: How safe are backboards? I have heard a fair amount of talk recently about how safe the long spine boards frequently used by EMS personnel after falls and car accidents are. How many - if any - studies have been done on this?

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The only studies I'm aware of come from the Emergency Medicine Journal, but other should exist for sure.

Some say it has drawbacks (discomfort, pressure sore) and that alternatives such as the vacuum mattress should be preferred:

Comparison of a long spinal board and vacuum mattress for spinal immobilisation
The use of the spinal board after the pre-hospital phase of trauma management

However, according to official guidelines (such as PSE1 and PSE2 that we apply here in France and that follow international guidelines), each tool has its proper use cases. For example (non-exhaustive list):

The vacuum mattress is used in case of suspected trauma of the

head
spine (lying victim)
pelvis
femur
and for multiple traumas.
It is carried on a stretcher or a spinal board, once the victim installed.

while the spinal board is used for

single traumas not listed above and preventing the victime from moving
spine trauma of a sitting or standing vitim, in conjunction with other tools
drawning
carrying the vacuum mattress (see above)
a few more cases not listed here.
And the spinal board allows doing CPR, while the vacuum mattress doesn't.

Respecting these use cases is the best way to reduce the risk for the victim, according to the professionals who wrote these international guidelines. This may evolve in the future or not, depending on studies and feedback, but currently, this is the standard.

And finally, as the spinal board is used in a context of first-aid, the victim is not immobilized on it for a long time: just the time to provide first aid and to evacuate to the hospital. I have personnaly never seen (nor heard about) any pressure sore or anything like that appearing after a spinal board immobilization. But it is true this board is not comfortable at all (I tried).