# KED or backboard only to extricate from a vehicle?



## newEMT (Dec 30, 2008)

I've seen both. Paramedics tend to place the patient involved in a MVA on a KED, and then transfer them to a long backboard. 

However, during my time with the volunteer FD, most firefighters just extricated the patient onto a long backboard so the ambulance personnel could just load and go. 

Which is better? When is a KED necessary? If I remember correctly from my EMT class, I think they said that you can just put the patient on a backboard (and forget about the KED) if there is an immediate threat to the patient's life or a life-threatening injury. Is this correct? Thanks!


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## traumateam1 (Dec 30, 2008)

newEMT said:


> If I remember correctly from my EMT class, I think they said that you can just put the patient on a backboard (and forget about the KED) if there is an immediate threat to the patient's life or a life-threatening injury. Is this correct? Thanks!



Life over limb. If you have a critical patient who needs a heli or to get out of there ASAP, you wouldn't spend the time it takes to get the KED set up, do the straps up and then get em outta there. You'd manually hold C-Spine, get the backboard under them as much as possible and then lay them down and go.

I do prefer the KED when getting somone outta a vehicle, unless they are critical and need to get to a hospital ASAP.


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## newEMT (Dec 30, 2008)

Is a KED more useful for rollovers or when the patient is laying in some odd position rather than sitting in the seat?


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## KEVD18 (Dec 30, 2008)

not using the ked is called a rapid extrication. its only meant to be done during imminent life threats(fuel leaking etc).

that being said, studies have proven time and time again that all of the efforts we do to "immobilize" the c-spine are pretty much crap. sure, in emt class where you have thirty people around to help and a perfectly calm and quite environment youc an do a pretty good job but on the street it just doesnt happen. even when you do it textbook perfect, its still awful.

stress over the details of you like. ked, no ked, order to do the straps in, 37 people to do the log roll etc. me personally, i recognize its all pretty much crap.


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## newEMT (Dec 30, 2008)

Also, where I work we have a 40 minute transport time by ground to the nearest ER. We are a BLS service, and the medics are about 20-30 minutes away from our station. Should everyone get rapidly extricated then since we are so isolated?


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## KEVD18 (Dec 30, 2008)

newEMT said:


> Also, where I work we have a 40 minute transport time by ground to the nearest ER. We are a BLS service, and the medics are about 20-30 minutes away from our station. Should everyone get rapidly extricated then since we are so isolated?


 
is there an iminent life threat?


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## DT4EMS (Dec 30, 2008)

KEVD18 said:


> not using the ked is called a rapid extrication. its only meant to be done during imminent life threats(fuel leaking etc).
> 
> that being said, studies have proven time and time again that all of the efforts we do to "immobilize" the c-spine are pretty much crap. sure, in emt class where you have thirty people around to help and a perfectly calm and quite environment youc an do a pretty good job but on the street it just doesnt happen. even when you do it textbook perfect, its still awful.
> 
> stress over the details of you like. ked, no ked, order to do the straps in, 37 people to do the log roll etc. me personally, i recognize its all pretty much crap.




Yeppers........ I have to agree........ hence the name change to Spinal Restriction since we never really immobilize 

But we should still give it our best.

And to add a point about rural treatment...... The KED is for NON rapid extrication situations period. Even though it can be used in peds or hip fx......... the intent was not for rapid extrication. Even if you have a 30+ minute transport time........ if the patient does not require "Rapid Extrication" don't do rapid extrication.


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## marineman (Dec 30, 2008)

I was talking to a medic tonight on my ride-along and he said in the 5 years he's been a medic he's never seen the KED used for it's intended purpose, doesn't make it right but it's a perspective of our use for it here.


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## BossyCow (Dec 30, 2008)

KED is an extrication device.. one of many options.. each case is different and the method used to extricate the pt will take into account the details of that particular call. Depending on how the vehicle is folded around the pt, the KED may be the only option. 

Its not particularly my favorite.. but I have used it when it was the best option for the call.


