# Simple KED Question... or not?



## EMSrush (Apr 23, 2011)

We had an interesting discussion at work today that I'd like some feedback on. It involves the immobilization process and the correct application of the KED on a seated adult patient. There are two basic sides to the coin:

1. Many EMS folks will maintain the head and neck in the position found (as reasonable and appropriate) and pad any spaces between the back of the head and the KED with the padding. The exact definition of "neutral in-line position" may vary, depending on the provider. 

2. There are others who believe that KED padding should never be used to pad the void between the patient's head and the KED (unless Kyphosis or similar condition is present). The act of bringing the head into a "neutral in-line" position, if done correctly, will ensure that there is no gap between the KED and the back of the head. According to this side of the coin, the definition of "neutral in-line" is to apply traction and pull the head and shoulders back, until the ears are aligned with the shoulders.

Aside from movement required to maintain an airway, I'm not too comfortable with excessive manipulation of someone's head and posture when c-spine precautions are necessary. Also, depending on the patient's natural posture and position that they are found in, the amount of manipulation that must occur to achieve the goal can vary widely. Those who disagree will probably say that bringing the head to a neutral position does not qualify as excessive movement.

I haven't found too much on this with National Registry yet, but I'm still researching. In the meantime, I'm curious as to where other providers and agencies stand on this topic. Thanks!


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## reaper (Apr 23, 2011)

Your answer would be simple. There is padding provided with the KED for a reason!


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## DesertMedic66 (Apr 23, 2011)

All depends on how the patient is. For practice some of us needed the pad in order to keep everything in line and some others didn't need the pad at all.


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## EMSrush (Apr 23, 2011)

That was my first argument... but then they cried out in unison,

"The padding is for your knees when you check PMS!"

(Ok, well not really in unison, but you get the point...)


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## DrParasite (Apr 23, 2011)

in 11 years, have used the KED exactly 2 times at an MVA.  both times we padded the best we could

food for thought, with everyone saying how we over backboard people, does that same thought process go that there is no evidence to support that KEDs do any good?


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## usalsfyre (Apr 23, 2011)

KEDs are probably completely pointless if your only removing people from cars to a LSB with them. Unfortunately, they can't be used routinely without a LSB. I've use them in this role a fair amount (way more than using them to remove people from vehicles) when I had a patient that couldn't tollerate lying flat. This is completely anecdotal, but everyone of them to a person has fared very well using this method.


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## DesertMedic66 (Apr 23, 2011)

EMSrush said:


> That was my first argument... but then they cried out in unison,
> 
> "The padding is for your knees when you check PMS!"
> 
> (Ok, well not really in unison, but you get the point...)



Never heard that before.


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## reaper (Apr 23, 2011)

usalsfyre said:


> KEDs are probably completely pointless if your only removing people from cars to a LSB with them. Unfortunately, they can't be used routinely without a LSB. I've use them in this role a fair amount (way more than using them to remove people from vehicles) when I had a patient that couldn't tollerate lying flat. This is completely anecdotal, but everyone of them to a person has fared very well using this method.



Yes, a KED is as close to full spinal immobilization as you can get. It is the most under used piece of equipment on a truck. Mainly because of lazy providers or people scared of them, from lack of using them. Any Pt that is not critical, should have one in place, before being moved. If you are worried about the spine, then it should be used. Unless a life threat is apparent, moving without one is wrong. 

A KED is a national standard. When you are in court and the expert witness states that fact, you will be hung out to dry. I have testified for ambulance chasing scum, because they know they have a case there. When it is considered a standard and you choose not to use it. You better have a damn good reason for it and document it very well.

It takes all of 2 minutes to place one and makes moving the pt securely, much easier. If the Pt is truely having neck or back pain, it will help relieve the pain from movement.

People there is a reason why NREMT still tests on it's use.


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## Akulahawk (Apr 23, 2011)

The KED does have it's uses... like extricating people vertically out of F1 Race cars.  They can also be used to stabilize a pelvis. While I still know how to apply one (and do it quickly) I view them mostly as extrication equipment.


