Question about a call I had

[FormerEMSLT297]

Firemedic 37,, what state are you in ? where they fly everyone ?...

o.K. back to the K.E.D. NO ONE can say that using a KED stabilizes the C-spine LESS than using hands. The KED keeps the c-spine, in line with the Thoracic and Lumbar regions.

I just REFUSE to buy into that, we rapidly extricated and c-spine precautions were the same as with a KED. As dust said, not possible, or at least, not probable,,,,

Once again I think that KED is the most underutilized piece of gear on the the unit. As to whether you should have used it,,,, check your protocols. Most have specific instances were "rapid extrication" is indicated.

And like I said, while the Squad is chocking and cutting and prying, the EMS crew should be able to place the KED and have the patient ready by the time the door "pops".

Ypu can't tell me that the squad had time to get a hurst tool off a truck, chock the car, start the tool pop the door, which takes anywhere from 3-10 minutes minimum, and yet the EMS crew didn't have time to KED the patient.

Severe Abdominal pain only absent hyoptension, altered LOC, or airway issues, does not in my mind make for forgoing the KED in favor of "rapid" Extrication.

I've been doing EMS for 23 years and I know that in most cases a KED can go on in 10 minutes or less..... most times a lot less if you and your practice.

[FormerEMSLT297]

Backboard and C-collar both- pad the voids- apply oxygen- do investigation on the abdomen because that warrents attention to internal injuries.

The KED has betters uses.

Imbobilizing a Child

Hip Injuries

I would never use the KED unless the car has allot of room the spare and time on my hands. As long as you took proper C-spinal protection hold the head and etc. your fine document well becasue it may be used in court

I guess this is whats wrong with NJ EMS,,,, KED, better uses than C-spine injuries,,,,,????????????? WTF,,, , what cars do you know of that have "allot of room"????? As for spare time,,, ?? how long does it take. Please if i'm ever in an mva with neck and belly pain,, do me a favor and do not come. I am not familiar with specific NJ protocols, but I can tell you this, NY, MD, DC, and VA, all have specific guidelines as to when "rapid" extrication is indicated, and when using the KED is appropriate, and unless the writer of this post can tell me that the patient was hypotensive, unstable, or needed an immediate airway adjunct, I stand by my statement, the KED should have been used.

As for you Pro-EMT,,,,, you are 17, what kind of WORLDLY experience can you possibly have, I have more Sick time in EMS than you have time in EMS. I've responded to more unfounded calls, than you have responded to valid calls,

So, please, spare us with your wealth of EMS knowledge, it doesn't play well to those of us that have been in this business a while, and dedicated our lives to improving pre-hospital care ...

My thoughts are my own and do not represent my agency dept. or company.

Former

[kyle308]

unless the writer of this post can tell me that the patient was hypotensive, unstable, or needed an immediate airway adjunct, I stand by my statement, the KED should have been used.

Former

My answers to those as the post maker are no, no, and no again. he was awake and talking to us the whole trip

they did not use KED and I believe they should of.

[Smitster_911]

All right folks,

Have all our backs here received a sufficient stabbing?

When did this board become a place for everyone to show everyone else:

1. How much better you are than anyone else, and,

2. How much dumber everyone is than you?

Why can't we just have a group hug and help each other out without having, first, to tear each other down?

Everybody, well, most everybody, well, some of us here, are just trying to learn from, teach, or support others when they have questions or concerns. Nobody knows all, and everybody can learn from anybody.

Now, let's just look at the facts of this case as presented (and I'm certainly no authority on anything. I've only been in EMS 16 years-out 2- and am, at least, smart enough to know that I still don't know squat, and have a great deal yet to learn).

Here is the original post in it's entirety, verbatim:

Well, Saturday night we got toned out to a MVA on the interstate. It was a mustang T-boned by a semi, we arrive on scene and one patient is pinned in the car the other got out and walked to a semi drivers truck and climbed in. The guy in the car we put a C-collar on and just slid in a backboard, once in the ambulance he was complaining of lower back pain and severe abdominal pain, I was wondering if we should of used a KED on the guy.

The man that climbed in the semi was also C-collared and backboarded before loading

Thanks before hand,

Kyle

Let's take a look at the information that was given to us, which is what I based my response on:

1. A Mustang (small) was 'T-Boned' on an interstate (speed limit at least 55 MPH) by a semi (big, and always wins against small) and that one of the people in said Mustang was pinned.

2. No other condition of pinned pt was given (until after extrication).

3. Second pt walked to truck and was found in it-presumably seated (and if so, this is the pt that should have gotten the KED).

4. Pt was extricated from car (a time no one other than the pt should be in the car barring exceptional circumstances).

5. Would the application of the KED have changed the parameters of the extrication (Fire really hates that!)?

Given the limited information available, I could only draw conclusions based on the condition of the car. While I agree that the pt should be treated based on clinical observation, and the cars condition should only be used as supplemental information, unfortunately, in this scenario, the cars condition is all that was known, so that's all I could base my treatment options on.

A lot of responses had to do with the pt going to a level I trauma center, and that is what I would also have suggested. A protocol (maybe yours?) that says transport to a level I is appropriate in a case like this (if that's what your region requires), doesn't it follow that a patient be expeditiously removed from a car from which he had to be extricated?

