Patent Publication Number: US-2007101501-A1

Title: Patient immobilization device

Description:
RELATED APPLICATIONS  
      This application is a divisional patent application of, and claims priority to, U.S. patent application Ser. No. 11/103,281, filed Apr. 11, 2005, and entitled “Patient Immobilization Device,” which is a divisional application and claims priority to U.S. patent application Ser. No. 10/335,523, filed Dec. 31, 2002, and entitled “Patient Immobilization Device,” now U.S. Pat. No. 7,036,167, which patent and application claim priority to Provisional Application Ser. No. 60/359,622, filed Feb. 26, 2002, and entitled “Backboard with Head Immobilizer,” which patent and applications are all incorporated herein by reference in their entireties. 
    
    
     FIELD OF THE INVENTION  
      This invention relates generally to a patient immobilization device including a backboard and head immobilizer used to support and immobilize injured patients.  
     BACKGROUND OF THE INVENTION  
      In accidents involving apparent injury to the head, neck, and/or spine, the patient is immobilized for treatment and transport. Specifically, the head and cervical spine areas of the patient are routinely immobilized to prevent further injury during transport to a medical facility. For such immobilization, devices such as rigid backboards are typically used to support and assist in immobilizing the patient during this time. A head immobilization device or immobilizer is used with the backboard. For example, the patient is placed on a board and stiff pillows or blocks are placed tightly on either side of his head. A combination of headstraps, chinstraps, and tapes are then tightly secured over the pillows/blocks and the board to fixedly hold the patient&#39;s head in place on the board.  
      Currently, there are several typical types of head immobilizers in use that are incorporated generally with a flat backboard. One type of head immobilization system utilizes a pair of reusable blocks, which are formed of a pliant, yet supportive material such as rigid foam or a suitable vinyl material. Generally, such blocks are secured to a board with hook and loop fastening structures, such as Velcro™.  
      Another type of immobilizer is disposable and utilizes inexpensive cardboard, which is manipulated to form a support structure for the head and neck. Generally, such a cardboard material is temporarily coupled to a backboard with an adhesive material. Other types of head immobilization systems utilize a combination of reusable and disposable elements that may be temporarily coupled to a backboard.  
      Although such systems have proven suitable for use with a backboard to immobilize a patient, they present other problems. While reusable foam or vinyl blocks may be relatively inexpensive, due to reuse, they must be repeatedly cleaned and maintained after each use to prevent the transmission of unsafe pathogens, either through blood or other bodily fluid, such as vomit. Repeated cleaning of the blocks may cause premature deterioration of the blocks and their covering or outer skin. Also, foam material can effectively turn into a sponge, thus trapping blood-borne pathogens and other pathogens. As such, after a certain amount of use, even reusable blocks will need to be replaced.  
      Another problem with such reusable blocks is that they are difficult to store when not in use. Emergency medical vehicles provide little excess storage space for equipment and materials. Therefore, generally, the reusable blocks are stored in a location that is remote from the tall narrow opening provided for backboard storage, such as in an ambulance. Separation of key pieces of the patient immobilization equipment for the purpose of storage can often lead to lost or misplaced items. This is particularly critical at an accident or medical emergency when the retrieval time may be critical for the patient&#39;s health and well being. Accident scenes are often chaotic environments involving multiple emergency medical service providers. Therefore, any lost time involved in gathering up all the pieces necessary for head and neck support and patient immobilization is particularly undesirable.  
      Furthermore, because the blocks are separate pieces from the board, they often become lost or are mistakenly collected by other medical providers, such as at an accident scene or during equipment recollection at a medical facility. As may be appreciated, patients may come into a hospital emergency room, supported and immobilized on the equipment of several rescue teams. The rescue teams then return to the scene of the accident for other patients or victims, or go out on other calls, and they leave the equipment at the hospital with their patients. After the equipment is removed, it is often placed in a common area for the various teams to recover. During such recovery, one team or unit may inadvertently grab the equipment of another unit.  
      Single-use, disposable head immobilization devices and systems do have some advantages over reusable systems in that they are generally smaller, are easier to store in an ambulance, and do not have to be recovered because they are discarded after one use. Furthermore, since they are not reused, they do not have to be cleaned and they do not present a significant risk with respect to transmission of unsafe bodily fluids from one patient to the next. However, because they are single-use devices, an emergency medical service provider must purchase and store a sufficient amount so as not to run out during response to an emergency situation. This requires frequent purchases, control of inventory at a central storage area, and distribution of the devices to all the vehicles that would use the devices. This essentially increases the overall cost of the equipment for an emergency service provider.  
      Furthermore, because such single-use devices often utilize adhesives for attachment to a backboard, repeated attachments require the removal and cleaning of the board proximate the adhesive. Repeated cleaning of the adhesive portions of the device after each use becomes a nuisance for the user.  
      Another drawback with disposal head immobilization devices is that they often use cardboard as their primary construction material. Many patients and the public, in general, do not perceive cardboard as a particularly robust material as compared with other materials used to make emergency medical equipment, such as rigid plastic used to make backboards and cervical collars. Patient and public perception of high quality care and equipment materials is an important factor in providing satisfactory service from emergency medical providers. Notwithstanding perception, the robustness of the devices themselves is important. Some patients may require intubation tubes to assist with breathing. Intubated patients who dislodge their tubes would have to be immediately attended to in order to maintain an unobstructed airway. One prevalent cause of a dislodged intubation tube is movement, particularly head movement, which can occur when a patient is panicking or is having a seizure. Therefore, it is important to have robust head immobilization devices that are sufficiently coupled with the backboard in order to keep patients from dislodging their intubation tubes.  
      Therefore, there exists a need for a patient immobilization device which addresses these issues. The present invention addresses various of the above drawbacks in the prior art and provides other advantages to assist in the care of patients requiring head and neck immobilization.  