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## usalsfyre (Apr 23, 2011)

reaper said:


> Yes, a KED is as close to full spinal immobilization as you can get. It is the most under used piece of equipment on a truck. Mainly because of lazy providers or people scared of them, from lack of using them. Any Pt that is not critical, should have one in place, before being moved. If you are worried about the spine, then it should be used. Unless a life threat is apparent, moving without one is wrong.
> 
> A KED is a national standard. When you are in court and the expert witness states that fact, you will be hung out to dry. I have testified for ambulance chasing scum, because they know they have a case there. When it is considered a standard and you choose not to use it. You better have a damn good reason for it and document it very well.
> 
> ...



"National standard" and "effective in any way whatsoever " are two completely different things. MAST and Isuprel were national standards at on point too.

I think a pretty convincing case can be built, based on evidence, that routine immobilization of any sort is not called for vs an expert witness spouting dogma out of a text book written at a 7th grade level.


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## akflightmedic (Apr 23, 2011)

A close friend of mine who is a Medical Director for several large departments in Florida had a discussion with me a few months back and he asked a question which made me stop and seriously think.

There is no clear answer to this question and I can see a lot of rationale in it...I would like to hear your views.

When a patient presents with a fracture and is already holding it in the position of comfort, we as providers do not attempt to manipulate it as long as all distal PMS is intact. We will do our best to keep it in same position and provide additional pain relief measures if possible.

If the above is true....then why do we insist on manipulating a person who has neck or back pain into what we deem a better position? They are already in their position of comfort and for this example let us say there is no distal neuro compromise....why do we force them out of that position into a "better" one?


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## Veneficus (Apr 23, 2011)

*regarding KEDs*

What makes the KED a national standard is not the device itself.

It is the desire for spinal restriction on a seated patient.

It is a device meant to improve upon the short spine board. It is not the only device to do so. From my experience there are actually better devices.

The idea of spinal motion restriction in stable patients is a matter of debate. I think it is important to recall the conditions and circumstances in which these devices gained notoriety. 

It was on cars made of steel with very little safety features and laws in place.

The very nature of the materials tranferred the force of the impacts directly to the occupants. Coupled with the lack of restraining systems, in my early days before seatbelt laws and the cultural shift towards wearing them, it was not unheard of to find seated patients with spinalcord injuries in vehicles.

Having said that, in a majority of the cases they also had other grevious injuries as well. Whether or not immobilization of any type at that point made a difference is a matter of debate. But the modern medical knowledge along with some emerging studies, cited in this forum for ages, are pointing towards "no."

Every now and again, humans being rather ingenious creatures, will manage to create a situation where there is a assumed potential benefit from spinal motion restriction in a seated position. (The most common I am aware of is amuzement park rides, particualrly roller-coasters, log rides, etc.)

Seated spinal motion restricition is a tool. Like every other tool in the box it is not meant for all patients or all circumstances. 

It is a tool designed to help with a medical condition which must be assessed by sound clinical judgement using today's knowledge and techniques.

It is also worthy to note that seated spinal restriction is meant for stable patients, instability being a contraindication to use. As well, all of the devices are meant to restrict movement, it really is not very likely complete immobilization can even be obtained.

Given that we know today that occlusion and ischemia are responsible for significant amount of cord injury, I think that the use of restriction devices needs to be seriously re-evaluated as they will reduce the the size of the compartment surrounding the spine. 

For the same reasons we don't use circumferential plaster splinting in the initital management of orthopedic injuries of the extremities, what possesses us to do exactly the opposite when a spine injury is detected or suspected and think we are actually helping?

As for the OP, officially when splinting anything, especially the spine, padding of void space is indicated. Otherwise, you are allowing movement.

The first question that really has to be addressed is not technique, but if the treatment actually makes a difference. In medicine there are also multiple ways to accomplish the same ends. There is no 1 right way.


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## EMSrush (Apr 23, 2011)

I appreciate the responses. I guess I was looking for specific feedback on the purposeful manipulation of the head in order to achieve a "neutral in-line position" and what actually defines neutral in-line position. Also, how much manipulation are you willing to do in order to achieve your goal?

Maybe I didn't phrase the question well- I was tired when I wrote it.


