Standard way to remove someone from vehicle

[MedicMal]

vs-eh I think he's dissing you :shock:

But yes, in class we're taught to use the KED on non-serious patients, but on the road I've never seen it used. I don't have much experience under my belt, but I think it's ok to not use a KED if you're careful about holding c-spine and not jiggling the patient around.

MedicMal

[JakeEMTP]

vs-eh I think he's dissing you :shock:

But yes, in class we're taught to use the KED on non-serious patients, but on the road I've never seen it used. I don't have much experience under my belt, but I think it's ok to not use a KED if you're careful about holding c-spine and not jiggling the patient around.

MedicMal

I'm sure when you go to court the plantiff's lawyer will think it's ok too. :wink: Yes it takes a little time to apply the KED, but remember, the 1st rule in EMS is to protect yourself. That includes your hiney.

[Dustdevil]

You're kidding yourself if you think that is even possible, no matter how "careful" you are. :roll:

If you are concerned about being careful, use a KED.

[chicagoambo]

I personally think the KED does more harm than good,if you need to be self rightgeous,use it!It's rarely used here because this equipment is a joke.Next I"ll here that you guys use mast pants alot too!Come on ! Yeah if you get an occasional legitimate c-spine injury you might dust the dirt off but thats not very often, most crashes are BS and you guys know that!

[akroeze]

I personally think the KED does more harm than good,if you need to be self rightgeous,use it!It's rarely used here because this equipment is a joke.Next I"ll here that you guys use mast pants alot too!Come on ! Yeah if you get an occasional legitimate c-spine injury you might dust the dirt off but thats not very often, most crashes are BS and you guys know that!

Because you have a portable X-ray/CT scanner in your pocket right? I wish I had one...

[chicagoambo]

Theres alot of equipment on the rig you rarely use,or do you use it all?Come on,be real!

[akroeze]

Theres alot of equipment on the rig you rarely use,or do you use it all?Come on,be real!

Yes, it is used very frequently here in my experience as it tends to keep the pt more stable than the "twist 'em and lay 'em down" method.

[Ace844]

Unfortunately here in my state they have taken the providers ability to choose their method of "immobilization and extrication to thus::

(MASS EMERGENCY MEDICAL SERVICES @ PRE-HOSPITAL TREATMENT PROTOCOLS, Sixth Edition

6. 032 Official Version, Effective November 14, 2005; 4.7: SPINAL COLUMN / CORD INJURIES)

REMEMBER: Patients that may have a spinal column / cord injury may be difficult to assess as they may not present with pain or other signs and symptoms of injury. Therefore, treatment (spinal immobilization) is recommended based upon the mechanism of injury alone.

ASSESSMENT / TREATMENT PRIORITIES

1. Ensure scene safety and maintain appropriate body substance isolation precautions.

2. Maintain an open airway using spinal precautions and assist ventilations as needed. Assume spinal injury and provide spinal immobilize accordingly.

3. Administer oxygen using appropriate oxygen delivery device, as clinically indicated.

4. Determine patient's hemodynamic stability and symptoms using O-P-Q-R-S-T model. Continually assess Level of Consciousness (AVPU/Glasgow Coma Scale), ABCs, disability and Vital Signs. Examine head for presence of lacerations, depressions, swelling, Battle’s Sign, Cerebrospinal Fluid (CSF) from ears/nose, and foreign (impaled) objects. Treat all life threatening conditions as they become identified.

5. When multiple patients are involved, they need to be appropriately triaged.

4.7 SPINAL COLUMN / CORD INJURIES (con’t)

6. Obtain appropriate S-A-M-P-L-E history related to event, including mechanism of injury. NOTE: Family and friends may be useful during the assessment to determine normal or abnormal mental status.

7. Prevent / treat for shock.

8. Patient care activities must not unnecessarily delay patient transport to an appropriate facility.

9. Initiate transport as soon as possible, with or without ALS. Do not allow patients to exert themselves and properly secure to cot in position of comfort, or appropriate to treatment(s) required.

