Question about a call I had

[firemedic37]

I do not know if the pt. was a rapid extrication or not. If it was not a rapid extrication then use the K.E.D. board. If he was a rapid transport then do your best to immobilize the spine and extricate quickly. The K.E.D. board is used not enough in a lot of services. Yes it can be hard to place the K.E.D. board, however if you just saved the individual from being injury further you did your job. I went thru the PHTLS class recently any they do instruct you to use the K.E.D. board.

Was this individual the one that was pinned or not? I do not know where you are located or the distance to the closest hospital. Our service requires that if the individual is pinned that we air lift them to a Level 1 Trauma Center, however we are 30 miles from the closest hospital which is a Level 3 Trauma Center and the closest Level 1 Trauma Center is 60 miles away. We air lift all MVA pts. that are pinned or death in the same passenger compartment.

[Dustdevil]

Our service requires that if the individual is pinned that we air lift them to a Level 1 Trauma Center, however we are 30 miles from the closest hospital which is a Level 3 Trauma Center and the closest Level 1 Trauma Center is 60 miles away. We air lift all MVA pts. that are pinned or death in the same passenger compartment.

Your service sucks.

For the sake of your professional development, I encourage you to attend much, much more education. Preferably NOT taught by your service. Apparently, they are stuck in the 1980s, and if you don't break out of there, they will drag you down with them.

[Rescue0ne]

Our service requires that if the individual is pinned that we air lift them to a Level 1 Trauma Center, however we are 30 miles from the closest hospital which is a Level 3 Trauma Center and the closest Level 1 Trauma Center is 60 miles away. We air lift all MVA pts. that are pinned or death in the same passenger compartment.

All patients which are "pinned" are airlifted to a Level One? Bet that's expensive. Out of sheer curiosity, how many instances like this does your EMS service have, in say, six months? Also, is your service ALS Ground Ambulance, or ALS non-Transport?

[kyle308]

ok. Well the guy that I had the KED question about, he ended up being transported to a bigger hospital because of a ruptured spleen i do belive, so thats why he had such severe abdominal pain.

also the extrication was not rapid as all they had to do was pop the door off and and peel the roof back just a touch and they got him right out.

[Rescue0ne]

Kyle,

Congratulations on your interest in EMS, and good luck if you decide to make it your career. You're the same age I was when I joined my Jr. Rescue Squad years ago. It's quite an eye-opener, isn't it?

[CBEMT]

One interesting point someone raised to me in another forum is that the KED, as designed, was intended for vertical extraction of racecar drivers, F1 I believe. Could explain some of the trouble people have applying the device and then pivoting the patient out the door...

[Dustdevil]

One interesting point someone raised to me in another forum is that the KED, as designed, was intended for vertical extraction of racecar drivers, F1 I believe. Could explain some of the trouble people have applying the device and then pivoting the patient out the door...

Interesting question. To be honest, encounter difficulty in pivoting almost every patient from a sitting position. Cars today, with their centre consoles and overall compactness, make it a challenge at the very least. However, I don't see where this difficulty is compounded by the KED.

The KED was not designed only to extricate. It was designed to facilitate extrication while maintaining spinal immobilisation. Regardless of the direction you are extricating in, the KED does this very well. Better than any method I know of, without contributing anything negative. Until something better comes along, it is the state of the art and must be utilised.

As for the so-called "rapid extrication" clause, it is painfully obvious that people are grossly overutilising this lame excuse for laziness. The KED is a medical device, and like any medical device, its use or disuse must be determined by using your medical judgment to decide if the benefits outweigh the risks. It takes more manipulation to extricate without it than with it, so the mechanics of application are not a risk. There is only one "risk" to the KED, and that is the time it takes to apply it. And, of course, this is a significant factor ONLY if the patient's condition is time critical. I repeat...

[align=center:819273c2ca]THIS IS A SIGNIFICANT FACTOR ONLY IF THE PATIENTS CONDITION IS TIME CRITICAL! [/align:819273c2ca]

This means the patient's ACTUAL condition. This does not mean the patient's potential condition, as conjectured by non patient-centric evidence. The condition of the patient's car does not count. The condition of the other passengers in the patient's car does not count. Neither the time necessary to extricate, nor the time necessary to transport the patient count. These factors are NOT patient centric.

I am amazed by people's inability to understand this very simple concept. We treat the patient, not the monitor. By the very same token, we...

[align=center:819273c2ca]TREAT THE PATIENT, NOT THE CAR. PERIOD. END OF STORY.[/align:819273c2ca]

Any other suggestion is archaic thinking which was refuted at least five years ago. I don't care how long your EMT instructor has been in EMS, if he is still spouting this "mechanism of injury" nonsense, he is wrong.

[EmergencyMedicalTigger]

In my opinion I think the KED is an effective and greatly under utilized device. Besides MVAs we've also used it on calls such as one we had w/back pain. He had a hx of back complications and surgeries, fell earlier, and was in excruitiating pain in a seated position on his couch. He couldn't move, so me and a fire guy immobilized him w/the KED and moved him to the stretcher that way. It worked well and kept him from moving his back unnecessarily.

[CAPEMT]

im going to jump up to the guy who was talking about his services protocols about airlifts....in the state of tennessee, we have trauma destination guidelines that mandate transport to level one trauma centers if there is a pinned patient with prolonged extrication time, intrusion to the vehicle more than 12 inches, death to another passenger in the same vehicle, etc,etc. Where our county is located, on a lot of these patients it is more time expedient to fly them. Considering that the closest level one trauma center is 45 minutes to an hour away, depending on traffic, we use the bird alot around here...we also use it for stroke victims to be transported to the local level one trauma center (it is the closest local hospital that administers thrombolytics). Yeah, airlifts are expensive....I've been flown myself as a burn patient. But our priority is to get our patients to definitive care as expeditiously as possible if we have any indication that there may be injuries we cannot see. That's where I stand on that. And as to the KED issue, I think they are wonderful, just underused. I've seen many patients moved rapidly when the situation did not call for it, all because whoever was on scene was either a) too lazy to use it or did not do their scene size up correctly.

Just a thought

Alittlebittyone

[Asysin2leads]

Sorry, I'm going to have to go with Dust on this one. I wouldn't use an airlift unless I confirmed or had very high suspicion of major injury. Using helicopters due to "ruling out" trauma is not good medicine. You're telling me that if there is deformity +12 inches into the vehicle, even if the person is AOx3, asymptomatic, with stable vitals, they buy themselves a helicopter ride? I hope at least they have the option of RMAing.

Secondly, and can someone please point me in the right direction for this one because its come up a few times, I was under the impression that flying stroke patients can be contraindicated due to changes in air pressure. Anyone know some place I can read up on this?