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.