Now what

[AJ Hidell]

Why does it take longer to apply a KED, then a LSB?

Even if it did take longer, that is no excuse for not utilizing it when indicated. This is not an ABC compromised or exsanguinating patient that warrants the ubiquitous and grossly overused "rapid extrication". If the patient needs c-spine, he needs it.

 

[EMTinNEPA]

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!

I'm not afraid of the KED. Hell, I TEACH the KED. KED does not intimidate me at all. I'm looking at it this way... history of seizures, ALOC, the patient COULD be postictal or interictal. And since the OP didn't mention anybody else in the residence, I'm guessing the fall was unwitnessed, so we don't know if the ALOC is related to the patient's seizure disorder, to the patient hitting his head, or to neither. OP didn't mention any CVA symptoms, no diabetic history, no smell of ETOH on his breath, and I'm hoping the patient has a patent airway and is breathing adequately otherwise we wouldn't be worrying about immobilization yet. So I would assume that patient could seize (again) at any time. I'd rather go with the LSB, which takes a minute and a half to apply, than the KED, which would take 2-3 minutes. While the extrication is not time-sensitive, immobilization is. Correct me if I'm wrong, but I'm pretty sure that a non-immobilized patient seizing with a possible spinal injury would generally be considered a bad thing. Plus, LSB by itself would be more comfortable than KED and LSB. And if the patient IS secured to the LSB appropriately, sliding shouldn't be a problem... I guess it depends how good you are at immobilization.

 

[reaper]

I'm not afraid of the KED. Hell, I TEACH the KED. KED does not intimidate me at all. I'm looking at it this way... history of seizures, ALOC, the patient COULD be postictal or interictal. And since the OP didn't mention anybody else in the residence, I'm guessing the fall was unwitnessed, so we don't know if the ALOC is related to the patient's seizure disorder, to the patient hitting his head, or to neither. OP didn't mention any CVA symptoms, no diabetic history, no smell of ETOH on his breath, and I'm hoping the patient has a patent airway and is breathing adequately otherwise we wouldn't be worrying about immobilization yet. So I would assume that patient could seize (again) at any time. I'd rather go with the LSB, which takes a minute and a half to apply, than the KED, which would take 2-3 minutes. While the extrication is not time-sensitive, immobilization is. Correct me if I'm wrong, but I'm pretty sure that a non-immobilized patient seizing with a possible spinal injury would generally be considered a bad thing. Plus, LSB by itself would be more comfortable than KED and LSB. And if the patient IS secured to the LSB appropriately, sliding shouldn't be a problem... I guess it depends how good you are at immobilization.

Well, since I am looking at this from a medic point of view. I am not worried about the seizures. I can control them. The KED is going to imobilize the head and neck just fine, normaly better then a LSB. The last line is where it all falls into place. You and I may imobilize a pt perfectly on a LSB, so there is no movement. Can you say that for every provider though? If you have plenty of man power on scene, then go with what ever feels right to you. If it is two of you on scene. The ked and stair chair will be the safest way to move this pt.

 

[EMTinNEPA]

Well, since I am looking at this from a medic point of view. I am not worried about the seizures. I can control them. The KED is going to imobilize the head and neck just fine, normaly better then a LSB. The last line is where it all falls into place. You and I may imobilize a pt perfectly on a LSB, so there is no movement. Can you say that for every provider though? If you have plenty of man power on scene, then go with what ever feels right to you. If it is two of you on scene. The ked and stair chair will be the safest way to move this pt.

Well, I'm looking at this from an EMT point of view. I can't control the seizures. The OP didn't specify whether, for this scenario, you (the provider) was an EMT on a BLS truck, an EMT on an ALS truck, or a medic on an ALS truck. From the BLS point of view, where seizures cannot be controlled, immobilizing the patient ASAP would be the best course of action. I'm also looking at this from MY point of view, as a provider who CAN immobilize a patient so there is no movement. So, from my point of view, there are time constraints due to what might be going on with the patient (which I can't diagnose since there isn't enough information to rule anything out) that call for whichever immobilization method would be fastest, and I'm confident enough in my immobilization kung-fu ninja skills to limit movement. Sure, the right answer differs from provider to provider. As for myself, for safety and for patient care, an LSB on a reeves would be the best course of action. But hey, diff'rent strokes...

