.   Right Side Hand Hold-2            25.   Left Side Hand Hold-2            26.   Right Side Hand Hold-3            27.   Left Side Hand Hold-3            28.   Right Side Hand Hold-4            29.   Left Side Hand Hold-4            30.   Right Side Hand Hold-5            31.   Left Side Hand Hold-5            32.   Right Side Mid Strap Aperture-1            33.   Left Side Mid Strap Aperture-1            34.   Right Side Mid Strap Aperture-2            35.   Left Side Mid Strap Aperture-2            36.            37.            40.   Middle V-Channel Stiffener            41.   Left Side V-Channel Stiffener            42.   Right Side V-Channel Stiffener            43.   Left Stiffener Void            44.   Right Stiffener Void            45.            50.   Right Perimeter Stiffening Channel            51.   Upper Right Perimeter L            52.   Lower Right Perimeter L            53.            54.   Lower Right Skid/Rail            55.            56.   Right Skid/Rail Stiffening Channel            60.   Left Perimeter Stiffening Channel            61.   Upper Left Perimeter L            62.   Lower Right Perimeter U            63.            64.   Lower Right Skid/Rail            65.            66.   Left Skid/Rail Stiffening Channel           116A.   Prototype Left Side Skid-Rear Section           116B.   Prototype Left Side Skid-Front Section           117A.   Prototype Left Side Skid-Rear Section           117B.   Prototype Left Side Skid-Front Section           118.   Prototype Rear Hand Hold           119.   —           120   Prototype Right Front Hand Hold           121.   Prototype Left Front Hand Hold           122.   Prototype Right Side Hand Hold-1           123.   Prototype Left Side Hand Hold-1           124.   Prototype Right Side Hand Hold-2           125.   Prototype Left Side Hand Hold-2           126.   Prototype Right Side Hand Hold-3           127.   Prototype Left Side Hand Hold-3           128.   Prototype Right Side Hand Hold-4           129.   Prototype Left Side Hand Hold-4           130.   Prototype Right Side Hand Hold-5           131.   Prototype Left Side Hand Hold-5           132.   Prototype Right Side Mid Strap Aperture-1           133.   Prototype Left Side Mid Strap Aperture-1           134.   Prototype Right Side Mid Strap Aperture-2           135.   Prototype Left Side Mid Strap Aperture-2