# Seated Spinal Immobilization



## AlaskaEMT (Mar 10, 2008)

In an upside-down vehicle!  How does this work?


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## scottmcleod (Mar 10, 2008)

AlaskaEMT said:


> In an upside-down vehicle!  How does this work?



[THIS IS NOT THE ANSWER], but my instinct would be to go:

- manual c-spine
- collar
- KED (somehow?)
THEN try to have the patient extricated, or vehicle rolled over or what not.

That being said, I don't actually know the real answer, so if anyone from fire, or who has worked in this situation can shine some light, I'm curious!


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## KEVD18 (Mar 10, 2008)

press hard, your making three copies. have a nice day.


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## rescuepoppy (Mar 10, 2008)

*Seated C-Spine*

I have several years of rescue experience so let me say that if the patient is upside down in a car he is probably not seated. He is probably all twisted up in an akward position meaning you would have to straighten him out before you can put him in a KED or XP-1.Normally the easiest thing you can do is to c-collar hold manual stabilization and ease patient on to a long board.  In a perfect world a vest would be the optimum way to go but sometimes you could do more harm by using one.  Again this is not the perfect way to go and certainly not the only way to go just what I have seen the most.


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## rescuepoppy (Mar 10, 2008)

scottmcleod said:


> [THIS IS NOT THE ANSWER], but my instinct would be to go:
> 
> - manual c-spine
> - collar
> ...



Just reread this post as a note I would not recomend rolling or moving the vehicle while the patient is in it until all other means of extrication have been exhausted. Trust me after 28 years of doing this we can aome up with some pretty unique options to get some one out. Not trying to be judgemental just trying to share a little experience.


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## reaper (Mar 10, 2008)

Just cut the belt. Once they fall to the roof, then you can get them on a BB easier!!!


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## scottmcleod (Mar 10, 2008)

rescuepoppy said:


> Just reread this post as a note I would not recomend rolling or moving the vehicle while the patient is in it until all other means of extrication have been exhausted. Trust me after 28 years of doing this we can aome up with some pretty unique options to get some one out. Not trying to be judgemental just trying to share a little experience.



Understood. That's what I was looking for... I've never responded to a call like this, nor have we encountered it in training. I'd immediately default to higher medical authority's advice in such a situation. By the time they'd have to be removed, EMS would be on scene, and I wouldn't be needed anymore, or I'd be assisting.

Care to describe most awkward extrication for our enlightenment?


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## KEVD18 (Mar 11, 2008)

one weak point with protocols is that they cant cover every possible situation and if they could, they would so voluminous as to be useless.

in situations that aren't covered by your protocols, you have to use your best judgement. step back, think it through and do it. just make sure to doc it thoroughly.

as rescuepoppy said, if the vehicle is inverted, the patient isnt in any sort of normal position. cspine is already compromised so you have few options. id skip the ked. its just not practical. imagine how they are going to fall if you just cut the belt(by that i mean imagine where their head will land, feet etc. then come in with a lbb and as many guys as you can get in to hold it right up under the pt. cut the belt as do you best to get the pt aligned on the board. oh yeah, before you do any of that, collar. lower and extricate. it wont be pretty, it wont be perfect but with the circumstances, your not going to get pretty or perfect.

agree with poppy again, you dont want to move the car with the pt still in it. crib it in place, extricate and then deal with the wreck(well that wont be you but you get what i mean). try and flip that car with the pt in it, you have no hope whatsoever of maintaining c-spine, not to mention how do you protect the rescuer whil your rolling a car?

or you could save all the time and effort and go with my first suggestion(kidding of course)


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## scottmcleod (Mar 11, 2008)

EDIT: Found it.

Definitely useful notes for tough extrications where C-Spine can be assumed comprimised.


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## certguy (Mar 11, 2008)

I encountered a whole new twist on this scenerio last week while driving a bus on my day job . Upside down vehicle on fire  , unrestrained driver hanging from the passenger side lying on an obvious broken neck ( 90 degree angle ) , doors were jammed , and roof somewhat caved in . Pt. had no radial pulse and agonal respirations on my arrival after putting out the fire the first time . ( 3 rekindles probably caused by a leaking fuel line on the exhaust manifold ) Though I knew I was probably going to lose him anyway , I saw no way to extricate him with no equipment through the window without manipulating that neck and ruining any slim chance of survival he may have had . The best decision I had was to sit tight till fire got there with the jaws , though if I couldn't have controlled the fire , I would've attempted to get him out rather than watch him burn . This was the proverbial no - win situation . Boy , did I feel helpless . Needless to say , he didn't make it .