     SUMMARY OF THE INVENTION  
      The patient immobilization device, the present invention, comprises a backboard having a front side and a back side. Generally, the patient is placed on the front side while the back side rests against a surface, such as the ground. A pair of opposing paddles are slidably mounted on the backboard and are configured to move between a storage position up against the backboard in a support position where they support the head and neck of a patient lying on the backboard. Each paddle has a leg portion depending therefrom and extending through a respective slot formed in the backboard between the front and back sides. Securing the paddle with the backboard is a spanning portion that depends from the leg portion and engages the back side of the backboard. When the paddle is moved between the storage position and the support position, the spanning portion moves in a generally arcuate path. In that way, while the paddle is held in place in the storage and support positions, it is freely movable between those positions, as the spanning portion moves in an arcuate path away from the backboard.  
      In one embodiment of the invention, index structures are utilized to secure the paddles into place in the support position. The index structure may be positioned on a front or a back side of the backboard. On the front side of the backboard, the index structure is engaged by the body of the paddle. On the back side of the backboard, the index structure may be engaged by the spanning portion of the paddle. In one embodiment, the spanning portion is a dowel that extends outwardly from a leg portion or between multiple leg portions. The paddle or spanning portion engages an index structure in the form of a plurality of grooves. Preferably, the grooves are open-ended and open into slots formed through the backboard so that the grooves may be easily cleaned and do not trap blood or other debris.  
      In an alternative embodiment of the invention, a friction engagement of the paddle and the backboard, rather than an index structure, ensures that the paddle is locked and placed into the support position. In one embodiment, a cam structure is coupled with a leg portion of the paddle and engages the back side of the backboard when the paddle is moved to the support position to secure the paddle into place. When the paddle is moved between the storage position and the support position, the cam structure is disengaged and the paddle may be slid to the desired position on the backboard to accommodate the width of the patient&#39;s head.  
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
      The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with a general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the invention.  
       FIG. 1  is a perspective view of one embodiment of the present invention.  
       FIG. 1A  is a side view, in cross-section, of a paddle of the present invention, in a storage position.  
       FIG. 1B  is a side view, similar to Figure a!, of a paddle moving between a storage position and a support position.  
       FIG. 1C  is a side view, in cross-section similar to  FIG. 1A , of a paddle in the support position.  
       FIG. 1D  is a perspective side view of an embodiment of a paddle of the invention.  
       FIG. 2  is a partial perspective view of one embodiment of the invention illustrating an immobilized patient.  
       FIG. 3  is a perspective view of an alternative embodiment of the present invention.  
       FIG. 4  is a bottom plan view of one embodiment of the backboard of the present invention.  
       FIG. 5  is a cross-sectional view along lines  5 - 5  of  FIG. 4 .  
       FIG. 6  is a perspective view of an alternative embodiment of the present invention.  
       FIG. 7  is a perspective view of an embodiment of the invention illustrating paddles in the storage position.  
       FIG. 8  is a side view, in partial cross-section, of a paddle of the invention in the support position.  
       FIG. 9  is a perspective view of an alternative embodiment of the present invention.  
       FIG. 10  is a side view, in partial cross-section, of an alternative embodiment of the invention illustrating the paddle in the support position.  
       FIG. 11  is a perspective view of an alternative embodiment of the present invention with paddles in the storage position.  
       FIG. 12  is a side view, in partial cross-section, of an alternative paddle of the present invention.  
       FIG. 13  is a side view, in partial cross-section, of another alternative paddle of the present invention.  
       FIG. 14  is a side view, in partial cross-section, of an alternative embodiment of the present invention.  
       FIG. 15  is a perspective view of an alternative embodiment of the present invention, with the exemplary paddles removed for clarity.  
       FIG. 16  is a partial cut-away perspective view of an alternative index structure of the present invention.  
       FIG. 17  is a partial cross-sectional view of an alternative embodiment of the invention.  
       FIG. 18  is an end cross-sectional view of another embodiment of the invention.  
       FIG. 19  is a side cross-sectional view of the embodiment in  FIG. 18 .  
       FIG. 20  is an end cross-sectional view of another embodiment of the present invention. 
    
    
     DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION  
      Referring to  FIG. 1 , a perspective view of a patient immobilization device  10  of the invention is illustrated. Generally, such a device comprises a backboard or backboard portion  12 , having a top side or front side  14 , and a bottom side or back side  16 . In use, a patient would generally be placed on the front side  14 , with their feet at the foot end  18  of the backboard and their head at the head end  20  of the backboard. For securing the head and neck of a patient, the invention utilizes a pair of opposing paddles  22   a  and  22   b , which are slidably mounted on the backboard  12 , and are configured, in a support position, to support the head and neck of a patient. Embodiments of the paddles  22   a ,  22   b  are illustrated in the support position in  FIG. 1 .  
      Referring to  FIG. 2 , the head  23  and neck  25  of the patient  26  are secured and immobilized between the paddles during use. The body of the patient  26  lies along the length of the backboard  12 , and often is secured to the backboard with straps, tape or other securement structures (not shown). As illustrated in  FIGS. 1A, 1B , and  7 , and discussed herein below, the paddles are movable between a support position or upright position, as illustrated in  FIG. 1 , and a storage position or flat position (see  FIG. 7 ) for storing the device  10  when not in use.  
      The backboard  12  can be made out of wood, plastic, or any other suitable, and preferably light weight, material for supporting a patient with their head and neck immobilized between the paddles  22   a ,  22   b.    
      The paddles may be made of a suitable rigid and light weight material, such as wood or plastic. For example, a polypropylene plastic, or high density polyethylene (HDPE) might be suitable. Paddles  22   a ,  22   b  include a layer or portion  28  of a conformable material for providing cushioning and comfort to the head  23  of the patient while providing a level of conformability to the paddles, for better securement and immobilization of the head and neck. For example, the layer  28  might be made of a conventional foam, such as a polyurethane foam, covered in a protective skin for cleanability. The protective skin  29  on the foam  28  provides an impermeable membrane for resisting the collection of bodily fluids and bacteria. Such a foam material is desirable both for its durability and its resistance to extreme temperatures and harsh chemicals, such as disinfectants.  
