# NREMT KED board help



## Naota_X (Oct 4, 2011)

hi everyone i just took the nremt practicals for paramedic i passed them all except for ked board ive been going over it in my head and was just wondering if i did the strap placement wrong i cant find a deffinitive answer online and they were changed several times during my medic course and i cant get ahold of my teacher at the moment so i thought id ask here i did top middle bottom secured legs secured then head secured last and i failed both times and they couldnt tell me what i failed at i just wanted to make sure that it was the proper order and i am retesting in ohio instead of michigan due to a closer date will the strap placements change there? thanks in advance for your help 

ive been going over the crital fails a few times now and think i may have did one of them  but im just covering my bases i was taught middle bottom top legs head before to then i was told this year it got changed to top middle bottome legs head by my school but im not sure if that change has gone into effect yet or what or if it even chaged at this point 
-nick


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## imadriver (Oct 4, 2011)

I was taught: Middle, Bottom, Top, (Loosely) Legs, (Tighten All) Then Head.


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## fast65 (Oct 4, 2011)

The problem might not be with the order of the straps (I do: top, middle, bottom, legs, head), but you might have excessively moved the pt. during the tightening of the straps. Did you thread the straps to tighten them, or did you just pull on them? 

Just go over the critical fails and try to think back about what you might have missed. Did you check PMS in the hands and feet? Before the C-collar, after securing them to the KED, and after moving them to a LBB?


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## Naota_X (Oct 4, 2011)

ive been going over the crital fails a few times now and think i may have did one of them  but im just covering my bases i was taught middle bottom top legs head before to then i was told this year it got changed to top middle bottome legs head by my school but im not sure if that change has gone into effect yet or what or if it even chaged at this point 

sorry i always do that lol
for fast 65 i did kinda pull on them but had my hand on the other end too and i only checked pms beofre ked placement and after they were on the back board thats all the sheet said but next time i was going to check it 3 times even though its not on the sheet


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## imadriver (Oct 4, 2011)

If it still matters, per Brady's Emergency Care (NREMT-B) Book:

1. Manually Stabilize Spine
2. Assess Pulse, Motor, Sensation
3. Apply Appropriate Collar
4. Position KED Behind Patient
5. Secure to patients torso (Doesn't specify order, I believe this includes legs)
6. Evaluate / Pad Head then Secure
7. Evaluate Torso Straps, tight but not restricting breating
8. Secure Arms / Legs as needed
9. Reassess PMS
10. Transfer Patient to Long Board (<-- ?)


? : I was taught to leave them in the KED? Any input on that too?


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## fast65 (Oct 4, 2011)

It the order of the chest straps shouldn't matter to the NR, basically you just need to secure the chest, then the legs, and the head last. 

The thing about transferring to a LBB is that you leave them on the KED, but you just release the leg straps.


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## Naota_X (Oct 4, 2011)

ok i didnt release the leg straps either i must of really messed up but its confusing cause none of that was on the sheet


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## fast65 (Oct 4, 2011)

When you look at the skill sheet, it doesn't say anything about securing the legs, so by that measure it isn't actually required for the station, or so I've been told. 

Just make sure that you check PMS before the c-collar, after securing them in the KED, and then after you verbalize moving them to a LBB. Take great care not to excessively move the patient, and don't forget about BSI/SS.


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## traumaluv2011 (Oct 4, 2011)

I failed it too the first time. My instructor gave me some key pointers that really helped pass it the next time.

- Check PMS. You should check it before and after c collar. After you apply the KED and in verbalized end state you will check PMS before and after securing to the long board. You can check PMS as many times as you want and you won't fail, so long as you keep within time limit.

- Get the straps real tight. When I first did it, I thought it was too tight, but the KED actually moved like an inch or two down on the person. So you should *CAREFULLY* crank those straps real tight. I hope you know that two hand technique for tightening the staps (crouch directly in front of the person and have one hand pushing the strap going across towards the buckle and other hand on the free end). If you want to ask the person to take a deep breath while you're tightening the straps, go ahead.

You should release the leg straps prior to securing the patient to the longboard. They are ment to keep the KED on the patient when lifting them and they can potentially cut off circulation in the legs if they are left on when strapped to the longboard.


