Your thoughts on the use of KEDS and Short boards.

[smokeygirl]

I know that almost all the trucks either have short boards and or KEDS. But how often are they used for what they are ment to be used for and how many of the professionals out there know the correct way of using them in the field.



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We dance where others fear to go.

[BURNSEMS]

Hello, Our Dept First Responds and we Have a Private Provider that transports, In our System and the State KEDs are the Standard of Care,, we utilize them often and (usualy) have the Pt Completely Packaged prior to arrival of EMS, as with any thing there are Times where the situation dictates speed and we utilize the PHTLS Body block to move those Pts to a Board when Nesessary, as far as training we train all new members through Skills Testing and only retrain if a problem is noted in Pt care Skills.

[smokeygirl]

Thanks for replying. I just thought I would toss that question out to everyone b/c at my refresher there was a heated debate over them. I have used both and try to make sure that if I have a "green" partner he or she knows how and when to use them.

Thanks for your time.

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We dance where others fear to go.

[Romania]

We do carry the KED, but I have to admit that I have seen it used twice. It is no longer a standard of care for every MVA patient.Infact it is seen as a general waste of time unless you have a difficult extrication (after cutting) or you have a very specific injury that you need to deal with. We tend to utilize very strong manual imobilization skills to remove patients from vehicles in the remainder of situations. We probibly should use these devices more, but in our area almost all of the providers have been jaded by the "A&O to the Eagle" patients and we would need 6 KED boards to cover all of our needs if we KED'd every MVA patient. So, it is a combination of the a change in ouor standards, lazziness, and realism that keeps us from using them more often. I do believe that if done corectly you can imobilize a patients spine and maintain that imobilization extreamly well if good manual techniques and teamwork is used.

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[Aff]

we have had good luck with both KEDS and short boards. Especially in difficult MVA's, they have a place and time. It's when you don't have it you appreciate it!

Stay safe...
Mark

[Pamela Baber]

I have frequently used the KED for seated spine immobilization but have used it more often to stabilize potential hip fractures.
In the event that you are not familiar with this procedure, try it on your partner first and see if it works for you. Begin by placing the KED upside-down on the longboard
lining up the top (which is really the bottom) with the patients lower rib margin. Shift the KED towards the injured hip and log roll the patient onto the board. The part of the KED that normally houses the head should end up under the affected leg. Attach the chest straps and adjust to patient comfort. Next roll a blanket and place one end between the patients legs bringing the other end below the patients foot on the affected side and up the outer aspect of the patients affected leg. Bring the foldable wings on the head housing up to form a cradle
on the affected leg on the outside of the blanket and use the head straps on the velcro to hold the wings in place. The blanket around the bottom of the foot will prevent the outwardly rotated foot from flopping up and down with every bump in the road. Check CMS before and after application. Your patient will be very comfortable during their ride to the hospital. Another tip you might try. "Swimmers Noodles" (approximately 6 foot long and tubular in shape, made from compressed foam and used for water recreation)make great void fillers when stabilizing on the long board. Cut 2, 12 inches shorter than your backboard. Cut a bevel into the top of each. Take a third noodle, cut it down to 4 ft. and double bevel the top. Cut the remaining pieces the width of the long board and slice them lengthwise. These pieces will easily slide under the small of the patients back, under the knees, etc. Next, place the four foot section between the patients legs, double bevel at the crotch end and the longer sections on either side bevels under the axilla. Strap the patient to the board as usual. The tension from tightening the straps will be on the noodles and not on tissue. The noodles will prevent the patient from sliding side to side and up or down. They are lighter weight and less expensive than blankets and can be disposed of if they become contaminated. They also work great for stabilizing lower extremity fractures in load and go situations.







[This message has been edited by Pamela Baber (edited December 15, 1999).]

[benson911]

Wow - Pam must have a lot of room to work in.