      To provide further comfort for an immobilized patient, a cushion  30  or a cushioned area between the paddles  22   a ,  22   b  might be used for cushioning the back of the head  23  of the patient. When a patient  26  is secured with the inventive device  10 , as illustrated in  FIG. 2 , the backboard  12  may then be lifted utilizing hand holes  32 , as are conventional with backboards.  
      Referring to  FIG. 3 , the layer  28  or layer material, may be removable, such as for cleaning purposes. For example, the cushions  23  might be held to the paddles  22   a ,  22   b  by a suitable adhesive, by hook/loop fasteners, or by physically sliding the layers into tracks (not shown) formed within the paddles. Other suitable securement methods may also be utilized to removably secure the layers  28  with the paddles  22   a ,  22   b . Preferably, the material utilized to form the paddles and any conformable layers  28  herewith is x-ray translucent so that x-rays may be taken with the patient in a stabilized position, as illustrated in  FIG. 2 .  
      The paddles  22   a ,  22   b  and associated conformable layers  28  have openings  34  formed therein so that the patient may hear better, such as for hearing instructions from a care giver or emergency medical personnel. Often overlooked during patient transport is the patient&#39;s ability to hear. The ear holes  34  are free from obstructions, thus decreasing the possibility of miscommunication with an injured patient.  
      Furthermore, the openings  34  allow visual inspection of the ears, or fluid coming from the ears, which is often indicative of head trauma. The ear holes, or openings  34 , are placed to allow for greater visualization of a patient&#39;s ear. Ear holes  34  allow for better visualization and touch by medical personnel. In that way, they provide important diagnostic information about the type and extent of the injury by the type and amount of any fluid drainage of the ear. In one embodiment, the ear openings or ear holes  34  have an aspect ratio (i.e., the ratio of the depth or thickness of the paddle at opening  34  to the width or length of the opening  34 ), conducive to better hearing.  
      In an alternative embodiment of the paddles, as illustrated in  FIG. 13 , the paddle might be split into multiple sections for visual and manual examination. One section is movable to a storage position to expose a portion of the head and/or neck while the other section remains in a support position to support the head and/or neck. Paddle  22   c ,  FIG. 13 , includes two sections:  36  and  37 , which may be coupled together with a coupling structure such as a clasp, key, or other structure. For example, in  FIG. 13 , rotatable keys  38  are shown that rotate into appropriately formed key slots  39 , formed in sections  36 ,  37 . The keys  38  in slots  39  assure that the paddle sections stay together to form the unitary paddle  22   c  for immobilizing the head and neck of a patient. When it is desirable to physically examine the neck or part of the head, the appropriate section of paddles  22   c  may be uncoupled and folded to a storage position to allow access to a portion of the head or neck. The other section remains in the support position to continue to support the head and neck. Then, the section can be folded back up into a support position, and secured to form a unitary paddle  22   c.    
      The shapes of the paddles, which are shown generally in a side view to resemble the shape of a “D” or “O”, provides support for both the temporal and parietal areas of the skull, while also providing support for the zygomatic arch and any cervical collar utilized on the patient, as illustrated in  FIG. 2 . To secure the patient&#39;s head and neck between the paddles and to hold the paddles in a support position against the head and neck of the patient, one or more straps  40  or other securement structures are utilized. The straps span between the paddles, as illustrated in  FIG. 2  and hold them in the support position. In accordance with one aspect of the invention, the straps  40  are integral with the device  10  and remain with it even when stored. In that way, the necessary straps are always with the device and do not have to be separately stored and retrieved. In the embodiment shown in  FIGS. 1 and 2 , one end of the straps is secured to the device  10 , while a free end may be spanned between the paddles, based upon the width of the patient&#39;s head and the separation of the paddles. Securement, adjustability, and storage of such straps  40  are discussed herein below, in accordance with other aspects of the invention. Also, as noted below, other securement structures (i.e., tape, separate straps) might be utilized.  
      In accordance with one aspect of the present invention, the paddles  22   a ,  22   b  are secured to the backboard  12 , and remain with the device  10  not only when in use, but also when it is stored. To that end, the paddles are movable from a support position, as illustrated in  FIGS. 1 and 2 , to a storage position, as illustrated in  FIGS. 1A and 7 . In one embodiment of the invention, the paddles are essentially rotatably mounted with respect to the backboard, and rotate between the storage positions and support about axes, which are generally parallel with the longitudinal axis of the backboard. Referring to  FIGS. 1A, 1B , and  1 C, the rotation of the paddles in one embodiment is illustrated. As discussed below, portions of the paddles, which extend through the board and along the back side, travel in a generally arcuate path between the storage and the support position. Referring to  FIG. 7 , in one aspect of the invention, the backboard, proximate the head end  20 , forms a recess  42  to receive the paddles  22   a ,  22   b  in the storage position so that the paddles are generally flush with or below the front side surface  43  of the backboard proximate the head end  20 . As is illustrated in  FIG. 7 , a raised area of the backboard is formed proximate to the head end to create such a recess to receive the stored paddles. Alternatively, the backboard  12  might be molded so as to form indents into the board to receive the paddles. For example, the entire thickness of the backboard might match that shown at the head end in the embodiment illustrated in  FIGS. 1, 2 , and  7  with a recessed area  42  formed therein for the paddles. The paddles  22   a ,  22   b  and the recessed area  42  may be appropriately configured and dimensioned to provide an interference fit for the paddles to keep them in the storage position until needed for use. For example, an interference or friction fit at the edges  46  of the paddle might keep them in the recessed area  42  until they are pulled upwardly to a storage position. Alternatively, some kind of latching or securement mechanism might be used to keep the paddles in place.  
