Raven EMS Education Program ManualTrauma Splint Backboard Long Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Explain the procedure to the patient (if conscious).
Take or direct manual stabilization of the c-spine in a neutral, in-line position; if resistance or extreme pain is noted, leave the head in the position found.
If the patient is prone and has a compromised airway, maintain c-spine stabilization and immediately log-roll the patient.
Assess CMS in all extremities.
Apply a cervical collar; if the patient is prone, place the collar after the patient has been rolled supine.
Position the immobilization device appropriately next to the patient.
Log-roll the patient onto the unaffected side, if applicable, and inspect/palpate the posterior side prior to rolling the patient onto the immobilization device.
Move the patient onto the immobilization device without compromising the integrity of the spine.
Elevate and pad under the patient’s head (adults) or shoulders (pediatrics) as necessary.
Adjust the position of the straps to accommodate the patient’s size as necessary (especially if a papoose or pediatric backboard is not available).
Apply padding to voids between the board and torso, legs, and straps as necessary.
Immobilize the torso first, and then immobilize the legs to the device.
Immobilize the patient’s head to the device.
Secure the patient’s arms as necessary to the board/torso.
Reassess CMS in all extremities.
Accepts evaluation and criticism professionally.
Shows willingness to learn/asks appropriate questions.
Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).
Passing criteria:
Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
Fail.
Fails to take or verbalize infection control precautions prior to performing procedure.
Did not explain and reassure the patient to allow informed consent.
Does not direct manual immobilization of the head.
Orders release of manual immobilization before it is maintained mechanically.
Does not complete immobilization of the torso prior to immobilizing the head.
Applies the device so that it excessively moves up, down, left, or right on the patient’s torso.
Provides head immobilization that allows for excessive movement.
Does not immobilize the head in a neutral in-line position.
Places a cervical collar on a prone patient prior to rolling supine.
Provides immobilization that allows for potential airway compromise.