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## Veneficus (Dec 30, 2008)

the only time I ever used a KED for its intended purpose was to extricate somebody from a rollercoaster car. (which it is very well suited for I discovered)


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## marineman (Dec 30, 2008)

What happened on a roller coaster car that required an attempt at spinal immobilization? Were they too tall to make it through the tunnel?


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## Veneficus (Dec 30, 2008)

marineman said:


> What happened on a roller coaster car that required an attempt at spinal immobilization? Were they too tall to make it through the tunnel?



Jumped the track at the bottom of the hill, got stuck and the next train ran right into the back of it and rolled over the heads of the people in the car.


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## marineman (Dec 31, 2008)

Ouch, that doesn't seem like something that would end well. How many patients total did you pull out of there?


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## stephenrb81 (Dec 31, 2008)

Veneficus said:


> the only time I ever used a KED for its intended purpose was to extricate somebody from a rollercoaster car. (which it is very well suited for I discovered)



I don't think I have ever seen someone voluntarily grab a KED at the service I work for or the one I worked at before it.  I usually have to request it.

I try to educate but it falls on deaf, unwilling ears.  In most situations the first responders are first on scene and they already have MVC patients secured to LSB's prior to my arrival


Side Note: It's always fun to see the look on the "old-timer's" face when I use a KED as a splint when missing a hare-traction splint


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## reaper (Dec 31, 2008)

I use it atleast 2-3 times a week. I cannot believe the amount of people that have no clue how to use one. That is a lot of the reason I use it so much. It helps keep people fresh on how to use them!


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## Veneficus (Dec 31, 2008)

marineman said:


> Ouch, that doesn't seem like something that would end well. How many patients total did you pull out of there?



9 that required transport. While some of the injuries were quite serious, nobody was killed or disabled which was quite surprising considering what the scene looked like.


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## FF894 (Dec 31, 2008)

In MA & NH it is mandatory to use the KED for extrication unless a life-threatening situation to either patient or attendant exists/prevents the time required to safely do so.


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## DT4EMS (Dec 31, 2008)

FF894 said:


> In MA & NH it is mandatory to use the KED for extrication unless a life-threatening situation to either patient or attendant exists/prevents the time required to safely do so.



Stuff like that "mandated" makes me nervous. The reason is it can open the agency/provider up for litigation. The are a blue billion reasons to do or not to do something on the side of the road. Most is left up to the assessment of the medic/EMT on scene to do or not do something based on the totality of the circumstances.

If you are mandated to do something........... well............... what if that if the patient was too large for the KED? 

Better yet............ what if there were too many patients and not enough KED's?

No matter what............ if something is "mandated" and you or your service fails to do it the mandated way............... 

How is that court defensible?

Has anyone challenged it yet?

Kip


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## lightsandsirens5 (Dec 31, 2008)

If it does not require rapid extrication, you have to use a KED or short spineboard then transfer to a longboard.


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## Bosco578 (Dec 31, 2008)

KED works well for extricating Sprint car drivers. We don't use them much in the city,usually just the LB.


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## KEVD18 (Dec 31, 2008)

never seen anybody get called out for not using the ked in ma.

soryy but ive lost count fo the number of mva's ive done here and can count on one hand the number of times ove used the ked. oems isnt beating down my door just yet, but i'll let ya know....


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## FF894 (Dec 31, 2008)

Sorry, should have elaborated a little more- KEDs are not used anywhere near 100% compliance.  I actually did not even realize it was in protocols until last year when it came up in a QA scenario.  I would say the majority of the time, it is NOT used.  However, it _is_ there that unless you are doing a ripid extrication the KED is to be used.  

Personally I have used it a few times for one thing or another.  At MVCs they are great once properly placed.  The problem is getting damn things on properly.  Not the same as sitting in a classroom.


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## KEVD18 (Dec 31, 2008)

FF894 said:


> they are great once properly placed.