      In accordance with another aspect of the present invention, the opposing paddles  22   a ,  22   b  are also slidably mounted with respect to the backboard to adjust their positions on the backboard. When the paddles are pulled up from the storage position and toward the support position, they may then be freely slid toward each other or apart to adjust to the width of the patient&#39;s head, neck, or any other medical gear or items attached thereto. Generally, in the storage position, the paddles are at 0 degrees with respect to the front side  14  of the backboard, or with respect to the overall plane of the backboard. In the support position, as illustrated in  FIGS. 1 and 2 , the paddles are approximately generally perpendicular to the front side  14  or to the plane of the backboard  12 . Of course, the paddles may be angled somewhat from a perpendicular position, and it is not critical that they are at 90 degrees with respect to the plane of the backboard in the support position. In accordance with an aspect of the invention, the paddles are configured so that generally when they are oriented at an angle between the range of approximately 20 degrees to 70 degrees from the plane of the backboard, they may be slid freely together and apart for proper adjustment. Of course, angled outside this range, they may slide as well, just not as freely. Once in the support position or perpendicular position, they engage a respective index structure, as discussed herein below, to lock the paddles at a desired separation for support of the patient&#39;s head  23  and neck  25  as illustrated in  FIG. 2 .  
      Turning now to  FIGS. 1A, 1B  and  1 C, the paddles include one or more leg portions  50  that extend or depend from the head-engaging section or body of the paddle. Referring to  FIG. 1A , a cross-sectional side view of a paddle  22   a  is illustrated showing a leg portion  50  depending from a head-engaging portion or body  51  of the paddle. The leg portion  50  extends at an angle with respect to a plane  53  formed by body  51  of the paddle. In one embodiment, leg portion  50  extends generally approximately 45 degrees with respect to a plane  53  formed by paddle body  51 . To accommodate and accept the leg portion or portion of the paddle, respective slots  56  are formed in the backboard proximate to each paddle and specifically proximate to the leg portions dependent therefrom (See  FIG. 1 ). The number of slots may vary, as discussed below. For example, the embodiment illustrated in  FIGS. 1 and 2  utilizes a pair of slots per paddle corresponding to the pair of leg portions depending from the paddles. The slots extend generally transverse to a longitudinal axis of the board.  
      Referring to  FIG. 1D , two leg portions  50  are shown extending from paddle  22   a . The paddles also include spanning portions  60  that depend from the leg portions and engage the backboard to secure the paddle with the backboard. In the embodiment illustrated in  FIGS. 1 , and  1 A- 1 C, the spanning portion  60  of the paddle is in the form of a pin or dowel  60 , which spans between the leg portions  50  of the paddle. In the embodiment of  FIG. 1 , the spanning portion  60  spans generally along the back side  16  of the backboard, securing the paddle to the backboard (See  FIG. 8 ). Furthermore, as noted below, the spanning portion  60  prevents the various paddles from being over-rotated in the support position so that they continue to remain at their desired support angle (e.g. 90 degrees) and to support the head and neck of a patient even when the backboard is turned on its side.  
      The spanning portion  60  of the paddle, such as the dowel or pin illustrated in  FIGS. 1A-1C , allows the paddle to be moved transversely on the backboard to space the paddles apart or to move them closer together to accommodate the patient. When the paddles are rotated upwardly from the storage position ( FIG. 1A ) and generally upwardly through a range of approximately 20 degrees to 70 degrees above the plane of the backboard ( FIG. 1B ), the paddle may slide freely transversely on the board as illustrated by arrows  62  in  FIGS. 1A, 1B . As shown in  FIG. 1C , when the paddle is moved to the support position, the spanning portion  60  engages the backboard, such as by engaging the back side  16  of the backboard, and along with other portions of the paddle, prevents the paddle from being over-rotated in the direction of arrow  64  significantly past a desirable support position, such as a generally perpendicular position. In one embodiment, it is desirable that the paddle is prevented from movement beyond approximately 20 degrees from the perpendicular or beyond approximately 110°. Of course, the paddles might be confined even closer to the perpendicular, like under approximately +10 degrees or +5 degrees from that position. The spanning portion is held into position by the leg portions  50  of the paddle, which have appropriate openings formed therein. That is, the dowel in the illustrated embodiment is a separate part slid into appropriate openings formed in the leg portions. The dowel has a head  55  (See  FIGS. 1C, 8 ) to secure it at one end. The spanning portion or dowel is then locked into place by securing the other end of the dowel with clips or other structures  57  (See  FIGS. 1C, 8 ). Alternatively, the spanning portion might be integrally formed with the leg portions of the paddle to span between the leg portions and secure the paddle with the backboard. Again, although two leg portions are shown for each paddle, a greater or lesser number of leg portions may be utilized with suitable spanning portions for engaging the backboard to secure the paddle to the backboard. As noted, spanning portion may be integral with the leg portions, such as being molded with the leg portions. In the embodiment of the paddle as illustrated in the Figures, the leg portions are generally molded or formed integral with the paddle which as being molded with the paddle. Alternatively, they might be separately formed similar to the spanning portion  60 , then secured to the paddle body  51 . Preferably, any securing structures such as screws or bolts, which couple portions of the paddle together, are x-ray translucent.  
      In accordance with one aspect of the invention, in order to provide the necessary clearance between the spanning portion  60  and the paddle body  51  for the purposes of movement of the paddles closer together or further apart, the spanning portion moves in a generally arcuate path between the storage and support positions. Referring to  FIGS. 1A, 1B , and  1 C, in the storage position, the spanning portion  60 , such as the dowel, rests against the back side  16  of the backboard. Generally, friction, and the engagement of the paddle body  51  and spanning portion  60  against the sides of the backboard, prevents or hinders movement of the paddle laterally on the board when it is in a storage position and the backboard is stored. When the paddle is folded up or hinged up toward the support position, as illustrated in  FIG. 1B , the spanning portion  60  travels a generally arcuate path away from the back side  16 , and then again toward the back side  16  when the paddle is locked in the support position, as illustrated in  FIG. 1C . That is, as illustrated in  FIG. 1B , movement of the spanning portion along the generally arcuate path  63  moves the spanning portion  60  away from the back side  16  to allow for lateral movement of the paddles, such as in the direction of arrow  62 . The spanning portion is disengaged from the backboard and the paddle is free to move or slide. Such generally arcuate movement of the spanning portion provides for easy adjustment of the paddles when they are between the storage and support positions. The arcuate path also ensures that the spanning portion subsequently engages the back side of the backboard to ensure that the paddles are held appropriately or locked in their storage and support positions. Usually, depending upon the positioning of the paddles, the spanning portions  60  will not take a purely arcuate path, as illustrated in  FIG. 1B , because the paddles will also be moved laterally, once they are out of the storage position. For example, the spanning portion  60  might move arcuately to the position illustrated in  FIG. 1B , and then might move in a linear fashion (arrow  62 ) as the paddles are adjusted to their proper widths for supporting the head and neck of a patient. Then, as the paddles are moved the rest of the way up to the storage position, as illustrated in  FIG. 1C , a generally arcuate path might again be traversed by the spanning portion  60 . Therefore, as used herein, the term “generally arcuate path” does not require that the arc be continuous, but only that the spanning portion move away from the back side of the backboard and then back toward that back side for movement between the storage and support positions.  