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## EMSrush (Apr 23, 2011)

akflightmedic said:


> If the above is true....then why do we insist on manipulating a person who has neck or back pain into what we deem a better position? They are already in their position of comfort and for this example let us say there is no distal neuro compromise....why do we force them out of that position into a "better" one?



I think that's kind of where I'm going with this. Add to that the possible damage that we can cause by manipulating into a "better" position and we can create some serious complications.


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## EMSrush (Apr 23, 2011)

Veneficus said:


> As for the OP, officially when splinting anything, especially the spine, padding of void space is indicated. Otherwise, you are allowing movement.
> 
> The first question that really has to be addressed is not technique, but if the treatment actually makes a difference. In medicine there are also multiple ways to accomplish the same ends. There is no 1 right way.



I agree with you. What some of my co-workers were saying, is that if you bring the head to a neutral in-line position "correctly", you will NEVER need to use the padding, because the back of the head will make contact with the KED on its own. I've never heard of this before.


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## 18G (Apr 23, 2011)

EMSrush said:


> I agree with you. What some of my co-workers were saying, is that if you bring the head to a neutral in-line position "correctly", you will NEVER need to use the padding, because the back of the head will make contact with the KED on its own. I've never heard of this before.



That is strange they would say that. When the head is neutral there is almost always a space between the head and the KED board which requires padding.

On the topic of KED's... they do double as decent pediatric backboards.


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## AMF (Apr 23, 2011)

EMSrush said:


> I agree with you. What some of my co-workers were saying, is that if you bring the head to a neutral in-line position "correctly", you will NEVER need to use the padding, because the back of the head will make contact with the KED on its own. I've never heard of this before.



This is what we Basics are taught (except for obvious anatomical variations) as of 2011


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## medicdan (Apr 23, 2011)

EMSrush said:


> I appreciate the responses. I guess I was looking for specific feedback on the purposeful manipulation of the head in order to achieve a "neutral in-line position" and what actually defines neutral in-line position. Also, how much manipulation are you willing to do in order to achieve your goal?
> 
> Maybe I didn't phrase the question well- I was tired when I wrote it.



I had this exact conversation with a group of 2 or 3 dozen skill and lecture instructors for an EMT program a few weeks ago. Many of the instructors were trained elsewhere, and had slightly different initial training, and we were working to standardize our curriculum, and testing for the class practical exam (comparing it to how we taught it). There were several state examiners in attendance, and each had a different take. Where we were looking for consistency, we found zero standards, and complete ambiguity in protocols, even the device instruction manual. 

I turned, like a good product of academia, to PubMed, and found the below articles/discussions:


> Wilderness Environ Med. 2008 Summer;19(2):108-10.
> The use of extrication devices in crevasse accidents: official statement of the International Commission for Mountain Emergency Medicine and the Terrestrial Rescue Commission of the International Commission for Alpine Rescue intended for physicians, paramedics, and mountain rescuers.
> Winterberger E, Jacomet H, Zafren K, Ruffinen GZ, Jelk B; International Commission for Mountain Emergency Medicine; Terrestrial Rescue Commission of the International Commission for Alpine Rescue.
> Source
> ...


Reading the full article, it provides no data for our question, it simply supports the use of a KED for seated/vertical trapped patients in a crevice, and stability of the KED to raise the patient out. 



> Ann Emerg Med. 1989 Sep;18(9):943-6.
> A practical radiographic comparison of short board technique and Kendrick Extrication Device.
> Howell JM, Burrow R, Dumontier C, Hillyard A.
> Source
> ...


In a controled situation, the researchers compared the effectiveness of a KED + Philadelphia Collar to Short Board + Philadelphia Collar (remember, this is 1989), and found them to be essentially identical, the distinction being in rotation, where the KED was superior. These were, of course, perfect conditions, and theoretically correct technique. I couldn't get full access to the article (on request through ILL), but when I do, I'll share their methods (if listed).



> Ann Emerg Med. 1987 Oct;16(10):1127-31.
> A radiographic comparison of prehospital cervical immobilization methods.
> Graziano AF, Scheidel EA, Cline JR, Baer LJ.
> Source
> ...


