Irrespective of your level as an EMS provider, the term "evidence-based medicine" should not be unfamiliar. Conceptually, it is a huge step in the evolution of medicine to let changes in the standards of care occur only when there is adequate science to support the changes. This is especially challenging in the field of pharmacology, where a significant number of drug labels declare "the exact mechanism of action is unknown." These drugs clearly work, but we don't know why. Does that mean that without science we will no longer be able to use these drugs? Of course not!
Given that mind-set, I find it amazing that the logroll maneuver continues to be taught as a first-line patient movement technique at all levels of EMS. Let me explain what leads me to say that.
Nearly 20 years ago, a study was done on the logroll maneuver using fresh cadavers with artificially created spine fractures. It was a small study, as I recall, with seven or nine cadavers. Even though the sample size was small, the information gleaned was important. In every case, there was significant anterior/posterior displacement during the logroll maneuver. Part of the displacement is easily attributed to anatomical differences between men and women. A woman with traditionally larger hips but a smaller shoulder girdle naturally "bends" over her hips during the logroll. By comparison, a male with much smaller hips but a larger shoulder girdle "collapses" down on his hips. In either case, the potential for some displacement of the spine is not just clearly evident, it is guaranteed. The question with each use is whether the displacement worsens an existing condition or creates a new one.
In today's research environment, it would be impossible to get an Ethics Review Board (ERB) or Institutional Review Board (IRB) to sign off on a spine study involving actual patients for the simple reason that we know with certainty what would happen if a spinal cord transected during a logroll. So while the revelation of that long-ago study was no surprise to anyone with a baseline understanding of human anatomy, and even though it involved cadavers, it, too, would be very difficult to get ERB or IRB approval for.
Another issue to consider is that it takes a minimum of three, and ideally four, people to pull off a logroll. For a rig staffed with a crew of two, that means you either call in another crew or give two people on the emergency scene a brief in-service. Neither choice is actually a good one. Bringing in a second rig with trained providers to perform a 30-second patient move is not a fiscally wise choice. Giving a couple of bystanders a brief in-service on the mechanics of performing a logroll and gambling that they can do the maneuver without turning the patient into a paraplegic or quadriplegic is beyond foolish.
Let's look at two other options. By far the simplest and safest choice is to use a scoop stretcher, for several reasons. First, it allows the patient to be moved in the position found, totally eliminating the anterior/posterior displacement common to the logroll. In addition, the scoop can be opened at either the top or bottom and quickly placed around the patient by just two providers. Even if the scoop has to be separated into two pieces and worked under the patient, it can be accomplished by a two-person crew.
Another excellent option is what I call a "flat lift." Depending on patient size, two or three providers kneel on either side of the patient, while another provider holds the head/neck in neutral, in-line position and the fourth person slides the board. Even with a 300-lb. patient, each of three providers on either side only needs to lift 50 lbs. 6"-8" off the floor. The key to making this particular move successful is that everyone lifts on the same count to the same height. The obvious downside to this technique is that it is clearly people-intensive, but for services that routinely run pumpers or trucks in first response mode, where manpower is not an issue, this is an excellent choice. This move is far easier on the patient's spine than the logroll. Its best application is for moving a cardiac arrest patient.
When you have EKG lead wires, oxygen tubing and IV lines running everywhere, the logroll is even more difficult to perform. As such, it greatly increases the likelihood that you will pull out an IV line or tear loose the oxygen tubing.
Given the much better options, I think it's time we seriously rethink making the logroll our primary choice for putting a patient on a long spineboard. If you're a crew of two, grab that scoop stretcher. If you are blessed with lots of manpower on scene, the flat lift is another fine choice.
In any case, I say it's time to lose the logroll as a mainstay of day-to-day EMS operations. Until next month…
Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of EMS Magazine's editorial advisory board.