Emergency Move/Rapid Extrication/KED

[jaksasquatch]

Hello all,

I'm a little bit confused on management of a MVA as an EMT. When I'm on scene is it helpful if I start vehicle stabilization/patient care (treating life threats). What if I find a critical patient in the seated position that needs to be moved to supine for ventilations/compressions etc... do I still put a C-collar on or is it life over spine?

 

[Medic Tim]

Hello all,

I'm a little bit confused on management of a MVA as an EMT. When I'm on scene is it helpful if I start vehicle stabilization/patient care (treating life threats). What if I find a critical patient in the seated position that needs to be moved to supine for ventilations/compressions etc... do I still put a C-collar on or is it life over spine?

If you find someone with no pulse or not breathing post mvc they are most like dead and are going to stay dead.

But to answer your question .... Get them out of the car as fast as you can if that is what is need. A ked is designed for a stable pt. they take some time to put on correctly. Doing a rapid extrication on a board can also be difficult if it is only you and your partner with no extra hands. If you have a critical (imminent death) situation where you need them out of the car now... Don't bother with the board and collar. Get them out and worry about that stuff later.

Also keep in mind that from region to region protocol and mindset can be different. Before following what I or other random ppl on the Internet tell you... Vet it with your system.

 

[Christopher]

Hello all,

I'm a little bit confused on management of a MVA as an EMT. When I'm on scene is it helpful if I start vehicle stabilization/patient care (treating life threats). What if I find a critical patient in the seated position that needs to be moved to supine for ventilations/compressions etc... do I still put a C-collar on or is it life over spine?

If you find someone with no pulse or not breathing post mvc they are most like dead and are going to stay dead.

THIS ---^

But to answer your question .... Get them out of the car as fast as you can if that is what is need. A ked is designed for a stable pt. they take some time to put on correctly. Doing a rapid extrication on a board can also be difficult if it is only you and your partner with no extra hands. If you have a critical (imminent death) situation where you need them out of the car now... Don't bother with the board and collar. Get them out and worry about that stuff later.

I'm going to take off my evidence based medicine cap for a second, and use the false assumption that Immobilization Saves Lives so we can discuss this situation from the perspective of the OP's protocols:

KED's do not adequately secure the C-spine when moving a patient. They lack shoulder straps and other key features. They also take 4+ minutes to place.

If your service carries a jacket-style CED, favor that.

Also keep in mind that from region to region protocol and mindset can be different. Before following what I or other random ppl on the Internet tell you... Vet it with your system.

Yep, if you're going to go against all available evidence....err wait I'm not on that soapbox.

If you're going to go with your protocol (regardless of where it falls in the realm of EBM) be sure you Do It Right.

Here is a link to a PDF containing the way to Do It Right if your protocol believes in fairy tales. It is an EXTREMELY well done manual on pre-hospital immobilization, and I recommend everybody read it (even if you do not believe in fairy tales, a lot can be learned from this guide).

 

[mycrofft]

After SCENE SAFETY........

Remember if seconds will make the difference the pt will probably die anyway. Not to say don't try and don't work with speed, but a botch done fast is still a botch. So do it right. Do-overs use more time too.

Airway over spine but usually you can do both. You're taught them separately because it's easier to make students understand discrete skill sets. Teaching multi-tasking is really hard.

If you think in a particular case spinal immobilization is called for, do it properly.

Follow protocols.

 

[Mariemt]

For testing purposes. If you have extra hands. As someone to stabilize manually while you extract. If you don't... don't.


Emergency moves are just that. Emergencies. Life over limb

 

[TheLocalMedic]

For testing purposes. If you have extra hands. As someone to stabilize manually while you extract. If you don't... don't.


Emergency moves are just that. Emergencies. Life over limb

Bingo.

And I'm not a big fan of backboarding people anyhow. Actually, I use the KED about as much as I do a board... For the stable patient the KED is more comfortable (you can sit them up with it) and really doesn't take that much time to apply if you know how to do it properly.

 

[Household6]

I'd guess they're probably dead anyways. At that point, you're not going to make them "more dead" by not taking C-spine precautions.

For testing purposes -airway before C-spine.

In real life, take charge of the scene and find willing bystanders to take your direction. Most people desire to help, they just need to be told what to do. And try not to work between a patient and an undeployed airbag.

 

[DesertMedic66]

And try not to work between a patient and an undeployed airbag.

This. While i haven't heard of it happening to anyone, I have seen several videos online of the airbags being deployed and knocking people out.

Emergency moves are well for emergencies. If you don't have enough people to hold C-spine then you don't worry about it. The goal is to move the patient to a save area so you can safely start treatment.

It does not need to be used on every car accident. If the patient is in immediate danger or you can not work on the patient due to their location an emergency move should probably be used.

 

[mycrofft]

C-spine: maybe get over.
No airway: see if that Rolex is real.