10. If the scene time and/or transport time will be prolonged, and a landing site is available, consider transport by air ambulance from the scene to an appropriate Trauma Center. See Air Ambulance protocol.

11. Monitor and record vital signs and ECG.

TREATMENT

BASIC PROCEDURES

1. Hyperventilation with 100% oxygen at a rate no less than 24/ minute with B-V-M if associated with a significant closed head injury and signs of herniation syndrome.

2. Control/stop any identified life-threatening hemorrhage (direct pressure, pressure points, etc.).

3. Determine presence or absence of significant neurologic signs and symptoms: motor function, sensory function, reflex responses, visual inspection, bradycardia, priapism, hypotension, loss of sweating or shivering and loss of bladder/bowel control.

4. Activate ALS intercept, if deemed necessary and if available.

5. Initiate transport as soon as possible with or without ALS.

6. If patient’s BLOOD PRESSURE drops below 100 systolic: treat for shock.

7. Notify receiving hospital of patient's status.

* See Spinal Stabilization/Immobilization Summary in this protocol.

*SPINAL STABILIZATION / IMMOBILIZATION SUMMARY

General principles:

· Provide manual in-line immobilization.

· Evaluate patient's responsiveness, ABCs, need for immediate resuscitation and check motor, sensory and distal pulses in all four extremities.

· Examine the patient's neck and apply cervical collar.

· Immobilize the patient's torso to the selected immobilization device such that the torso cannot move up, down, left or right.

· Evaluate torso straps and adjust as needed.

· Place an appropriate amount of padding behind head and/or neck and small of back, if needed for adult patients and under the thorax and/or neck for pediatric patients (age 7 yrs. or under) to maintain in-line spinal immobilization.

· Immobilize the patient's head.

· Once patient is immobilized, secure patient's arms and legs to the board or immobilization device.

· Reevaluate patient's responsiveness, ABCs, need for immediate resuscitation and check motor, sensory and distal pulses in all four extremities.

· Reminder: seated patients MUST be immobilized using a short spineboard or commercial equivalent (KED, LSP, Greene, etc.), before being moved onto a long spineboard. The only circumstances in which the use of a short spineboard may be omitted include:*

· You or the patient are in imminent danger;

· You need to gain immediate access to other patient(s);

· The patient’s injuries justify urgent removal.

* See AAOS, “Emergency Care & Transportation”, 7th Edition.

Mosby, “Paramedic Textbook, 2nd Edition

Mosby, “PHTLS: Basic & Advanced”, 4th Edition

and again here::

(MASS EMERGENCY MEDICAL SERVICES @ PRE-HOSPITAL TREATMENT PROTOCOLS, Sixth Edition

6. 032 Official Version, Effective November 14, 2005; pg 15)

EMT’s are reminded not to allow patients with medical or trauma conditions found in these protocols, to walk, or otherwise exert themselves. All patients, especially children, shall be properly secured to the ambulance cot, using all of the required straps, or in an approved infant/child carrier or seat, or harness*, or in an appropriate immobilization device, in a position of comfort, or in a position appropriate to the chief complaint, and/or the nature of the illness or injury.

It should be noted that recent "depeartment rulings to a number of providers in the state have indicated a department preference that

"Every pt you encounter should be extremity lifted to whatever extriaction and or transport device the EMS crew is using to treat and transport the pt to ensure that the pt in no circumsytances exerts themselves so as not to exacerbate their acute medical condition."

Just to give ya an idea of how oppressive the practice environment is becoming here...

out here,

ACE844

[Dustdevil]

Unfortunately here in my state they have taken the providers ability to choose their method of "immobilization and extrication...

It's a shame, Ace. But unfortunately, that is exactly what happens when so many people in the field are too lazy, poorly educated, and just plain stupid to make sound clinical judgments regarding patient care. And yes, that is currently the case in EMS nationwide. Just ask our friend in Chicago.

[chicagoambo]

If you did 20-25 runs per day of bull crap ,you wouldn't use the ked either!Most of these people are there to sue and are full of shit!An occasional use I agree but majority I don't see.Ask any ghetto rigs out there and you'll see the same crap.