**Using A Ked**

[firecoins]

The Golden hour and Platinum 10 has been proved as a myth by trauma surgeons. Another thing that just keeps getting taught in schools, with no research behind it!

okay show me the science disproving it. Every MD I talked to says time is a factor.

 

[mikie]

I've never used a KED in the field, and I've had oppertunities to (MVAs), but we just extricate using a LSB and quarter-turns with the patient (while maintaining c-spine and such)

When using it in class, it seemed when you strapped the KED pt to the LSB that the spine would sit higher than the lower half of the body, is this a problem?

 

[lilbeddoe]

i posted this thread
i have wanted to use a ked many times but have been denied by my crew
recently ive used it and it only took 2 minutes, we used it because it was an mva and we had time, if you have time why not use it and even if there is no spinal injury why not spend the 2 minutes to use the kED

 

[KEVD18]

a drill can have only one primary focus. your eother focusing on time, with perfection coming in second or focus on perfection with time as a secondary concern. me personally, id rather have my emt's take an extra 2 minutes and do it perfectly than be in a race to get it done and paralyze me. but if you folks want to be paralyzed by your local pit crew, you're more than welcome to have that view point.

as far as the golden hour, google is your friend:

^ Lerner, EB; Moscati (2001). "The Golden Hour: Scientific Fact or Medical "Urban Legend?"". Academic Emergency Medicine 8 (7): 758–760. doi:10.1111/j.1553-2712.2001.tb00201.x.
^ a b "Tribute to R Adams Cowley, M.D.," University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Accessed June 22, 2007.
^ "Original data supporting the 'Golden Hour' concept produced from French World War I data," Trauma Resuscitation at Trauma.com, Accessed June 22, 2007.
^ Bledsoe, Bryan E (2002). "The Golden Hour: Fact or Fiction". Emergency Medical Services 6 (31): 105.

 

[Ridryder911]

okay show me the science disproving it. Every MD I talked to says time is a factor.

Where have you been? The old myth was started by Dr. R Adams Cowley of the Shock Trauma fame, (even though himself was a cardiologist) and was never scientifically proven. In fact multiple studies have disproved such.... yet, we still keep on teaching and spitting out propaganda without facts. That is why it is now called the platinum hour. Really, majority die way before the first hour even the first few minutes before EMS arrives or afterwards past the hour.

Trauma is surgical disease. No doubt. Yes time is a factor... in other words do not procrastinate in all areas. Field, ED even in trauma centers. Although, after working in a multiple level I's I do see that there is more time than once thought. Chances of survival by an extra minute is not going to change the outcome of a patient. If they are that severe, their chances are against them.

There is little to no treatment of trauma patients in the field, especially at the basic level. The main treatment would be airway control and possibly reversing a tension pneumothorax, other than that it; it is primarily surgical intervention. Yes, prevent needless delays but be very aware of the real extent and results of trauma.

R/r 911

 

[Sasha]

You cant convince me that time is not a factor in patient survival rate.

 

[BLSBoy]

You cant convince me......nevermind...

 

[firecoins]

Where have you been? The old myth
There is little to no treatment of trauma patients in the field, especially at the basic level. The main treatment would be airway control and possibly reversing a tension pneumothorax, other than that it; it is primarily surgical intervention. Yes, prevent needless delays but be very aware of the real extent and results of trauma.

R/r 911

I am sorry but maybe I misunderstand what the golden hour but its my understanding that we want to get the patient into the hospital quickly for the very reason that there are no treamtents in the field.

 

[KEVD18]

sure...quickly is in order. but racing around the scene trying to save every last second and thus sacrificing quality patient care is asinine.

whats the big thing with EV driving now? SLOW DOWN! the two minutes you save busting down traffic lights without even covering the brake pedal doesnt help your patient. the 5 minutes you save not ked'ing your pt doesnt help them. the
"load and go" v. "stay and play" mentality rarely matters.

people need to stop focusing on this urgency. its ends up killing/injuring more patients than it helps.

 

[firecoins]

sure...quickly is in order. but racing around the scene trying to save every last second and thus sacrificing quality patient care is asinine.

whats the big thing with EV driving now? SLOW DOWN! the two minutes you save busting down traffic lights without even covering the brake pedal doesnt help your patient. the 5 minutes you save not ked'ing your pt doesnt help them. the
"load and go" v. "stay and play" mentality rarely matters.

people need to stop focusing on this urgency. its ends up killing/injuring more patients than it helps.

A new thread was started but the KED is for stable patients. If a patinet is unstable, I don't put a KED on. That 5 minutes counts. "Load and go" is in fact important.

 

[Sasha]

Same here. Unstable=Rapid extrication time!