Lastly, this study from 1987, also examined the Short Board, compared to KED, XP-1, and StiffNeck Collar (I presume the predecessor to the current Laerdal collar, but does anyone else know?). The Short board was found to be the best of the group-- and statistically significant in certain circumstances, KED and XP-1 in others. I am also waiting on ILL access to the full text.

So, short story: No data proving even base effectiveness of the KED. No academic discussion of cervical spinal manipulation. Brown, maybe this should be your next published study?


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## usalsfyre (Apr 23, 2011)

emt.dan said:


> So, short story: No data proving even base effectiveness of *spinal immobilization*



Fixed that for ya .


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## medicsb (Apr 24, 2011)

reaper said:


> Yes, a KED is as close to full spinal immobilization as you can get. It is the most under used piece of equipment on a truck. Mainly because of lazy providers or people scared of them, from lack of using them. Any Pt that is not critical, should have one in place, before being moved. If you are worried about the spine, then it should be used. Unless a life threat is apparent, moving without one is wrong.
> 
> A KED is a national standard. When you are in court and the expert witness states that fact, you will be hung out to dry. I have testified for ambulance chasing scum, because they know they have a case there. When it is considered a standard and you choose not to use it. You better have a damn good reason for it and document it very well.
> 
> ...



Considering how infrequently it is used, it would be hard define it as a "standard of care".  For something to be a standard of care, would not it have to be frequently employed for a given condition.  In 8 years I've applied the KED once for an individual who couldn't tolerate a LSB.  I've only seen it applied one other time.  I know of few medics and EMTs that have used it more than once.  Its most frequent use seems to be for off-label purposes - pelvic fractures, immobilization of pediatric patients, etc.  It is in no way a standard of care.  The book does not determine the standard of care, the sum of the end-users does.  To state it as a standard of care in my area (and many many others) would be to tell a lie.


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## mycrofft (Apr 24, 2011)

*Five is four*

If the patient requires the immobilization offered by the KED, do it, and cause the least movement you can, which means padding dense enough to prevent laxness of the restraints. If the particular pt does not warrant a KED, don't do it unless your protocol dictates; then, do it right if the pt is safely helped. Can't hide behind protocol if on-scene conditions make it dangerous.


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## AnthonyM83 (Apr 25, 2011)

usalsfyre said:


> I think a pretty convincing case can be built, based on evidence, that routine immobilization of any sort is not called for vs an expert witness spouting dogma out of a text book written at a 7th grade level.



I disagree (legally speaking). To go against local and state protocols written by panels and MDs, standard of care, National Registry, all the paramedic books I've read (including those unpopular ones written at higher reading levels), just because of the latest studies....I wouldn't take my chances. To be clear, I'm not contesting the latest studies, rather I'm contesting the strength of that defense in court (realizing that if you end up in court, injury probably did happen).

Of course, you used the word "routine"...that could be used as an "out" since the definition/application of the word is a bit subjective (does it mean you cspine regularly or that you cspine everyone, etc etc etc)


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## AnthonyM83 (Apr 25, 2011)

medicsb said:


> Considering how infrequently it is used, it would be hard define it as a "standard of care".  For something to be a standard of care, would not it have to be frequently employed for a given condition.  In 8 years I've applied the KED once for an individual who couldn't tolerate a LSB.  I've only seen it applied one other time.  I know of few medics and EMTs that have used it more than once.  Its most frequent use seems to be for off-label purposes - pelvic fractures, immobilization of pediatric patients, etc.  It is in no way a standard of care.  The book does not determine the standard of care, the sum of the end-users does.  To state it as a standard of care in my area (and many many others) would be to tell a lie.



You're right, standard of care is affected by local practice. But why aren't you practicing what the book says on your own regardless of what your peers do?

Pretty much all of the providers where I work have mom hold infants and toddlers in their arms unbelted (mom sits on the gurney and holds baby)...they fare okay. They might be able to defend it as local "standard". But why would I partake in that instead of just using the pediatric restraint device we carry (especially for stable patients)???


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## usalsfyre (Apr 25, 2011)

AnthonyM83 said:


> I disagree (legally speaking). To go against local and state protocols


No state protocols, and local ones don't mention the KED.  



