# Immobilizing a baby...



## medicnick83 (Nov 19, 2011)

Scenario!

You arrive at a call.
Baby has fallen of a mothers back, she says the baby landed on it's feet and then fell and hit it's head.
Wasn't a high fall, say, 100cm ± however, as we all know, babies are fragile.
You check for a KED and find that one doesn't exist on the ambulance, it was taken off because it was damaged and not replaced.
Why a KED? Well, I've seen it being used to immobilize a baby before so I thought it would be a good thing to use because we don't have collars small enough.

The baby is quiet, not putting up a fight, so holding the baby's head with your hands seems to be working but you need to do your vitals and the mom is freaking out and not helping and she is slightly intoxicated.

How do you immobilize this baby ?

...

I ended up using a blanket roll to immobilize the baby, but because of the lack of a KED, I made a phone call to another crew member to ask and that is what he suggested I do as a precaution.

I then gave the baby O2, but 4L/per min and I basically dismantled the O2 mask and let it blow from the mouth region.

Did more, but the main question was "as above" but I want to know what you guys would've done.


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## DV_EMT (Nov 19, 2011)

Well, our protocols here say use a Ped C-spine board. Ked board would work as cited here

http://en.wikipedia.org/wiki/Kendrick_Extrication_Device

If it were me, I'd attempt to use a neck roll to improvise a C collar and then i'd C spine on a standard adult board while using towels under the shoulders to maintain ariway. i may even adjust the straps to fit the child more appropriately. However, as an infant, its hard to say what the "best" route is. So long as you follow "do no harm" you should be ok.


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## medicnick83 (Nov 19, 2011)

I couldn't use the Ked because as you know it wasn't on the ambulance so that route was out.

I couldn't use a trauma board or scoop because head blocks wise and spider harness... nah - wouldn't work.

I made a blanket roll to fit the overall size of the baby and rolled it up and put the baby in and fitted it to the baby and then got the mother to hold it tight (after explaining in detail why)

To me, that's all I could see (that I could use at the time) but I'm a big fan of looking back on stressful calls and trying to find better ways.


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## DV_EMT (Nov 19, 2011)

Arm length SAM Splint with tape Perhaps??


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## medicnick83 (Nov 19, 2011)

DV_EMT said:


> Arm length SAM Splint with tape Perhaps??



Explain in detail so I get the idea...


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## DV_EMT (Nov 19, 2011)

well.... take a SAM splint and use it to fit the size of the baby lengthwise, use a towel roll for the improvised c-collar, & put towels under the shouders to keep airway open. Then (if the same wide enough) fold the edges on either side up at a 90 degree so it makes a so called rail for the infant. Then use some tape to make makeshift spider straps. In theory, it the sam splint look like a bracket.

Should look like this  

I_____I

where the "I" are the folded up edges and the ______ is the where the back/head/feet of the PT is.


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## medicnick83 (Nov 19, 2011)

DV_EMT said:


> well.... take a SAM splint and use it to fit the size of the baby lengthwise, use a towel roll for the improvised c-collar, & put towels under the shouders to keep airway open. Then (if the same wide enough) fold the edges on either side up at a 90 degree so it makes a so called rail for the infant. Then use some tape to make makeshift spider straps. In theory, it the sam splint look like a bracket.
> 
> Should look like this
> 
> ...



Nice... I'll keep this in mind!


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## Enzo (Nov 19, 2011)

You can also use a vacuum splint. The biggest one we have, a model that fits a leg both upper and lower, can be used as a pediatric vacuum spine board.


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## medicnick83 (Nov 19, 2011)

Enzo said:


> You can also use a vacuum splint. The biggest one we have, a model that fits a leg both upper and lower, can be used as a pediatric vacuum spine board.



I don't think I've ever seen this on a ambulance, private or government.


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## Handsome Robb (Nov 19, 2011)

Enzo said:


> You can also use a vacuum splint. The biggest one we have, a model that fits a leg both upper and lower, can be used as a pediatric vacuum spine board.



This is pretty standard for us too. We do have a pedi board, collars, a scoop and a KED on every unit as well. Lots of options h34r:

If they are in a car-seat they usually are getting spinal motion restriction in it as long is the seat itself is not deformed. Lots and lots of tape and padding.


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## medicnick83 (Nov 19, 2011)

NVRob said:


> This is pretty standard for us too. We do have a pedi board, collars, a scoop and a KED on every unit as well. Lots of options h34r:
> 
> If they are in a car-seat they usually are getting spinal motion restriction in it as long is the seat itself is not deformed. Lots and lots of tape and padding.



Every ambulance is supposed to have the standard equipment, but honestly, besides normal splints, I don't think I've ever seen a vacuum splint.

In all honesty, I am upset there was no KED on the ambulance in question - it shows you all that I didn't check the ambulance correctly (Yes, I am man enough to admit it) even though later, I was informed that it was taken out because it was damaged and needed to be replaced - I could've insisted I take one off another ambo for the duration of the shift.