      Referring to  FIG. 8 , a side view of the paddle is shown, in partial cross-section, wherein the paddle is in the support position. As illustrated, the spanning portion  60  spans between the leg portions  50  and engages a portion of the backboard, such as the back side  16  of the backboard to secure the paddle and prevent the paddle from rotating in a storage position generally beyond perpendicular or some other desired angle. In accordance with one aspect of the present invention, the spanning portion engages the backboard when the paddle is moved to the support position and restricts movement of the paddle in the support position significantly beyond 90 degrees from the plane of the backboard. Preferably, in the illustrated embodiment, the spanning portion  60  maintains the paddle generally close to perpendicular. In that way, the neck and head of a patient are maintained in a desirable position on the backboard when the backboard is moved, and particularly when it is turned on its side. As may be appreciated, with the head secured between the paddles, such as with straps  40 , turning the backboard  12  on its side, such as to move the patient between a doorway or some other opening, puts significant stress upon the upper portions of the paddle pair because the weight of the head cantilevers from that paddle. In the present invention, with the paddles prevented from rotating in the support position significantly beyond perpendicular or 90 degrees; this ensures that proper immobilization of the head and neck is maintained during movement of the patient. Generally, when the straps  40  are secured into position snugly on the head and neck of a patient, the paddles will be secured in a generally perpendicular position, ensuring full contact between the sides of the paddles and the head and neck of the patient. Proper utilization of the securement straps and proper positioning of the paddles on the sides of the head ensure that the paddles will generally not be less than approximately perpendicular or 90 degrees from the plane of the backboard.  
      In accordance with another aspect of the present invention, in the support position, the paddles are locked into position at the proper spacing, utilizing index structures that are engaged by the paddles. The paddles generally engage their respective index structures when the paddles are moved to the support position and thereby are locked relative to each other to support a patient&#39;s head and neck. Preferably, they are locked in a position that is centered about the center of the longitudinal axis of the backboard so that the patient&#39;s head and neck are centered on the backboard with the patient.  
      Referring to  FIG. 1 , index structures  70  are illustrated positioned on a front side of the backboard. The index structures  70  of  FIG. 1  are in the form of a plurality of grooves (See  FIG. 7 ), which extend longitudinally with respect to the backboard&#39;s long axis. The grooves  72  define various index points along the index structure for positioning of the paddles  22   a ,  22   b . The grooves  72  may be formed as individual index structures for each paddle, as illustrated in the Figures. Alternatively, they may be part of a continuous index structure with a portion of the index structure being utilized for each respective paddle. The embodiment in  FIG. 1  shows two individual index structures  70 , one for each paddle. The index structures are positioned proximate a side of the slot or slots.  
      The index structures, such as grooves  72 , may be integrally formed with the backboard  12 , such as by being molded as part of the backboard. Alternatively, the index structure or structures might be separately formed and then secured to the backboard. For example, the grooves  72  might be formed in a plate that is then fastened to the backboard, such as with screws or other fasteners. While the grooves  72  are shown somewhat elongated to engage in an elongated, protruding ridge  74  of the paddles, as discussed below, they might be shortened to essentially form indents. The protruding ridge  74  would then be appropriately shortened to essentially form a knob to engage the indent and secure the transverse or lateral spacing of the paddles  22   a ,  22   b.    
      To lock the paddles into position with respect to each other and to prevent them from being spread apart when the head and neck of the patient has been immobilized, a portion of the paddle engages the respective index structure. Specifically, in an embodiment illustrated in  FIGS. 1 and 1 A- 1 C, a protruding ridge  74  engages a respective groove  72  of the index structure  70 . Referring to  FIGS. 1A and 1B , when the paddle is moved from the storage position and is positioned generally in the range of 20 degrees to 70 degrees above the plane of the backboard, the spanning portion  60  and the ridge  74  of the paddle are not forced to engage the backboard and the grooves  72 , respectively. That is, they are double open-ended grooves. In that way, the paddle slides freely in the direction of arrow  62  (see  FIG. 1A ) to the proper position, such as close to the neck and head of a patient lying on the backboard. At the proper position the paddle can be moved or rotated completely upwardly to the support position, which, for example, may be generally perpendicular to the plane of the backboard. At that time, the spanning structure  60  is forced into engagement with the backboard such as the back side  16  of the backboard, and the ridge  74  meets and slides into a particular groove  72  to lock the paddle at an index point on the index structure. As illustrated in the cross-section of  FIG. 1B , the ridge  74  seats within the respective grove  72  when the paddle is in the support position. The engagement of the index structure by the paddle in that way laterally locks the position of the paddle so that it cannot be moved apart from the opposing paddle. With both the paddles in the support position and locked in such a way, the width or spacing between the opposing paddles for accommodating the head and neck of the patient is fixed. The present invention may accommodate a wide variety of head widths, ranging from pediatric to adult, even up to a patient with a helmet, such as a motorcycle helmet, on their head.  