I understand that protocols are just guidelines, and deviations must be well documented as to why the change, since I keep leaving my X-Ray eyes and MRI glasses at home (I never seem to be able to find them!) if there's any question at all I'll just go with the local standard of care.

In the hospital, they may have the luxury of ruling things out, but in the field, we have to rule things in to make sure all our i's are dotted, and t's crossed.

Treating the pt is paramount, but in a forum like this, the ideal situation doesn't always exist so improvisations must be made-as in real life. As one of my Captains used to say: "Life, like EMS, is fluid and dynamic in nature and subject to change without notice."

While I learned many moons ago that I can't change the world alone, if we work together, WE can.

Working together is the key.

[Lone Star]

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:f83a643b64]THIS IS A SIGNIFICANT FACTOR ONLY IF THE PATIENTS CONDITION IS TIME CRITICAL! [/align:f83a643b64]

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:f83a643b64]TREAT THE PATIENT, NOT THE CAR. PERIOD. END OF STORY.[/align:f83a643b64]

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.

Well said Dust!

Much to the chagrin of some partners I've worked with, I try to use the K.E.D. as often as possible. My personal school of thought is this: If the pt is NOT 'time critical', then why not take all the steps available to ensure proper spial precautions are in place?

Having been a pt in a couple of situations where proper protocols weren't followed, I have to say that Im pretty lucky to even be walking, let alone even be here at all. It amazes me how many 'justifications' I've heard for not following protocols, and how many partners stand by and allow it to happen!

[Dustdevil]

When did this board become a place for everyone to show everyone else:

1. How much better you are than anyone else, and,

2. How much dumber everyone is than you?

I'm afraid I can't answer that. However, it has been that way since at least August of 2005, when I first joined.

When something works for us, we stick with it. 8)

[brentoli]

Guidelines From The American College of Surgeons Call For Rapid Transport When:

• Ground transport to an appropriate facility poses a threat to the patient's recovery or ground transport is delayed due to weather or geography.

[*]Extrication time or road conditions will seriously delay the patient's access to advanced life support

[*]Motor vehicle accidents have occurred at 20 mph or more and the occupants are not wearing seat belts

[*]The passenger area of the motor vehicle is compressed to 18 inches

[*]The occupant is thrown from the vehicle

[*]A motor vehicle rolls over

[*]Another occupant in the vehicle dies

[*]A pedestrian is hit by a motor vehicle traveling 20 mph or more

[*]A person falls from 20 feet or more

[*]Burns to chest, neck, face or perineal area.

[*]Any traumatic injury which requires significant fluid replacement or neurological impairment.

Now I am sure we have all seen people who were just fine after any of the vehicle conditions listed above.

I am also sure we have all seen people who needed Level 1 treatment and did not fit those criteria.

There is a key word in this post though... [spoil:43b14c9fb3]Guidelines[/spoil:43b14c9fb3]

We use guidelines in EMS all of the time, we adjust them for the situation and what the specific needs are.

Are you sure your service REQUIRES a flight on any of those situations? I only have a lowly 2 years of experience, but I can count on one hand the times we have landed a helicopter. And that includes 5 miles of serious wreck prone interstate.

It sounds to me like some people are in kahutz with the state and milking some money out of services that don't know any better.

As far as the KED goes, that too I have only seen used a few times. Is that right? Probably not. Does it happen, everywhere. Yes

From the forum surfing I do, I notice there are issues that never die... badges, lights on POV's, EMT-B's and IV's, and KED's. I'm sure there is more out there.

Anyway, you have to make a judgement call as far as the KED goes, you know your c-spine protocols better then anyone else (I hope).

[Ridryder 911]

Guidelines From The American College of Surgeons Call For Rapid Transport When:

• Ground transport to an appropriate facility poses a threat to the patient's recovery or ground transport is delayed due to weather or geography.

[*]Extrication time or road conditions will seriously delay the patient's access to advanced life support

[*]Motor vehicle accidents have occurred at 20 mph or more and the occupants are not wearing seat belts

[*]The passenger area of the motor vehicle is compressed to 18 inches

[*]The occupant is thrown from the vehicle

[*]A motor vehicle rolls over

[*]Another occupant in the vehicle dies

[*]A pedestrian is hit by a motor vehicle traveling 20 mph or more

[*]A person falls from 20 feet or more

[*]Burns to chest, neck, face or perineal area.

[*]Any traumatic injury which requires significant fluid replacement or neurological impairment.

. [spoil:0388431af6]Guidelines[/spoil:0388431af6]

We use guidelines in EMS all of the time, we adjust them for the situation and what the specific needs are.

Ironically, when I was designing trauma standard guidelines, I asked ACS where they obtained their specific standards and recommendations, they were unable to send me references or studies, rather they described it came from "committees". Again, another form of standards we based upon what? Evidenced base medicine ? nope. Ironically, ACS does not consider "burns" as trauma.

That is why I believe we will see these recommendations change quite drastically and remember they are for

channeling patients into their facilities to be examined by their "ACS physicians) =$$$. Hopefully, this and the "Golden Hour" myth will soon be displaced by hard fact evidenced medicine.

R/r 911