 

even properlly placed(which is damn near impossible in the real world), they are still crap. sure, in a classroom in a chair with no arms and a perfectly complaint patient, you can get a perfect ked with zero c spine manipulation. just try to do that in the filed with a car on its side and other cars whizzing by at highway speed.

sorry to be blunt, but theres a significant problem with thinking that a device or procedure is great or even adequate when it really isnt.

all prehospital c spine is is an allusion of stability. we cant do nothing, so we do something that "looks" like it will be ok. if you read the current research(look to someone else for links etc), its all crap. i know nobody likes the term cosmetic cspine precautions, but when you get right down to the nitty gritty, thats pretty much what it is.

im not dogging on any one state or service or practitioner, just generally at the whole genre of ems procedures.


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## FF894 (Dec 31, 2008)

Right, I somewhat agree with what you are saying.  However, almost every state does mandate that you do follow some sort of c-spine precaution for now and if we do have to follow those guidelines for now, when you have a patient in a car that you need to restrict movement and be able to lift them out- the KED is currently the best option.  So, until someone invents some technology like Sly uses in that movie where the foam totally covers him in the car and protects him from the impact, we have to use the devices we have available and the KED is currently the standard.


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## traumateam1 (Dec 31, 2008)

KEVD18 said:


> even properlly placed(which is damn near impossible in the real world), they are still crap. sure, in a classroom in a chair with no arms and a perfectly complaint patient, you can get a perfect ked with zero c spine manipulation. just try to do that in the filed with a car on its side and other cars whizzing by at highway speed.
> 
> sorry to be blunt, but theres a significant problem with thinking that a device or procedure is great or even adequate when it really isnt.
> 
> ...



Oh I'd like to see those studies.. who has the links?


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## KEVD18 (Dec 31, 2008)

heres one:
http://www.emsresponder.com/features/article.jsp?id=3437&siteSection=16


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## mycrofft (Jan 1, 2009)

*NHTSA invented EMTA & P because largely of C spine injury done by "rescuers" at MVA's*

Spinal splinting is there to prevent responders from further harming the pt (iatrogenic injury).
When you are on a scene your time sense tends to get warped and the sense of urgency prevails. The ninety seconds (maybe longer due to circumstances and lack of training) to use the KED may well be time well spent. Or are we clearing C spines before extrication?
Be the subject of a KEDS application done right some time. I had it done once and it d$^n well did immobilize me, sitting at the wheel of a '56 Chevy pickup and applied from one side. If it is a valued procedure it will be rehearsed, if it is rehearsed it will go smoother and faster. If there are circumstances preventing its use, then there are, so be it.Sure beats the old short boards, albeit more expensive.

PS: I hate it when they (bean counters) want you to KED folks who slipped in the kitchen because you didn't seem them fall, too.
PPS: Want a useless expensive tool? (Other than the other shift's assistant chief)? Try using a "build a board" in a restricted position.


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## mikeylikesit (Jan 12, 2009)

KEDs aren't ideal for what they were designed to do. however, they do make get extraction devices for peds. and great CPR boards in the field. but like others have siad they take too long and are waay too hard to place without perfect conditons.


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## MAC4NH (Jan 14, 2009)

Don't forget your "Golden Hour" of trauma.  Trauma cases need to be in the trauma center stat.  If there was enough energy to possibly fracture the person's neck, that's a trauma case due to (at least) mechanism of injury.  Therefore(IMO), if a KED is indicated (high energy impact; spine instability; neuro deficit), it's usually contraindicated because it delays transport to the trauma center (unless the hospital is a couple of minutes away). If you don't have trauma criteria but have neck or back pain, you can use the KED although it's not going to do anything. 

In the same vein, a couple of years ago I saw the results of a study that showed that once the injury occurs, what comes afterward usually has no significant effect on outcome.  

This is the citation:

Hauswald M, Ong G, Tandberg D, et al: "Out-of-hospital spinal immobilization: Its effect on neurologic injury." Academic Emergency Medicine. 5(3):214–219, 1998.

The citation was found in an article written by Dr. Bryan Bledsoe.  He cites 9 other articles on other subjects that you should find interesting.


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## MAC4NH (Jan 14, 2009)

My bad!  I forgot to put the link to Dr. Bledsoe's article.  Here it is:

http://www.jems.com/news_and_articles/columns/Bledsoe/bledsoe_top_10_ems_studies.html


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