      As illustrated in  FIG. 1 , the ridge  74  is dimensioned to generally span the length of the grooves of index structure  70  to provide proper securement of the paddles in the proper position. The spacing between the various index grooves  72  and the length of the grooves and the ridge  74  may be varied depending on the desired spacing of the indexing points and the robustness of the paddles and their securement. When the paddles are moved to the vertical or support position with respect to the backboard, the protruding ridges  74  are preferably configured to fit somewhat snugly into the grooves  72 . This allows the paddles to freely stand up in a support position while simultaneously locking the transverse position of the paddles on the backboard. The straps  40  can then be applied to span the head and neck of the patient and between the opposing paddles as illustrated in  FIG. 2 .  
      In accordance with another aspect of the present invention, it is desirable that a backboard, particularly the head and neck restraining portion of such a backboard, be readily and easily cleanable. Prior art backboard and prior art head/neck immobilization structures have provided a plurality of cavities and recesses in which blood or other bodily fluids might collect when in use. To then clean and sanitize the structures for the next use, medical personnel must painstakingly scrub the structures and get into the various cavities to reduce the risk of transmission of fluid and blood-borne pathogens and contamination of a subsequent patient. In the present invention, the grooves  74  are open at their ends and open into the respective slots  45 , as illustrated in  FIGS. 1, 2 , and  7 . In that way, the grooves can be wiped clean without any corners or walls for catching fluids. That is, the contents of the grooves can be wiped into the slots  56  which are open and therefore subject to easy cleaning. Alternatively, a fluid such as water or a disinfectant can be sprayed down into the grooves and will easily flow out the open ends and into the slots  56 , and thereby off the backboard.  
      To secure the paddles together in a support position to support a patient&#39;s head and neck, straps  40  may be utilized to span between the paddles and over a patient&#39;s head and neck, as illustrated in  FIG. 2 . Referring to  FIG. 6 , such straps may be made of tape  40   a  that span across the top edges of the paddle and are secured to the edges of the backboard in the typical securement methodology. However, by spanning tape across the top edges  80  of the paddle, the height of the securing straps or tape  40  is set by the height of the paddles. This may not provide desirable securement of the patient&#39;s head and neck, particularly for smaller patients such as infants and toddlers whose heads will be significantly below the height of the edges. In accordance with another aspect of the present invention, the strap  40  is adjustable in height on the paddle to adjust to different head height. Referring to  FIGS. 1 and 2 , openings  82  are formed in the paddles to receive the straps  40  at different heights on the paddle. Two such vertically spaced openings  82  are shown in the embodiment of the Figures. However a greater number of openings may be utilized for adjustment purposes. In that way, rather than spanning over the top edges  80  of the paddles, the straps  40  extend through the paddles and thereacross to span across the patient&#39;s head as illustrated in  FIG. 2 . The corresponding openings  82  are formed in each paddle for each strap utilized. In the illustrated embodiment, two straps are utilized, one at the forward end of the paddle (closest to the patient&#39;s forehead) and one at the rearward end of the paddle (closest to the patient&#39;s chin). The ends of the straps may be coupled to the backboard in any suitable fashion.  
      In the disclosed embodiments, a single strap is secured to each paddle and is secured with that paddle. The strap then spans across to the other paddle and is secured into position with an appropriate fastening technique. Referring to  FIGS. 1 and 2 , an end of the strap  40  is shown secured at a leg portion. Specifically, referring to  FIG. 1C , the leg portions  50  are split into separate sections to allow the strap  40  to be secured around the spanning portion  60  that engages the leg portion  50 , such as a dowel or pin. For example, the strap end might be slid around the dowel and be sewn. For immobilizing the head and neck, the free end of the strap is placed through the desired openings  82  in the paddles, over the head and neck of the patient, and through similar openings in the other paddles. As illustrated in  FIG. 2 , multiple straps, one on the forehead, and one proximate to the chin, might be utilized. The free end of the strap is then secured with an appropriate method, such as with adhesives, a buckle, hook/loop fasteners, or other securing mechanisms. In the illustrated embodiment, a cam buckle  86  is utilized to receive the free end of the strap  40 .  
      Therefore, in accordance with one aspect of the present invention, the strap is integral with the immobilization device  10  and is stored with the backboard along with the paddles  22   a ,  22   b  to be readily available for use. Therefore, precious time is not wasted in securing paddles or blocks to the board and then securing the head between the paddles and block such as with separate tape or strap structures. While the straps  40  are shown secured to opposite paddles, they might be fixed to the same paddle with both free ends extending over to the other paddle.  
      The present invention contemplates storage of the straps with the paddles in the storage position. In accordance with another aspect of the present invention, the paddles are configured for storing the straps out of the way when the paddles are in the storage position. In one embodiment, as illustrated in  FIGS. 1, 2 , and  3 , an indent  88  is formed in the back of the paddle for receiving a folded strap. When the paddle is then folded to the storage position, an interference fit keeps it within the paddle to keep it out of the way to prevent it from being caught during storage of the immobilization device  10 . Alternatively, as illustrated in  FIG. 6 , raised walls  90  might be utilized to capture the strap  40  to secure it in an interference fit when the paddles are in a storage position. Therefore, once the strap is folded and loaded into the paddle, it is prevented from becoming loose by a tight interference fit.  
      An alternative embodiment of the invention is illustrated in  FIG. 3 . Layers  28  utilized with the paddles  22   a ,  22   b  may be removable for being disposable, or disinfected and reused. For example, they might be fastened by a suitable adhesive or hook/loop fasteners to be readily pulled away from the paddles after each use and discarded. Alternatively, they might slide into tracks or otherwise engage paddles  22   a ,  22   b  to be easily removed and replaced after each use so that the layer does not need to be cleaned. Referring to  FIG. 13 , if the paddle is split, a suitably split cushion is utilized to allow the separate sections of the paddle to be separated as desired.  