 

[BossyCow]

Well, since I am looking at this from a medic point of view. I am not worried about the seizures. I can control them. The KED is going to imobilize the head and neck just fine, normaly better then a LSB. The last line is where it all falls into place. You and I may imobilize a pt perfectly on a LSB, so there is no movement. Can you say that for every provider though? If you have plenty of man power on scene, then go with what ever feels right to you. If it is two of you on scene. The ked and stair chair will be the safest way to move this pt.

I would go with the LSB. I mean there are those who will blow IV's, gut tube or otherwise mangle care... doesn't make the practice inappropriate, if we removed all skills that some people mess up, we wouldn't be able to do anything.
My concern with this pt and the KED is what happens if the pt starts to seize again halfway down the stairs. Infinitely more manageable on the LSB than with the KED. KED leaves the extremeties loose, dangling and a possible issue in the tight stairway.

And didn't the OP state that stairchair wasn't an option?

 

[medic417]

A ked is not meant to carry someone down stairs!

It stabilizes back and neck while you get patient out to a more secure location. If you can not use backboard as happens in many older rural homes, you at least have provided some support for possible spinal injury.

 

[medic417]

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.

Based on OP saying you could not use a stair chair anyone that has been in EMS very long would know that also would mean you could not use a back board, a scope stretcher, etc. If you can use the backboard you can use a stairchair.

 

[BossyCow]

Based on OP saying you could not use a stair chair anyone that has been in EMS very long would know that also would mean you could not use a back board, a scope stretcher, etc. If you can use the backboard you can use a stairchair.

Um... unless maybe they don't have a stairchair???

 

[EMTinNEPA]

Based on OP saying you could not use a stair chair anyone that has been in EMS very long would know that also would mean you could not use a back board, a scope stretcher, etc. If you can use the backboard you can use a stairchair.

Negative, ghostrider. An LSB isn't as wide as a stair chair, so the LSB can fit in narrow stairwells that a stair chair couldn't. And don't talk about turns in the stairwell because the OP ruled those out as well. Plus, what if you're on a chase truck or a QRS and you don't HAVE a stairchair? Or what if your service are a bunch of cheap idiots and didn't buy a stairchair for every bus?

By the way, thanks for the condescending "anyone that has been in EMS very long would know" thrown in there. Upset that BossyCow ruined your master plan by pointing out that stairchair wasn't an option? Your certification number has nothing to do with your knowledge.

 

[medic417]

Um... unless maybe they don't have a stairchair???

Then they should be fired for failing to do a proper check of the ambulance. If the service does not provide a stair chair they need to find a new service.

But the way I took OP's statement was it would not work on theses stairs so I took his statement as a hint that you could not use backboard either then. You apperently felt he meant they had forgotten it at the station or something like that.

 

[EMTinNEPA]

But the way I took OP's statement was it would not work on theses stairs so I took his statement as a hint that you could not use backboard either then. You apperently felt he meant they had forgotten it at the station or something like that.

Well then there's NO way to get down the stairs, or for you to get upstairs, so I guess you'd better call the fire department.

 

[medic417]

Negative, ghostrider. An LSB isn't as wide as a stair chair, so the LSB can fit in narrow stairwells that a stair chair couldn't. And don't talk about turns in the stairwell because the OP ruled those out as well.

By the way, thanks for the condescending "anyone that has been in EMS very long would know" thrown in there. Upset that BossyCow ruined your master plan by pointing out that stairchair wasn't an option? Your certification number has nothing to do with your knowledge.

LOL, you so don't get it. Actually most styles are same width as most backboards. And OP did not specify no turns or widen stairwell till after I brought that into play.