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## Martyn (Oct 4, 2011)

Easiest way to remember the straps is:
My middle
Baby bottom
Looks legs
Hot head
Tonight top
...or as one of my instructors sayd 'My B!tch Looks Hot Tonight'
And yes, don't forget to undo the legstraps once pt is supine or as has already been mentioned, check PMS before/after 'C' collar and before/after KED is on.

More info:
http://www.nremt.org/nremt/downloads/spinalimmobilizationseated.pdf

More info here:
http://en.wikipedia.org/wiki/Kendrick_Extrication_Device


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## crazycajun (Oct 4, 2011)

You are over thinking things.

1. Direct assistant to hold manual c-spine.
2. Tell assistant to not release c-spine until you tell them to. 
3. PMS
4. measure and apply correct size c-collar
5. Tell examiner that you will now slightly move the pt forward while your assistant maintains c-spine to correctly place the device behind the PT. (hint- Place one hand on PT shoulder and use two fingers to press slightly in the small of the back. This will make your PT move to correct posture)
6. Slide in device making sure leg straps are not twisted
7. Secure torso
8. Secure Legs
9. Secure head making sure you have adequate padding.
10. Tell assistant to release manual C-spine
11. Re check straps for tightness
12. Verbalize ONLY moving PT to Long Spine Board
13. Re-assess PMS
DONE
Remember to use the feed and pull method to tighten straps. This keeps from moving the PT excessively. Also remember to use the brow line for securing the head.


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## Martyn (Oct 4, 2011)

Oh, and don't forget to palpate the neck 'C' spine area before applying collar and when you move PT forward to 'insert' KED palpate thoracic and possibly lumbar spinal regions if possible :wacko:


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## MMiz (Oct 4, 2011)

I took my refresher this weekend and forgot a few things:

1.  Checking for PMS often
2.  Head padding
3.  Too much movement

They were using the NREMT assessment sheets.  I'd go over those over and over again until you're confident you know the process.


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## Handsome Robb (Oct 4, 2011)

I was always taught:

Manual stabilization
CMS
Palpate C-spine
Collar
position KED/Palpate T-spine
Titties
Tummy
Testes
Legs
Pad the void and secure the head
Reassess CMS
Transfer to LSB
Release Legs
Secure to LSB
Reassess CMS

You should only be able to fit 1-2 fingers inside the straps when they are tight. I always ask the patient to take a deep breath and hold while I tighten each strap.

Good luck!


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## fast65 (Oct 4, 2011)

Martyn said:


> Oh, and don't forget to palpate the neck 'C' spine area before applying collar and when you move PT forward to 'insert' KED palpate thoracic and possibly lumbar spinal regions if possible :wacko:



That's not actually part of the station. In the NREMT they're not looking for little added extras, that's not going to score you any extra points, just keep it simple and go by the sheets.


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## hoss42141 (Oct 4, 2011)

Don't forget that you can fail the station if you tighten the straps to tight. They want them tight, but not keeping the pt, from being able to breathe.


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## Naota_X (Oct 5, 2011)

thank you all for your advice i appreciate it i feel alot better about passing it next time


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## Rightroad (Oct 5, 2011)

I read your post, just have two things that might have happened beside PMS, and excessive movement while applying the straps. 

did your partner let go of C-spine stabilization to help you with the head straps?  

Did you pad behind the head? because if you did not when you move the patient to the LBB there will be excessive movement

Hope this helps


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## Oiball (Oct 11, 2011)

I seems you've either remembered the order wrong, or (hopefully not) been taught wrong.  The correct order for the KED is Middle, Bottom, Legs, Head, Torso.  The familiar mnemonic is "My Baby Looks Hot Tonight...' Any variation could be a critical fail.


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## BandageBrigade (Oct 11, 2011)

That method for order is now several years old. The head is now secured last.


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## NomadicMedic (Oct 11, 2011)

Oiball said:


> I seems you've either remembered the order wrong, or (hopefully not) been taught wrong.  The correct order for the KED is Middle, Bottom, Legs, Head, Torso.  The familiar mnemonic is "My Baby Looks Hot Tonight...' Any variation could be a critical fail.



One small change... My Baby Looks Hot Tonight is the mnemonic for Middle, bottom, legs, head, Tighten the Top strap. The RED chest strap is pulled tight last. 



Sent from my iPhone.


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