       FIGS. 4 and 5  illustrate another aspect and embodiment of the present invention, which facilitates grasping and lifting the backboard by medical personnel, and also ensures sufficient operation of the paddles when they are adjusted. Referring to  FIG. 4 , the backboard  12  includes a network of raised areas  92  along the length of the backboard and also proximate the head end  20  of the backboard. The raised areas elevate the hand holes  32  off the ground to allow medical personnel to easily slide their hands underneath the backboard to lift a patient secured thereon. Generally, the hand holes  32  will be placed equidistant along the border of the backboard  12  to promote balance while carrying the patient. The raised areas might be formed by securing appropriate ridges to the back side of the backboard. Alternatively, such raised areas may be molded with the backboard, such as when the backboard is made out of a suitable plastic material. In accordance with another aspect of the invention as illustrated in  FIG. 4 , the hand holes  32  might include pins that span the holes and are configured for strapping to clips or straps such as for strapping a patient onto the backboard.  
      The raised areas  92  proximate the head end  21  provide proper clearance for movement of the leg portions  50  and spanning portion  60  of the paddles. Turning again to  FIGS. 1A, 1B , clearance for the lateral adjustment of the paddles is necessary so that the leg portions and spanning portion are not hindered. Similarly, interference between the paddle and a ground or support surface is prevented so the paddles may be readily moved between storage and support positions.  
       FIGS. 9 and 10  illustrate an alternative embodiment of the invention, in which a single slot  56   a  is utilized rather than multiple slots, while the index structure is in the form of a plurality of grooves  72   a ,  72   b  positioned on either side of the slot  56   a . That is, the index structures  70   a , rather than spanning between two slots, is positioned on either side of the single slot  56   a .  FIG. 10  illustrates a paddle  22   d  that engages slot  56   a  and the index structure  70   a . The protruding ridge is divided into two sections  74   a  and  74   b , for engaging the respective grooves  72   a  and  72   b  in the index structure when the paddle  22   d  is moved to the support position as illustrated in  FIG. 10 . Paddle  22   d  includes a single leg portion  50   a  that engages the slot  56   a . The spanning portion  60   a  of the paddle  22   d  spans to either side of a leg portion  50   a  to secure the paddle to the backboard. In the embodiment illustrated in  FIG. 10 , the spanning portion is in the form of a pin or a dowel that extends through an appropriate opening formed in the leg portion  50   a  and spans along a back side of the board generally below the grooves  72   a ,  72   b  of the index structure. The pin or dowel is held into position on one side by a head  100  and on the other side by a clip  102 . Alternatively, as noted above, the spanning portion might be integrally formed with the leg portion  50  or the paddle  22   d , such as by being molded with either of those components.  
       FIG. 11  illustrates an alternative head end for an immobilization device of the present invention. The paddles utilized are similar to those illustrated in  FIG. 1 , although they could be any suitable paddles, included those illustrated herein. The head end  20  of the backboard in  FIG. 11  utilizes a raised area  104  that has recessed areas therein  106  for receiving the paddles  22   a ,  22   b  in the storage position. The raised area tapers at a rearward edge  108  down to the front side of the backboard. In that way, the raised area  104  defines an area for supporting the head of a patient and also demarcates a position at the rearward edge  108  for positioning the shoulders of a patient. That is, at the tapered demarcation provided at the rearward edge  108 , the medical personnel have a reference point for sliding the patient&#39;s body along the board for proper alignment of their head with the paddles. Because of different physiologies among patients, the edge  108  does not provide an exact point, but rather offers a reference point between the paddles. To receive the head, an indent portion  110  is formed to allow the head to nest between the paddles  22   a ,  22   b . The raised portion might be formed as a separate piece attached to the front side  14  of the boarded or it might be molded integrally with the board. The indent portion  110  in one embodiment includes a suitable cushion material, similar to cushion  30 , as illustrated in  FIG. 1 .  
       FIG. 12  illustrates an alternative embodiment of a paddle  22   e  in which the height of the paddle is raised to provide a wider and taller ear hole  34   e . Paddle  22   e  is configured to have an indent area  88  therein for storing the strap  40 . Furthermore, the paddle has openings  82  for positioning of the strap along the height of the paddle to adjust to different patient heads. To receive the free end of the strap  40 , such as from the other paddle, a buckle, such as a cam buckle  112  or other attachment device is utilized and is rotatable about a center axis as illustrated by arrow  114 . The other end of strap  40  is secured, such as by coupling with spanning portion  60 .  
       FIGS. 14-17  illustrate further alternative embodiments of the invention, and particularly illustrate an alternative index structure for locking the paddles at certain indexed positions on the backboard. Rather than being positioned on the front side of the backboard, the index structure is incorporated into slots formed through the backboard. Specifically, with respect to  FIG. 14 , a paddle  22   f  is shown and is somewhat similar to other paddles discussed previously, such as those shown in  FIGS. 7 and 8 . Therefore, like numerals are utilized where possible for similar components between the embodiments.  
      The index structure  70   b  includes a plurality of posts  120  that extend into slots  56   b  formed in the backboard. As illustrated in  FIG. 16 , two sets of posts in an opposing relationship extend into the slots  56   b  from a side wall  122  of the slots. The posts provide index channels  124  there between into which corresponding index tabs  126  slide when the paddles  22   f  are in the support position (see  FIG. 14 ). Therefore, the posts  120  provide an index structure  70   b  for indexing the paddle  22   f  at desired positions to provide for proper spacing between the opposing paddles to secure and immobilize the head and neck of a patient. Similar to the paddles discussed above, the paddle may be freely movable when raised to a position between the storage position and the support position and will slide transversely with respect to the slots  56   b  to vary the space between the opposing paddles. When the paddles are moved to a generally perpendicular support position and the spanning portion  60  of the paddle engages the backboard, the index tabs  126  engage the index posts  120  in the slots  156   b . More particularly, the index tabs  126  slide into the channels  124  created between the index posts. The embodiments illustrated in  FIGS. 14-17  further enhance the cleanability of the immobilization device of the invention by eliminating any cavity that catches fluid. Any fluid proximate to slots  56   b  and the paddles  22   f  and specifically fluid contacting the index structures  70   b  will be able to pass over the slots and various posts  120  that form the open channels  124 . In that way, water or other fluid may be directed down through the channels  124  and around the posts to keep them clean of blood or other bodily fluids.  