AnthonyM83 said:


> written by panels and MDs, standard of care, National Registry, all the paramedic books I've read (including those unpopular ones written at higher reading levels), just because of the latest studies....I wouldn't take my chances.


Here's why this doesn't fly. EVERY new treatment at some point goes against what text books, MDs, standard of care, ect says. If we went solely by this medicine would still be bloodletting. 



AnthonyM83 said:


> To be clear, I'm not contesting the latest studies, rather I'm contesting the strength of that defense in court (realizing that if you end up in court, injury probably did happen).


The studies are actual hard, scientific evidence (granted some of it is stronger than other parts of it). The books and protocols are based on expert recommendations that may, or may not be based on misguided thinking, old standards, sacrificed chicken blood or any other number of things. 

All in all, the KED, with a few small improvements would probably be a FAR superior to the LSB for patient immobilization. But using the KED the way we do now, in conjunction a LSB is overkill, uncomfortable for the patient, and stupid. The only reason we continue to do things the way we do is EMS providers have been convinced more than any other area of medicine that the lawyers are out to get them, and as such, we can't advance based on evidence.


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## Veneficus (Apr 25, 2011)

EMSrush said:


> I agree with you. What some of my co-workers were saying, is that if you bring the head to a neutral in-line position "correctly", you will NEVER need to use the padding, because the back of the head will make contact with the KED on its own. I've never heard of this before.



Wouldn't that depend on the size and shape of the patients head?

I actually wrote a paper once on the false science of using cranial vault volume as a measure of intelligence. Skulls are not all the same size or shape. The KED is.


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## mycrofft (Apr 25, 2011)

*KED is adjustable to a point, and I'm enjoying this exchange!*

The KED limitation is inferior-superior length, since the head flaps have velcro which can be variably secured. If you are too tall or too short for the KED at hand, then you have to make it safe or do it another way. My experience IN a KED (as a demo) is that is it a truly effective tool of its sort; not a panacea.

I'm seeing pointed, reasoned exchanges as well as opinions being forwarded without _ad hominum _shin-kicking. Good deal! 

BTW, a bunch of guys and gals sitting around the ambulance floor talking about how they might subvert safety protocols, if it results in an injury, could be possibly considered a conspiracy.


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## medtech421 (May 5, 2011)

usalsfyre said:


> No state protocols, and local ones don't mention the KED.
> 
> Google search produced a protocol for Detroit on the KED so there are a few areas that have protocol concerning this device.
> 
> ...


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## usalsfyre (May 5, 2011)

I'm not going against my treatment guidelines by not utilizing a KED.

I ask again, what evidence does the standard have to back it up?


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## medtech421 (May 5, 2011)

usalsfyre said:


> I'm not going against my treatment guidelines by not utilizing a KED.
> 
> I ask again, what evidence does the standard have to back it up?



Utilizing or not utilizing is at your discretion.  I have seen your posts and you seem to be an intelligent person.  You just have to say "would 12 other people say I did the right thing".  Does the standard have to have evidence?   Before you skewer me for that question think about it....Men and women with more medical education than we have sat down and said this is the standard and we will put it in the books.  We will teach every EMT and Paramedic to do this to prevent injury.  When the patient gets injured the very first thing the lawyer will say is "Were you taught how to use this device and told it may prevent injury?"  I am not saying you are wrong, I am saying the system used to judge us is.  Unless those very educated men and women sit back down and say "We have detailed reports showing this thing has no major benefit in this capacity." We have to sit back and wait.  When i started in this field, MAST were the best thing since O2.


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## Veneficus (May 5, 2011)

medtech421 said:


> Unless those very educated men and women sit back down and say "We have detailed reports showing this thing has no major benefit in this capacity." We have to sit back and wait.  When i started in this field, MAST were the best thing since O2.



I wouldn't hold my breath waiting for those very educated people.

Many of them I have met see little value in EMS. 

The handful who do have interest seem absolutely impotent to effect change.

If things are ever going to change it will have to come from EMS.


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## usalsfyre (May 5, 2011)

medtech421 said:


> You just have to say "would 12 other people say I did the right thing".  Does the standard have to have evidence?


