Kendrick Extrication Device

[WolfmanHarris]

Hugely underutilized piece of equipment. That being said, I haven't used one outside of class.

On MVC's my patients have either been so stable that boarding was practically cosmetic, or so unstable there was no time.

We carry two on each truck.

[Quakefire]

KED is really nice for hip fractures as well, MAST pants work great for pelvis fractures (yes we do have a car that still has a pair on board) The hardest thing on the KED is getting the padding on the head just right

[Chief1C]

I've found it necessary to keep a roll of Velcro for the purpose of sewing onto fabric, on hand; and just a simple hospital hand towel. We're lucky to get a KED back, Trauma Center distances don't warrant just picking them up. There's at least two on each ambulance, and Rescue truck; but the head strap and "pillow" never get returned. As far as pelvic fractures, standard devices meant for those, work best IMO. In the half dozen or more times I've used the MAST, it's never been for an isolated injury, usually a combination.

[FredG]

I've used KEDs on several occasions. My department carries two on each unit and 1 on the Rescue.

It has come up from time to time in my region about the excessive use of "rapid extrication" straight to the longboard. The debate always revolves around two things, whether you should take the time to use the KED for better stability of the patient's neck and spine before any movement and whether there is any justification for rapid extrication on any call. Personally, I can see using the KED on a more severely injured patient or a higher MOI accident simply because the KED does provide better stability over simply rotating and laying down on the board. I use "rapid extrication" on the minor incidents where the need for immobilization is debateable.

I find it useful to apply a KED is for extended extrication, if you can get the KED into the patient. That frees up a responder from having to stay in a risky position in the vehicle with the patient to provide head stabilization and also helps protect the patients spine earlier in the evolution of the call. This was much easier in older cars, with newer cars that have bucket seats and center consoles it is harder to get a KED into position without increasing the risk of moving the patient.

I also like to use the KED for extrications when the vehicle is down an embankment or at an angle that makes it difficult to put a longboard in place the perform a "rapid extrication". We can KED the patient, then have a longboard on the ground right next to the vehicle, then properly fix them to the longboard while minimizing the risk of dropping the board or having a responder slip and injure themself. In these cases, we usually have the Rescue with us and then place the board into the basket for extra safety.

I did have an incident last year that was a bit unusual and required the KED. A patient who fell off a trampoline, then walked to a chair and sat down...upon which lost sensation in both legs. I decided to KED the patient then slide the patient onto a longboard. The reason being that this was no longer a "suspected" spinal compromise, we had positive proof of the compromise and we had easy access to the patient from all angles. So, rather than doing a "rapid extrication", I choose to use the KED to stabilize the neck and spine before we did anything further in order to minimize any further aggravation to the spinal column.

[ERDoc]

I used them for 10 years because that is what our protocols said. I challenge anyone to provide evidence that:

1. they provide any degree of true immobilization

2. they provide any benefit to the pt

[FredG]

I used them for 10 years because that is what our protocols said. I challenge anyone to provide evidence that:

1. they provide any degree of true immobilization

2. they provide any benefit to the pt

This is an ongoing issue in EMS. There is a lack of evidence for a lot of what we do in the field. It seems that the only area of EMS that is being actively studied is Cardiac Care and CPR/Defib. Most other facets of EMS are based on protocols that have no solid basis.

What clinical studies are there proving the necessity of Longboards?

What studues show that longboards are better than a scoop...or vice-versa?

How about C-Collar usage? Are the stiffer collars really better than a soft collar?

Are MAST really useless in treatment of shock? Were any real studies done before MAST was removed from most protocols?

Has there been any studies done to validate the dispatch priorities and Lights and Siren recommendations based on dispatch criteria?

Until studies show otherwise (if they are ever done), we have to abide by protocols handed down to us by our medical directors.

As far as KEDs and other Spinal Immobilization, logically speaking, they are acting as a splint and are the best devices that we have available right now to act as a splint. From an anatomical perspective, they do not provide proper support for the natural curve of the spine, so they could cause more harm than good, however there are very few devices that would provide that support, so we have to use what we are given and allowed to under our protocols.

[Chief1C]

They do make it easier to remove victims from cars....however.... if they're truly 'entrapped', or worse entangled, it's still a bitch to get it on the patient. That's why I'm a huge supporter of cutting the hell out of the car, to ease access. These days, with all of the new technology, it's a fairly quick job to cut a car apart if you know what you're doing.

On collars. We purchased a device for technical and confined space rescue called the Yates Spec Pak. It came with a new collar that I seen in JEMS, called the XCollar. http://xcollar.com/

After discovering that your male parts are in danger with the application and lifting of the patient in the device. I also discovered that while the XCollar provides better support than conventional collars. It's difficult to figure out, and in my opinion as the victim, it could cause problems if you've got bone floating around the spinal cord. Certainly not an ideal device, to package with a confined space rescue harness/vest.

[tniuqs]

Ok late entry .. I checked out the link X collar (the better mouse trap).. got distracted and did not read Freds post. I am saying the same thing I guess NOTE To SELF read the entire thread before hitting reply.

I used them for 10 years because that is what our protocols said. I challenge anyone to provide evidence that:

1. they provide any degree of true immobilization

2. they provide any benefit to the pt

LOL ... I will take a stab at that, provide evidence to the opposite ps no one can its a catch 22.

Just me if I had neck pain post "incident" I would want a KED or OSS device its just logical, far superior control of C spine .

And back at you, can any "prove" study wise if a LSB actually has any EBM studies that:

1. they provide any degree of true immobilization

2. they provide any benefit to the pt

cheers

Edited November 12, 2010 by tniuqs

[ERDoc]

Ok late entry .. I checked out the link X collar (the better mouse trap).. got distracted and did not read Freds post. I am saying the same thing I guess NOTE To SELF read the entire thread before hitting reply.

LOL ... I will take a stab at that, provide evidence to the opposite ps no one can its a catch 22.

Just me if I had neck pain post "incident" I would want a KED or OSS device its just logical, far superior control of C spine .

And back at you, can any "prove" study wise if a LSB actually has any EBM studies that:

1. they provide any degree of true immobilization

2. they provide any benefit to the pt

cheers

That is my whole point. There is no evidence that any of this does any good. I've seen several people who have fallen or been in an MVA who come in several days later with neck pain. They end up with an operative cervical fx. It raises the question, "If someone can walk around for days with an unstable neck fracture, is there really any value in immobilization." I realize that anecdote does not equal a controlled study but it makes one wonder. Imagine, if after all of these years, a study is done that shows immobilization in any form is not necessary, what it would mean. No more collars, no more KEDs, no more long boards. It would surely be interesting. We have studies showing that long boards can be harmful in the way of pressure sores but nothing to show they have any benefit.

[Richard B the EMT]

The classic anecdotal story is the high school football linebacker who took a hard hit. He exhibits no deficit in any way without c-spine immobilization during evaluation, then takes a cup of Gatorade, tilts his head back to sip the beverage... and collapses, full cardiac arrest with no ROSC (Return Of Spontaneous Circulation). The autopsy indicates he had a partially severed spine, with the head tilt fully severing the spinal column and cord.

Food for thought.