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## Jon (Mar 11, 2008)

Most protocols allow that if the patient is in extreme danger, extrication should be expedited, and if that means that you don't worry about C-spine... don't worry about C-spine. If the choice is to be dead or paralyzed, it is theoretically better to be alive and paralyzed than dead.

As for a vehicle that is upside down or on it's side... I once had a 500+ lbs guy in a Ford Ranger pickup... the truck was down an embankment, resting on it's side. We cut the A, B, and C posts on the "top" of the veihlce and flapped the roof down onto the ground. The Pt. was still supported in the vehicle by his seatbelt. I think we used nylon webbing to gently lower him into a Stokes basket and then hauled him up the hill, immobilized as best we could due to his size.

There will always be times when the patient's presentation will not allow for optimal C-spine immobilization. In those cases, do the best you can. If the patient is still restrained by a seatbelt, I'd try to get at least 1 other person, get the best access we could, and then carefully lower the patient down onto a backboard. I probably wouldn't play around with the KED, because I wouldn't have a lot of room in the vehicle.

In the event the patient is suspended upside-down... the patient is probably going to be VERY uncomfortable, and would probably try to unhook themselves prior to EMS arrival.

Rid, et al - I'm not sure if "having the blood rush to your head" could actually cause medical complications... any idea? I assume that there are possibilities of airway compromise due to poor positioning.


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## Ops Paramedic (Mar 11, 2008)

I would have to go with KEVD18 on this one.  Cam you imagine being in the wreck and "trying to perform some form manual c-spine control" while whoever is supposedly doing a controlled rollover onto the wheels??

The trick would be to get as many hands in the wreck as safely permits and then while supporting the patient on the way down (if the patient is suspended) to the board, cut the safety belt, as it is not the fall to roof of the car that will cause damage, but the sudden stop thereoff.  You can look at lowering (or "uppering" in this case) the back rest to give you more space to work in.  However you will know remove any support the patient may have had, so be ready and careful.

Should the patient be on the roof, then rather cut the wreck away from the patient, and just sarcasm to end of with: "Never let the patient get in the way of a good rescue"


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## Jon (Mar 11, 2008)

The other thing I didn't say is that, if possible, it wouldn't be a bad idea to get a C-collar on them.


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## rescuepoppy (Mar 11, 2008)

scottmcleod said:


> Understood. That's what I was looking for... I've never responded to a call like this, nor have we encountered it in training. I'd immediately default to higher medical authority's advice in such a situation. By the time they'd have to be removed, EMS would be on scene, and I wouldn't be needed anymore, or I'd be assisting.
> 
> Care to describe most awkward extrication for our enlightenment?



Maybe I should run this as a scenario, a few years ago we had a pickup run off the road  and end up stuck in the forks of a tree about thirty feet above the ground. We had to do the extrication of three passengers using high angle equipment. No available paramedics that night had rope training. Try to pull off stabilization in that situation. By the way all three survived.


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## scottmcleod (Mar 11, 2008)

rescuepoppy said:


> By the way all three survived.



Impressive. +3 Kudos to you.


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## certguy (Mar 12, 2008)

That pickup must've been a heck of a rescue . I would've liked to have seen that one . Years ago , our county fire had a p/u hanging in a tree in the Kern river canyon , though not nearly as high . Keds were designed to vertically lift race car drivers from thier cars . Did you KED them , then lower them ?


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## MikeRi24 (Mar 12, 2008)

my fire department has a car we got that was in a roll-over that we are gonna use to practice extrication on...when we cut it up and "get the pt out" i'll let you know how we did it


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## aussieemt1980 (Apr 10, 2008)

Actually done this while with volunteer road crash rescue - c spine collar, ked, full metal side extrication, remove as carefully as possible.

If seat belt is on, dont cut until ready to move patient, or patient comes crashing down...

best bet for medics - leave it to the rescue team to do, that way they can figure it out....

lol, the quickest buck passer in the southern hemisphere...


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## CFRBryan347768 (Apr 10, 2008)

KEVD18 said:


> press hard, your making three copies. have a nice day.



i agree, if they have rolled and are upside down woldnt compromised cspine be an understatement? i would think c-spine at that point would be to prevent furter damage and cover our end.


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