And bossy did not ruin my statement she just interpeted OP differently. So no I am not upset because even if she had pointed out something where I was wrong I would happily accept the correction, but she didn't so no problem.

 

[medic417]

Well then there's NO way to get down the stairs, or for you to get upstairs, so I guess you'd better call the fire department.

You really have not done this very long. I have been in many old houses that you climbed stairs sideways or with both shoulders touching outer walls and turns at the top and bottom. Poorly designed but thats poor people construction with no building code.

 

[EMTinNEPA]

LOL, you so don't get it. Actually most styles are same width as most backboards. And OP did not specify no turns or widen stairwell till after I brought that into play.

And bossy did not ruin my statement she just interpeted OP differently. So no I am not upset because even if she had pointed out something where I was wrong I would happily accept the correction, but she didn't so no problem.

Really? Because I actually measured, and at every service I run with (all five of them) the stairchairs are wider than any LSB we have

Regardless of when he specified it, he specified it. He ruled out stairchair, he did NOT rule out LSB. He didn't give a reason for ruling out stairchair, all he said was that stairchair wasn't an option. Until he rules out LSB or Reeves, my plan still stands.

 

[medic417]

With updated info from OP you could use a backboard. Heck with his update you could set up a rope lowering system and lower over the rail if you wanted to. That change changed the whole scenario.

 

[EMTinNEPA]

You really have not done this very long. I have been in many old houses that you climbed stairs sideways or with both shoulders touching outer walls and turns at the top and bottom. Poorly designed but thats poor people construction with no building code.

OP already ruled out turns. If you have to go up with both shoulders touching the outer walls, you could still get a LSB on a reeves through. LSBs are NOT that wide, and the reeves was designed for confined space rescue. If you have to climb the stairs sideways, there is no way to get the patient down. Both of our ideas are ruled out, so now what? How about instead of getting your jollies off by trying to assert yourself as an authority figure over the youngins based solely on how long you've been in EMS, which could be 20 years of experience or one year of experience over and over for 20 years, you propose a new idea?

 

[EMTinNEPA]

With updated info from OP you could use a backboard. Heck with his update you could set up a rope lowering system and lower over the rail if you wanted to. That change changed the whole scenario.

Thank you.

 

[Veneficus]

Even if it did take longer, that is no excuse for not utilizing it when indicated. This is not an ABC compromised or exsanguinating patient that warrants the ubiquitous and grossly overused "rapid extrication". If the patient needs c-spine, he needs it.

I think the term "rapid extrication" maybe over used, but I have been on record for several years now doubting that a LSB can actually immobilize a pt.

I wish there was some data that shows the KED does a better job at immobilizing, most of what I have heard anecdotally comes from AU EMS with the device.

I do think that a fall from standing may create a head injury, but I very much doubt a significant spine injury that is not grossly apparent without a comorbidity. I know everyone (including me) has seen walking taking c spine fx, but the body does a very good job at self spliting, and there is absolutely no evidence I have ever heard of, demonstrating that these patients benefit from immobiliation. I am sure you know (but for others benefit) we yank boards in the ED immediately if not sooner. If that doesn't aggrivate an occult injury I seriously doubt a reeves, KED, or stairchair will.

We need to refine the spinal criteria to exclude more.

 

[medic417]

but I have been on record for several years now doubting that a LSB can actually immobilize a pt.

It seems like a few years ago there was a report of a sevice in another country basically doing away with backboards. They would use scoop stretcher to lift them onto the cot and then just secure them to the cot because they felt that if more comfortable they would move less thus creating less injury. I can not find that for the life of me though.

 

[Veneficus]

It seems like a few years ago there was a report of a sevice in another country basically doing away with backboards. They would use scoop stretcher to lift them onto the cot and then just secure them to the cot because they felt that if more comfortable they would move less thus creating less injury. I can not find that for the life of me though.

That's how it's done here