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Standard way to remove someone from vehicle


SpongeDude

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Hope someone can clear up some things.... I helped on a call the other day where a young woman in passenger seat for MVC. (not major)- Just complaining of slight pain- They put on collar and manually held CSpine-placing on long board with block, straps....etc. - Wouldn't this be indication for KED- or other shortboard?? Or in this case (precautionary) is manual OK?

Also- What is the criteria for rapid extrication?? For example- Would you yank someone out of a car because they were unconscious (but breathing ok)??? Can you give me the situations (other than the obvious- Car is on fire) Where you would take someone out quicker??

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I've done some searches on this and have read some interesting responses to the KED debate..... Lots of folks have responded that they don't even use it. here is my question then:

If you are not doing a rapid extrication of a seated pt complaining of neck pain- What method are you using to remove them from the vehicle and onto the long board???

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KED is the tool of choose as long as the PT. is stable because it does take a little bit longer to use than just a Collier and a board.

I believe it would be a liability not to use one if you had one. if something happened to the PT from excessive movement

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I'm just a PCP student, but in lab the way we seem to do it is:

- KED for stable pts only, which means basically no one who has been in a car accident (unless it is extremely minor but they are complaining of head/neck pain with no other injuries)

- for pts who are not stable but do not have an ABC problem, we usually collar and then try to slide the board under them (or usually part of their butt) and then turn them onto the board and lie them down

- rapid extrication (meaning hold C-spine and try to move along the long axis of the body but just get them out fast) for pts who have problems with ABCs or if the car becomes unsafe

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If you are not doing a rapid extrication of a seated pt complaining of neck pain- What method are you using to remove them from the vehicle and onto the long board???

The walking method.

Do what ya have to do for school, then sit back and let me inform you of the real world...

"Rapid extrication" will only be done in an extremely rare set of circumstances in EMS. They will always involve an immediate life threat to the ABC's where "prolonged" or "proper" extrication will impede "life saving" intervention. Quite rare. I hope you aren't pulling people out of a burning car if you are not also in a firefighter role...

95% of the MVC's you encounter will be "Oh you have mid-line neck/back pain? Ok, well you are going to have to go on a board, it won't be comfortable, blah blah blah". These cases will invlove no gross injury or neuro deficits, and will likely not be the most "textbook" of immobilizations (i.e. no real manual stabilization, perhaps the stand and pivot, etc...).

5% will involve either substantial mechanism and/or gross injury/deformity/bruising/neuro deficits/parethesia/etc...These of course should be done with as much care as possible.

Most "real" potential spinal injuries in my experience come from non-MVC type mechanisms.

As for the almighty KED, it may be pumped in school, but in field practice is rather limited. Again, in my experience it is mainly used (and rarely at that) for suspected hip/pelvic fractures and pediatric immobilization's. Very very very rarely is it used for any type of MVC extrication. It unfortunately limits chest/abdo/etc... assessment once it is in place should the clinical picture of the patient change.

Peace.

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The walking method.

OK- let me get this striaght.... people involved in "minor" MVC with complaint of back/neck pain but stable.....you are going to still take a chance and not protect C-Spine all the way through either via manual or shortboard/KED???

I know it takes longer but I'm not sure I understand why you would not play it safe....

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Notice how those who say they don't (or rarely) use a KED never offer any scientific rationale for their actions? Notice they always try to obscure their ignorance with such babble as "the real world" and "how we always do it."? Tell one of those same idiots that you always shock v-fib at 20 joules because you don't think they need 200 "in the real world" and watch them throw a fit telling you how the book says you're supposed to do it.

I am inclined to fire any employee I ever hear mouthing off about "the real world," because it is a clear indication that he likes to make up his rules as he goes rather than following established procedures. And, "it's what everybody does!" is going to get you laughed out of court. Out of the unemployment office too.

Unless your patient is suffering an immediate threat to his ABC's, scene safety, or is actively fighting you, there is no excuse for not immobilizing prior to transfer to a long board.

You can make scientifically sound arguments for not immobilizing more than half of the people we currently immobilize. But there is no sound argument for not properly immobilizing those who we do choose to immobilize. And that means using the KED.

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