I'll give you absence of evidence does not equal evidence of absence. However, when the evidence of harm starts to outweigh the evidence therapeutic value (where spinal motion restriction is getting might close to being), the "standard" starts to look might shaky legally. Not to mention I hate practicing based of being (unrealistically) scared of the legal system. I know it's beat into EMTs and paramedics, but how many cases have you heard of in your area that have centered around spinal immobilization? 



medtech421 said:


> Before you skewer me for that question think about it....Men and women with more medical education than we have sat down and said this is the standard and we will put it in the books.  We will teach every EMT and Paramedic to do this to prevent injury.


Not trying to skewer you at all, very sorry if I came off that way. As you note below, those same educated people taught MAST, Isuprel, airway was more important than compressions, high dose epi, the list goes on and on. When the evidence piled up they were harmful, they were eliminated. The only reason spinal motion restriction continues in it's current form is....



medtech421 said:


> When the patient gets injured the very first thing the lawyer will say is "Were you taught how to use this device and told it may prevent injury?"  I am not saying you are wrong, I am saying the system used to judge us is.


...legal fears masquerading as good medicine. Legal fears that may, or may not be, unfounded. The US is the only first world EMS system that takes spinal motion restriction to the ridiculous level that we do. Our argument for doing so is either we're scared of lawyers, or we're too dumb to assess the patient (how many time have you heard "I don't have xray vision") The cynical side of me says certain providers push spinal precautions as so important because without it the EMT curriculum will look even more like a first aid class.



medtech421 said:


> Unless those very educated men and women sit back down and say "We have detailed reports showing this thing has no major benefit in this capacity." We have to sit back and wait.  When i started in this field, MAST were the best thing since O2.


The impetus is on EMS itself to drive change. We're probably still years away from a large trial, but we should be trying to push things that way. Waiting on "the smart people" is one reason why EMS is the redheaded stepchild of medicine.


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## medtech421 (May 5, 2011)

Now THAT is an intelligent debate my friends!  Wish more posts would go that way.


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## LucidResq (May 5, 2011)

To throw my quick, somewhat uninformed 2 cents in on this discussion - 

After playing with the cumbersome KED again in my refresher class, and bearing in mind the general research consensus on the usefulness (lack thereof) of spinal immobilization, I'm not impressed. A special forces medic and former PA and I had a conversation about this, and agreed the KED has very limited practicality. He said he's only used it once in the field to extricate someone "from a hole." It takes too much time, it's too cumbersome, and spinal immobilization is not as critical as people think it is anyways. 

However, I'd still like to have it available in my "toolbox." As has been mentioned, it does seem to have practical use in odd situations - pediatric patients, weird confined space rescues, etc. 

And my final point - I thoroughly believe people are way too scared of legal liability. I know you've been taught from the get-go that YOU WILL GET SUED 800 TIMES SO YOU BETTER BE READY TO STAND TRIAL AT ALL TIMES!!! But, I really don't think it happens as much as people think. I think a solid argument for why you made the intelligent, evidence-based decision you did, will go a long way. But that's just theoretical I guess. 

Those who have been sued for such an issue please stand up.


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## medtech421 (May 7, 2011)

I would love to live in a world where, reasonable,informed decisions keep people from liability.  I would love to think that there is no sleazy lawyer just waiting for the case that will help pay off his student loans.  I wish I could say that "it doesn't happen that often" would easily translate to "it wont happen to you"..Finally I would love to think that someone who orders a hot cup of coffee would never sue a restaurant for giving them a hot cup of coffee.


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## mycrofft (May 7, 2011)

*Anyone can be sued anytime.*

It takes a good judge to throw out the trash suits, and good lawyers to decline to take them. Unfortunately, that isn't always the case, or a plaintiff has a point.

If you are busy doing the right thing for the pt and are not out there writing your own portocols as you work, then you are likely to come out ok, unless the legal bills kill you.


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## Melclin (May 7, 2011)

I've been pretty vocal about only immobilising people who need it on this forum, so I'm the last person to bouncing about boarding every sore toe and finger ouchie. 

