Kendrick Extrication Device

[ERDoc]

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.

Sorry Richard, but if you provide a story like that you have to provide the evidence. Are you sure this is not just urban legend?

[Richard B the EMT]

I don't know if the story is urban legend or not. Please note I prefaced my comment by saying

The classic anecdotal story

[CBEMT]

One (1) KED required on all ambulances (therefore that's exactly how many there are), hardly ever used by any agency in the area. Hell, if you even get strapped to the backboard you're probably a friend of the crew in some departments...

But I digress- back to the KED.

If you consider that increasing the time spent onscene applying the device also increases the likelihood of a secondary collision that could take out you, your partner, your patient, or all of the above (risk), balanced against securing the patient's c-spine (benefit)....

...But also consider that the benefit can't be proven to actually exist, but the risk certainly has.....

Edited November 16, 2010 by CBEMT

[ERDoc]

One (1) KED required on all ambulances (therefore that's exactly how many there are), hardly ever used by any agency in the area. Hell, if you even get strapped to the backboard you're probably a friend of the crew in some departments...

But I digress- back to the KED.

If you consider that increasing the time spent onscene applying the device also increases the likelihood of a secondary collision that could take out you, your partner, your patient, or all of the above (risk), balanced against securing the patient's c-spine (benefit)....

...But also consider that the benefit can't be proven to actually exist, but the risk certainly has.....

Can you show where the risk has been proven? Obviously plenty of people have been paralyzed/killed by breaking their neck in an accident. How many people have been paralyzed/killed after the fact by normal daily movements? I don't think you can find any documentation of such. The question is, is it the forces in the accident that cause enough force/movement to lead to paralysis/death? If a person breaks their neck in an accident and doesn't seek care, is there enough force provided in daily activities to cause any problems? While anecdote does not equal a quality study, I personally have seen quite a few people who have had "unstable" fractures that have been walking around for a few days who finally come in because they are tired of the pain but do not end up with neuro deficits. Hope I've made my questions as clear as mud.

[vetlemakt]

We had the KED until seven or eight years ago. I was happy to see it go to be honest, we seldomn used it, it took time to "mount" properly, it took up valuable space in the van and we already had a spine board, scoop stretcher and vacuum splints. Nowadays we use spine board for extraction, full body vacuum splints for transportation. For infants and small children we use smaller splints.

[FredG]

KED is still protocol here and is still a required station for EMT recerts. So, we carry and use them.

That being said, if there is sufficient MOI, then I'd rather do something that may protect the patient's spine vs not doing anything. Yes, there is virtually no scientific evidence supporting either stance. However, if you take a step back and look at the ever increasing survival rates, I will side with the "we must be doing something right" crowd until some definitive study is performed.

Additionally, I will also side with the fact that my state and regional protocols require application of an immobilization device if there is any neck or spinal pain and since EMS agencies operate under our medical director's license, I will abide by his standing orders. In my case, our MD basically signs off on the regional protocols with very little variation, but he is open to discussion for minor variations if we can make a solid case for it. Because immobilization (and KED usage) is so ingrained in EMS protocols, if an EMS provider varies from that protocol without good reason, it increases the risk of a lawsuit. Whenever I have a high MOI, I document the reasons behind every immobilization decision.

As for CBEMT's comment, yes, there is a risk of doing anything on a highway. That's why, if there is easy access, most providers do not spend time with the KED and do a "rapid extrication". However, if you're stuck on a bad extrication job, there's nothing you can do except to stabilize the patient as best as you can and ensure that the scene is as safe as possible. Personally, if there is a Engine on scene, I ask the FD to park it 100 feet or so behind the accident. Let the Engine take the 1st hit and with the weight of the truck and water its carrying, it makes for a good barricade.

[CBEMT]

Can you show where the risk has been proven? (etc etc) Hope I've made my questions as clear as mud.

You misunderstood me completely, Doc. The risk I referred to is the risk to us of getting plowed by a car while onscene fiddling with a KED. Therefore, risk: proven. Benefit of KED: unproven.

Personally, if there is a Engine on scene, I ask the FD to park it 100 feet or so behind the accident. Let the Engine take the 1st hit and with the weight of the truck and water its carrying, it makes for a good barricade.

I wish. Here the chief in command decides where the other apparatus go- and there seems to be more emphasis on keeping them OUT of traffic than protecting me from it (we don't have any highways). Unless its something horrendous that gets the whole road shut down, chances are I'm feet from moving traffic.

Edited November 16, 2010 by CBEMT

[Richard B the EMT]

1) Local protocol in NYC seems to use the Ladder/Truck company more than an engine company, for the portable blockade.

2) I think the FDNY EMS may be overusing the KEDs and IDEAs, but that is when, not only due to the MOI, the crew "has a high level of suspicion".

3) Some times, at least in my response area, we'll be in agreement with the ER doctors that the immobilization actually was unnecessary, except for protocols, level of suspicion, or the MOI. However, as mentioned in this string, nobody wants to be sued for Malpractice in denying a patient a form of "accepted" treatment.

[WolfmanHarris]

Last weekend I attended the Paramedicine 2010 conference. One of the sessions covered selective spinal motion restriction. Specifically the Ottawa C-spine rule, state of the research supporting it and progress on moving it fully into the pre-hospital setting. Ottawa Paramedic Service has already done a study where Paramedics were documenting whether a Pt. would meet the rule and whether they could rule out SMR while still using SMR on everyone. Starting in the new year they will be the trial site in Ontario for full implementation with the hope of it quickly expanding throughout Ontario.

Here is a link to the Conference website. They've posted some of the presenter notes from the conference there including the notes on Ottawa C-spine.

Session Notes

Most of the research cited wasn't news to me, but having them all together in context was really enlightening.

[tniuqs]

We had the KED until seven or eight years ago. I was happy to see it go to be honest, we seldomn used it, it took time to "mount" properly, it took up valuable space in the van and we already had a spine board, scoop stretcher and vacuum splints. Nowadays we use spine board for extraction, full body vacuum splints for transportation. For infants and small children we use smaller splints.

Full Body Vacuum Splints I have had some minor experience although limited to warmer climates they are good kit. Perhaps a better mousetrap for spinal restrictions overall ?

Question:

Do you have any problems with them when going from a cold environment to a warm environment ?

The odd thing I find with this thread is that there is an improved "SMR" device the Oregon Spinal Splint which on the training video provided demonstrates that using a chin strap (a movable joint, closing the airway and using non compressible head pads) most honestly everything we are taught is to keep airway open ... and then we do this chin strap thing ? There is a better way of securing the head without closing the mouth. Although in this link the "traditional" chin and forehead straps is demonstrated.

http://www.skedco.com/product/detail/sk-300-gr

A split chin "type" strap split over the nose using the Zygomatic arches as point of contact instead of using chin and forehead as securing points ... just saying there are ways of "C" spinal restriction that are logically better but for some reason never applied to EMS I find this most befuddling.

cheers