       FIG. 17  illustrates another alternative embodiment of the invention and shows a cross-sectional view of a backboard and paddle shaped for more closely conforming to the head of a patient. Specifically, paddle  130  is not generally similar to other paddles discussed herein above. Rather, the paddle has a concave shape toward the head and neck of a patient to provide better conformity around the head of the patient. The top  132  of the paddle  130  has a concave shape that will more closely conform to the side of the head of a patient. Paddle  130  may be made of a pliable material such as a plastic or hard rubber material that will allow it to more closely conform to a patient&#39;s head when in the support position. Straps, tape or other securing structures spanning between the opposing paddles  130  will secure the paddles in the support position and will more closely conform the paddles to the patient&#39;s head and neck. In one embodiment, the entire paddle may be formed of pliable material. Alternatively, the paddle might include a pliable tip section  134  that will provide conformity generally where the paddle engages curved portions on the side of a patient&#39;s head or neck. In another aspect of the invention, as shown in  FIG. 17 , the side of the backboard, proximate the head end  20  where the paddles are located, is formed to hold the conformable paddles  130  in the storage position. As illustrated in  FIG. 17 , the backboard  12   a  includes a side section  136  with an overhang  138  that captures the top portion  134  of the paddle. The compliant paddle may then be pulled from a storage position and out from the overhang  138  to be moved to the support position as illustrated in  FIG. 17 . Paddle  130  includes one or more leg portions  50   b , which extends through slots  56   c  formed in the backboard. A spanning portion  60   a  secures the paddle  130  with the backboard and provides a stop mechanism for the paddle in the support position to prevent over-rotation, as discussed above. In the embodiment of  FIG. 17 , an index structure  70   c  includes a plurality of posts  120   a  at index positions along the width of the board. Index tabs  126   a  on the paddles  130  engage channels  120   a  formed between the index posts  120   a  to laterally or transversely secure the paddle in a specific indexed position corresponding to a particular width of the head and neck of a patient. The embodiment of  FIG. 17  also provides the benefit of open channels  124   a  that do not collect bodily fluids and associated blood/fluid-borne pathogens. The paddles  130  may be secured around the head and neck of a patient such as with straps, tapes, or other securement structures. Furthermore, the paddles  130  may have other features such as ear holes and strap storage components similar to those in the embodiments discussed above.  
      In an alternative embodiment of the invention, as illustrated in  FIGS. 18 and 19 , a specific index structure with discrete index positions, is not utilized to hold the paddle in position when it is moved to the support position. Rather, a friction fit between elements of the paddle and the backboard provides the fixation of the paddle in a specific position. More specifically, the spanning portion and paddle body rest against respective back side and front side surfaces to secure the paddle in place in the support position. Referring to  FIG. 18 , paddle  140  has a paddle body  142  that moves between a support position and a storage position, as discussed above. One or more leg portions  144  depend from the paddle body and extend through respective slots  146  formed in the backboard. A spanning portion  60 , such as a dowel, spans from the leg portion or spans between and is secured by the leg portions  144 . In one embodiment, the spanning portion and paddle may be configured to pinch the backboard there between when the paddle is moved to the support position. That is, no index structure is utilized and the friction provided at the front and back sides of the backboard will hold the paddle in place. Alternatively, cam structures might be used as illustrated in  FIGS. 18, 19 . Positioned on the spanning portion  60  are one or more cams  148 , which are configured to engage a back side  16  or a portion of the backboard to lock the paddle when it is in the support position, as illustrated in  FIGS. 18 and 19 . In the embodiment illustrated in the Figures, two cams  148  are utilized, one associated with each of the leg portions  144  extending through the backboard. Referring to  FIG. 18 , when the paddle  142  is moved to the support position, the cam  148  includes a flat surface  150 , which engages a back side surface  16   a  of a portion of the backboard. Simultaneously, a portion of the paddle  152  engages a front side section  12   a  of the backboard. The cam  148  rolls about its pivot axis, which is generally co-axial with the dowel  60  to pinch itself and the paddle against respective surfaces of the backboard. For example, the surface  150  of cam  148  is directed against surface  16   a , while the paddle is directed against surface  12   a . The pinching provides a frictional engagement or interference with the backboard, such that the paddle is locked into the support position, as desired for supporting the head and neck of a patient. One advantage of the embodiment illustrated in  FIGS. 18 and 19  is that discrete index positions are not utilized. Rather, the paddles may be adjusted to a seemingly infinite number of different head widths along the continuous respective backboard surfaces  12   a ,  16   a . The cam  148  provides a wedging or pinching action in the support position; however, when the paddle is moved from the support position toward the storage position, the cam is free to pivot such that the flat surface  150  disengages from surface  16   a  to allow lateral movement of the paddle to a desired position.  
       FIG. 20  illustrates another embodiment of the present invention wherein the index structure  70  is utilized on the back side  16  of the board. Referring to  FIG. 20 , similar reference numerals are utilized to note similar elements. The index structure  70   a  utilizes grooves  72   a  at various index points along the index structure. The spanning portion  60 , such as a dowel, and the grooves  72   a  are configured such that the dowel can engage the grooves when the dowel is moved to the support position, as illustrated in  FIG. 20 . A bottom surface of the paddle  74   a  engages surface  16  of the backboard, and the paddle is thereby locked into position.  
      While the present invention has been illustrated by a description of various embodiments and while these embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. For example, various features are shown for the different embodiments, but those features do not have to all be used on a single device. Different combinations of features and components might be used on various different embodiments of the immobilization device. Additional advantages and modifications will readily appear to those skilled in the art. The invention in its broader aspects is therefore not limited to the specific details, representative apparatus and method, and illustrative example shown and described. Accordingly, departures may be made from such details without departing from the spirit or scope of applicant&#39;s general inventive concept.