Nonetheless, spinal immobilisation is still the standard of care. You can jump up and down all you want about spinal immobilisation probably not working, but if the spinal injury specialists still recommend immobilisation, then it should be done. We're not reading any special literature that they don't have and they have careers dedicated to the topic. We need to listen to them, just like EM docs in hospitals, ED nurses and the drs and paramedics on our advisory board and guideline working groups. The standard is the same in hospital as it is out, its nothing to do with some deficiency in pre-hospital education or literature.

I'm all for not putting collars on people who have low likelihood of spinal injury based on neuro exam, and some evidence based clearance criteria. But while immobilisation is a standard of care, its gotta be done for people in whom it is indicated. If it can't be with a board then, with whatever the next best option is. The KED is pretty useful to have available in my opinion, for some of those trauma jobs but especially for those, '89 year old nanna tripped over the bathroom mat, smacked her head, had an LOC of unknown length and osteoporosis, and is now wedged nicely behind the toilet and you wanna use a drag mat to move her out from the bathroom and around 2 corners' type jobs. They're not that uncommon.


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## mycrofft (May 7, 2011)

*Second that, Melclin.*

Small studies get cited, but I want a large scale study comparing field immobilization, broken down by presentation to the responder and their evaluation, plus their protocols, and sequelae attributable* in each case* to use of a spinal immobilizer, and final in-house (hospital that is) diagnosis. Also, frequency of refusal. Make a matrix, follow these for a whole year, then do it again elsewhere.

_*KED is an effective tool if you are not excited and have practiced it a few times, and have half a brain; you have to use it appropriately*_.

*Every single time* you lay hands on a pt, the questions "What is probably wrong here?" and "What can I do to actually help that?" must be raised. Overtreatment starts everytime with failure to truthfully answer each of those questions, and maltreatment states by ignoring them or lying.


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## Veneficus (May 7, 2011)

mycrofft said:


> Small studies get cited, but I want a large scale study comparing field immobilization, broken down by presentation to the responder and their evaluation, plus their protocols, and sequelae attributable* in each case* to use of a spinal immobilizer, and final in-house (hospital that is) diagnosis. Also, frequency of refusal. Make a matrix, follow these for a whole year, then do it again elsewhere.
> 
> _*KED is an effective tool if you are not excited and have practiced it a few times, and have half a brain; you have to use it appropriately*_.
> 
> *Every single time* you lay hands on a pt, the questions "What is probably wrong here?" and "What can I do to actually help that?" must be raised. Overtreatment starts everytime with failure to truthfully answer each of those questions, and maltreatment states by ignoring them or lying.



Would have been nice to have that study before people decided spinal immobilization should be so pervasive.

Of course is long boards and KEDS work so well, why is nobody in the hospital on one? Hmmmm...


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## mycrofft (May 8, 2011)

*Vene, you should be an insructor! (Oh, yeah...)*

 ( I'm about to preach to the choir and teach grandpa how to rustle cattle).

I'm always getting all "Five is Four" on other people, but we must remember the history.

When EMT's were invented, it was by NHTSA because wreck victims, in 1960's or earlier automobiles travelling up to seventy legal miles per hour, were being exacerbated in their injuries, including spinal ones, through the efforts of would-be rescuers. Since then, we have air bags, crumple zones, seat belts and shoulder harnesses, safer highway designs, and lower highway speed limits (stop laughing back there!). Also, EMS sees many times more non-MVA cases now than was anticipated when EMT's were devised.

The goal was to train as many people as quickly as possible to perform extrication, and to prepare and transport them, without a doctor physically looking over their shoulder. This was an outgrowth of the military experience with medics at forward positions during wartime doing so much for final outcome.

However, a condition for medical sign-off on standards was that certain universal standards needed to be in place to limit and guide the urge for self-direction in practitioners without adequate medical training/experience (or equipment in the field) to make a definitive diagnosis. Hence, spineboards.

People forget that splinting and spineboards are *packaging for transport, not care*. They are preventative, just like you donning gloves to prevent infection. They are there to prevent exacerbati0n of extant injury by the responders, or the exigencies of transport, like potholes.

Raise the level of training, and we should be able to dispense with universal anything except billing and safe driving. 

(Paranoid ambulance company owners and medical controlers, take note). 

5=4​


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