 

[BossyCow]

a drill can have only one primary focus. your eother focusing on time, with perfection coming in second or focus on perfection with time as a secondary concern.

Once you drill enough to have a skill down, you can perfect the timing. Doing the skill repeatedly will perfect both the ability to do it well and part of doing it well is doing it quickly. I repeat they are not mutually exclusive.

 

[mycrofft]

Well, we'll just aim for fast perfection after we cut the car up!

To tell the truth, the vollies who KED'ed me sort of did it as revenge for my showing them how hard it was to use the brand new build-a-board they'd had fundraisers and created a handmade naugahyde carrier for. They used me for the dummy (apt, apt) and let me sit in it for a couple minutes.

Five minutes to KED someone? Have they started using slow buckles or something? Rehearse starting other measures at the same time so they don't conflict, like starting IV, BVM, etc.

 

[Ridryder911]

A new thread was started but the KED is for stable patients. If a patinet is unstable, I don't put a KED on. That 5 minutes counts. "Load and go" is in fact important.

Hence; that is the problem I see more and more. Very poor assessment techniques and truthfully what is really life threatening and what is not. The same problems is being ignored but continue on using helo EMS and transporting patients to a Level I. There are few instances that the patient is truly unstable in comparison to those that can be transported calmly and timely.

Those that meet the criteria of Level I patients (as per ACS/ your local area may be slightly different):

A patient is identified as a CTP when any of the following physiologic and/or anatomic
factors are present. These patients should be transported rapidly.
Physiologic criteria
● Glasgow Coma Scale < 12 or;
● Blood pressure < 90 systolic or;
● Respiratory rate < 10 or > 29
Please note: Normal vitals for pediatric patients differ
Anatomic injury factors:
● Penetrating injury to the torso, head, neck, groin, or extremity proximal to the knee or
elbow
● Evidence of two or more proximal long bone fractures (femur, humerus)
● Traumatic amputation above the wrist or ankle
● Traumatic paralysis

Paramedic Consideration In addition, the following mechanisms of injury may be used to
identify a CTP. In general, these patients can be transported urgent, however, differing field
circumstances and/or patient condition may require a rapid transport.
● Death of an occupant in the same passenger space
● Extrication time of greater than twenty (20) minutes
● Auto vs. pedestrian with mechanism of injuries
Submersion with trauma
● Significant blunt trauma to head, neck, torso or abdomen
(e.g. starred windshield, loss of consciousness)
● Vehicle rollover without restraints
● Ejection of patient from vehicle
● Falls greater than or equal to fifteen (15) feet
● Falls greater than ten (10) feet (<14 or >55 years of age)
● Significant vehicle damage (e.g. front axle rearward displaced; passenger space
intrusion of one foot or more; bent steering wheel/column)
● Ejection from a moving object

The main emphasis that they truly have the mechanism of injury and also may present hemodynamic compromising.

Not all patients that have the indications need to go to a level I. i.e. star windshield. When a Level II or even a Level III can handle such injuries. Unless, again that patient is symptomatic in relation to the injuries.

There is not much difference in Level II and Level I except the research criteria. Most states have adopted ACS standards or similar modified ones. Be sure to understand what is a true emergency and one that can be handled at a lower level center.

As well as when one needs to really expediate and those that can be calmly dealt with.

R/r 911

 

[FireFlyYFD]

KED is the standard of care. I think some of you hit on the head with its a training issue and laziness issue. I've used the KED on multiple occasions, not only with MVA's but with a few house extrications in conjunction with a stair chair. Our two trauma 1 facilities will rip us a new one if a pt is brought in with no KED (if it was indicated).

 

[firecoins]

not only with MVA's but with a few house extrications in conjunction with a stair chair.

you put someone in a KED and than in a stair chair? Give me an example of a call where you went from KED to stair chair? Could you not fit a backboard in the area?

Our two trauma 1 facilities will rip us a new one if a pt is brought in with no KED (if it was indicated).

But 1 facilty wouldn't?

 

[FireFlyYFD]

We had an elderly man fall in his living room in a singl level home. His son picked him up and helped him to his room. Pt was complaining of neck pain. the hall way leading from the bedroom to the front door was narrow with a couple of sharp turns. We placed him in a KED and then on the stair chair. wheeled him right out of the house. Much easier then having to stand him up on a board going through the hallway.

 

[FireFlyYFD]

We have two level one trauma centers in CT. If we brought a pt to either one without a KED and it was indicated. They would have a big issue with that.

 

[firecoins]

We have two level one trauma centers in CT. If we brought a pt to either one without a KED and it was indicated. They would have a big issue with that.

sorry misread that.