The KED was the next best option for the case in question but I like hearing your guys 'alternative' options... I like thinking out of the box, even if I get help (via you lot) to think out of the box. :rofl:


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## DV_EMT (Nov 19, 2011)

NVRob said:


> If they are in a car-seat they usually are getting spinal motion restriction in it as long is the seat itself is not deformed. Lots and lots of tape and padding.



Here, protocols state that car seats are not good enough for true spinal immobilization.... gotta love that.


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## tssemt2010 (Nov 19, 2011)

adapt and overcome, you could use a regular long board if thats your last option, pad in every which direction with towel rolls, modified c spine


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## Steam Engine (Nov 19, 2011)

I'd probably have used a combination of blanket roll and pedi-board (with plenty of padding), or even some sort of flat board found on scene. Seriously though...please check your ambulance before you go in service to make sure you have everything you need. It should only take a few minutes.


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## MediFaithLoveCoffee (Dec 7, 2011)

The kids car seat if available with blankets tightly packed to immobilize the full body and head / cspine I've heard works well. Or a short board with padding. Improvise. Be creative. Adapt and overcome. As long as the end result is an immobilized child.


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## abckidsmom (Dec 7, 2011)

IF you chose to immobilize the baby, then in your situation I'd use the foot end of a regular spine board and tape the baby to it or use cravats with lots of padding.

In regular circumstances, I'd check my truck out at the start of my shift and not blame equipment problems on anyone other than myself after that point.


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## Sasha (Dec 8, 2011)

abckidsmom said:


> IF you chose to immobilize the baby, then in your situation I'd use the foot end of a regular spine board and tape the baby to it or use cravats with lots of padding.
> 
> In regular circumstances, I'd check my truck out at the start of my shift and not blame equipment problems on anyone other than myself after that point.



He accepted responsibility for not having a KED. No need to shame him further 

I'll be the first to admit I don't always check the entire truck. Sometimes we are being rushed out or I'm running behind.  We(where I work) don't use back boards, we don't use the scoop or KED or traction splinter.  Half the time there isn't a stair chair to be found and I don't want to go scavenge from the trucks...

 Haven't gotten bit yet, sure I will sometime. 

Sent from LuLu using Tapatalk


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## MSDeltaFlt (Dec 8, 2011)

medicnick83 said:


> Scenario!
> 
> You arrive at a call.
> Baby has fallen of a mothers back, she says the baby landed on it's feet and then fell and hit it's head.
> ...



You will NEVER be able to get spinal "immobilization" in the prehospital field.  That can only be done by a neurosurgeon placing a HALO on that pt.  Therefore all you can get is spinal "restrictions".  Without the availability of a car seat, pediatric board, KED, or similar device, your only hope is to use whatever you have available.  In this case you used blanket roll(s).  Which is fine especially if you were able to maintain distal neuro in this child's extremities. 

I would have done the same thing.


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## Joe (Dec 8, 2011)

DV_EMT said:


> well.... take a SAM splint and use it to fit the size of the baby lengthwise, use a towel roll for the improvised c-collar, & put towels under the shouders to keep airway open. Then (if the same wide enough) fold the edges on either side up at a 90 degree so it makes a so called rail for the infant. Then use some tape to make makeshift spider straps. In theory, it the sam splint look like a bracket.
> 
> Should look like this
> 
> ...



i am adding this idea to my bag of tricks! i probably would have gone with the rolled up towels and secured to a board.



Enzo said:


> You can also use a vacuum splint. The biggest one we have, a model that fits a leg both upper and lower, can be used as a pediatric vacuum spine board.


yup! havent had to use those yet. could be pretty handy. we have a ton or the vacusplints in some random compartment i didnt know existed untill i did inventory the other day... oops ha

also for the record. our rigs go oos if were missing imobilization (sp?) equipment. someone obviously knew the ked was broken and not in service and still the ambulance was out on the road. yea "your bad" for not checking but someone else knew also and that reflects on the prior crew. we left a backboard at the hospital and didnt run any calls for the rest of the shift. told the crew in the am and they picked it up. talk to your crews people!


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## firecoins (Dec 8, 2011)

NVRob said:


> If they are in a car-seat they usually are getting spinal motion restriction in it as long is the seat itself is not deformed. Lots and lots of tape and padding.



Yep and you can buckle the car seat to the cot.  Everything is taken care.


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## rmabrey (Dec 11, 2011)

NVRob said:


> This is pretty standard for us too. We do have a pedi board, collars, a scoop and a KED on every unit as well. Lots of options h34r:
> 
> If they are in a car-seat they usually are getting spinal motion restriction in it as long is the seat itself is not deformed. Lots and lots of tape and padding.



Usually what we do. Towels on either side to hold the head straight. And they usually don't kick and scream this way 

Sent from my Desire HD using Tapatalk


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## durac (Dec 11, 2011)

vacuum splints (if you got them).. work amazing for pedi immobilizers ... like a big teddy bear hugging you


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