Now what

[rescueman]

Ok... we all know the bathroom is the most common place in a home for the slip and fall. I'd like to ask for a consensus from the group about the best way to deal with this..... it's all hypothetical.

Middle of the night, 65 YOM slip and fall in the second floor bathroom with altered loc, hx of seizures, possible head / neck injury. 16 step narrow stairs. OK.... stair chair isn't an option, what is? Reeves.... backboard... both... neither ?

Inquiring minds would like to know..... thanks !:unsure:

 

[EMTinNEPA]

Backboard. How narrow are we talking?

 

[Sasha]

slip and fall in the second floor bathroom with altered loc, hx of seizures, possible head / neck injury.

Backboard. And people who don't trip and fall easily while walking down stairs.

 

[medic417]

Narrow stairs why not use the KED.

 

[EMTinNEPA]

Narrow stairs why not use the KED.

Altered level of consciousness and possible seizure activity would contraindicate the KED. It'd be quicker (and safer) to just go with the backboard. If you're worried about tripping going down the stairs and dropping the board, then whip out the reeves so you down have to bend over so much. If you can't lift the patient, call the Fire Department. ^_^

 

[medic417]

Any turns in stair well or at top or bottom may make it impossible to turn with backboard. Is this an open stairwell or walls on both sides?

 

[Sasha]

A ked is not meant to carry someone down stairs!

 

[rescueman]

Continued

Thanks....The points about not being able to turn on a stairway with a backboard and keds not really being appropriate are well taken.

I'll try to clarify a little.... let's make the stairs standard size and a straight run with a wall on one side and bannisters on the other. I'm interested in the best way to immobilize the pt as well as secure him to prevent / minimize movement as much as possible given the incline of the stairs. Never want the backboard to become a sliding board ! YIKES !!!!:unsure:

 

[Sasha]

Never want the backboard to become a sliding board ! YIKES !!!!

If you do the straps properly they shouldn't. And have lots of three inch tape on hand. But if you're still concerned, perhaps a scoop or basket stretcher would be an option for you.

 

[AJ Hidell]

Not sure why a KED would be appropriate for extricating from a car, but not from a stairwell. The purpose is to immobilize the c-spine, and it does that job on stairs as well as in a car.

 

[EMTinNEPA]

If the patient has altered mental status and might have had a seizure, why would you waste time putting on a KED? A KED is indicated only for possible cervical and upper thoracic injuries and when you have a lot of time to waste.

Given the type of stairs the OP described and the patient's situation, a backboard would be the optimum choice. Possibly a backboard on a reeves, depending on the incline.

 

[reaper]

KED to stairchair, stairchair to LSB,Transport. That's not that hard!

 

[Sasha]

Retracted.

 

[EMTinNEPA]

Or maybe just LSB to transport?

 

[reaper]

If the patient has altered mental status and might have had a seizure, why would you waste time putting on a KED? A KED is indicated only for possible cervical and upper thoracic injuries and when you have a lot of time to waste.

Given the type of stairs the OP described and the patient's situation, a backboard would be the optimum choice. Possibly a backboard on a reeves, depending on the incline.

OP stated possible neck injury. Is the neck not Cervical in nature? Why would I need a lot of time to waste? Does not take long to apply a KED.

OP stated "narrow stairs", this means tight manuvers with a LSB. A KED is a perfect fit for the job. Then a staichair is the safest way to transport the pt.

 

[EMTinNEPA]

OP stated possible neck injury. Is the neck not Cervical in nature? Why would I need a lot of time to waste? Does not take long to apply a KED.

OP stated "narrow stairs", this means tight manuvers with a LSB. A KED is a perfect fit for the job. Then a staichair is the safest way to transport the pt.

It takes longer to apply a KED than to apply a LSB. OP ALSO said altered LOC and history of seizures, or did you forget about that. Did I say the neck wasn't cervical in nature, or was that a thinly veiled personal attack? And it the patient can walk down the stairs, then they aren't too narrow to take a LSB down. Unless the LSB magically makes the patient wider or the stairs more narrow.

 

[Veneficus]

a consensus in medicine?

If the stiars are straight, why not whip out your trusty howd strap, (aka rope webbing) secure them to the board and carefully slide them down the stairs using the strap? (my first choice)

What makes you think spinal injury? Hx of osteoporosis? malnutrition? Or just the fact that he fell?

KED is an extrication device, if you could get it on in a timely manner, no reason not to use it.

Personally I am partial to the reeves, I think it is the best piece of equipment ever devised for confined space rescue and this sounds like a confined space.

 

[EMTinNEPA]

a consensus in medicine?

If the stiars are straight, why not whip out your trusty howd strap, (aka rope webbing) secure them to the board and carefully slide them down the stairs using the strap? (my first choice)

What makes you think spinal injury? Hx of osteoporosis? malnutrition? Or just the fact that he fell?

KED is an extrication device, if you could get it on in a timely manner, no reason not to use it.

Personally I am partial to the reeves, I think it is the best piece of equipment ever devised for confined space rescue and this sounds like a confined space.

I'm not thinking spinal injury. The OP is thinking spinal injury and questioning method of extrication. I don't know if the patient actually told him their neck hurts or if he felt something abnormal upon palpation or if it IS just the fact that he fell. Given the information I was, I went with the LSB.

LSB would be more timely than a KED. You'd only have to roll the patient once to get them on the LSB where with the KED you'd have to roll one way, then the other. Plus, the KED has the leg straps.

The Reeves would be great, except that it wouldn't provide immobilization. Patient on LSB would be ideal or Patient on LSB on Reeves for safety.

 

[Veneficus]

Nepa

sorry, didn't mean to imply you thought spinal injury, that was directed at the OP. My fault.

I thought the new reeves allowed you to insert a LSB?

But we are in agreement, LSB would be my first choice. I am a big fan of sliding. Makes it harder to drop a pt. plus saves the back of the providers.

But I also think a skillful provider would have no problem with a KED or a stair chair, just depends on if you really think there is a spinal injury. Not enough info as you pointed out to rule that out, but there would have to be a significant contributing factor to make me think somebody who fell fx any more than a transverse or spinus process. Babinski reflex and rectal tone (if there is incontinence with seizure hx that makes it a little tougher) should be a large indicator if the pt is breathing properly.

a lot of unknowns, but the pt still needs to come out, and a head injury is a good assumption, but we could stipulate all day.

 

[reaper]

It takes longer to apply a KED than to apply a LSB. OP ALSO said altered LOC and history of seizures, or did you forget about that. Did I say the neck wasn't cervical in nature, or was that a thinly veiled personal attack? And it the patient can walk down the stairs, then they aren't too narrow to take a LSB down. Unless the LSB magically makes the patient wider or the stairs more narrow.

Why does it take longer to apply a KED, then a LSB? Why are so many in EMS afraid of a KED? It is one of the best devices you have on your truck.

I did not forget about the ALOC or seizures. What do they have to do with the extrication of the pt?

Most EMS providers do not secure a pt to a LSB appropriately, so there is movement. As you maneuver the pt down the steps, they are sliding around on the LSB.

Even if it takes to 2-3 minutes to apply a KED, what is the difference. This is not a time sensitive extrication. Take the time to ensure pt safety. The KED will immobilize the head and neck. The stairchair will safely and comfortably transport the pt down the stairs. This will require a lot less effort and manpower then carrying a LSB or Reeves down the stairs.

I am not taking a shot at you, I am trying to provide a point of view that is often overlooked!