KED or backboard only to extricate from a vehicle?

[KEVD18]

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....

 

[FF894]

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.

 

[KEVD18]

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.

 

[FF894]

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.

 

[traumateam1]

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.

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

 

[KEVD18]

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

 

[mycrofft]

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.

 

[mikeylikesit]

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.

 

[MAC4NH]

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.

 

[MAC4NH]

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