Anyway, the KED is EXCELLENT for hip fractures. The general idea is to support the hip and thighs with the wide end of the KED and the legs using the thin (head) end of the KED. The last time I used it was to move a hip Fx pt out of a 4'x5' bathroom, not including the tub.(I amazed the private ambulance guys with that one.) The device is wonderful to slide under the pt any way you can and attach them to it. Lifting them to the board and the cot is MUCH less painful after their hip is immobilized. And it has handles, too!

I really like Pam's technique to stabilize the leg - I used to strap them together, but I'll use a blanket now.

Oh yeah, I used to get people out of cars with it, but it takes a little too long and involves too much room to work. I agree with Romania on KED use on crashes; it does work, but we can "roll out" a pt while maintaining manual control just as well and much faster than the KED. Plus, the head immobilization isn't that great as compared to a sure set of hands. The pad behind their head never seems to be correct after the KED is used to lift and move the pt.

[smokeygirl]

Thanks Pam! I never thought of using the KED that way. Its true. You learn things everyday in this job.

I want to thank all of you for posting on this topic. And I hope to talk to you all later on other interesting and educational posts.

L.Cairns

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We dance where others fear to go.

[Romania]

Update: Just used the KED this am. I had a 13 year-old patient who was riding in a school bus that recieved major damage to the front right quater (right where the door is). Our patient was complaning of neck and pack pain with some minor deformity to around c-4/5 and increased pain upon palp. Due to space and the fact that we had to lower the patient out of the bus from the emeregcy exit I decided to place the patient in the KED board and chair carry the patient out. Worked great.


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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[craig7404]

We carry and use short boards as per our medical procalls from our medical director. Sense we do not transport patients we do not carry a KED. The county ambulance service does carry KED and we are trained by them in there use and we do use the whenever the ambulance gets on scene before we get the patient(s) out, otherwise we will use a short board.

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Good Luck And Be Safe
Captain
Craig Lambert

[twinbridge22]

we have both keds and short boards the only time we use a short board was for infants, but now that we have an infant board we used the short board once in about 4 yrs.And the ked we use at just about all automobile accidents with suspected c-spine injury

[Sleddawg3]

Thanks Smokeygirl, That was a good topic! The KED in our bus is burried under the bench seat and is used once a year for that non legal case where someone is highly likely of having a serious C-Spine injury. I agree that with good training/Teamwork manual stabilization does the trick. Running at a Squad that does 62% trauma we do neglect the KED and training with it. After viewing this topic, maybe the KED will find its way to the top of the pile under the bench seat and be used for some of the ideas that your brilliant reply'ers have come up with! Keep up the good work!

Thomas A. Richmond
Firefighter/EMT-Paramedic
Richboro, PA

[firelieut14]

I like the KED. Granted, it takes a few minutes to remember what strap gets buckled first and last, and why they include that pad for behind the neck (never works). But on majority of the MVA's or wierd calls where we might acutually use it, we (Fire Dept) tend to ALWAYS beat EMS to the scene. So we tend to have those few extra minutes (so to speak) to break it out, blow the dust off of it and have the Pt. packaged prior to EMS arrival.

It is very handy in confined space rescue situations where there is NO way to get a spine board anywhere near the opening, nevermind into the opening.

My engine company (all of us are EMT-D's) used one about a month ago in a stairwell of a high-rise. The Pt. fell down a full flight of stairs, tried to get up and proceeded to fall down the next flight of stairs. And as if he hadn't had enough fun, he tried to get up and venture down the steps for a total of three floors. We found him sitting against the wall behind the door that leads to the hallway. No room for a spine board. We used our good ol' KED (even though the Ambulance crew wanted to lay him down and slide him into position in the center of the stairwell). Come to find out later that shift, our clumsy Pt. shattered 2 vetebre in his upper back. Guess he should have used the elevator...

The short board tends to get used as a sled in the winter to pass the time around the station. We tend to use it as "hard cover" between the Pt. and the flying car parts during an extrication.

Be safe...

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firelieut14@hotmail.com

The above message is of my own opinion, and not that of the U.S. Coast Guard or that of the Coast Guard Fire Department

[smokeygirl]

I want to thank everyone that has posted here. Its great seeing how different crews use the equipment that everyone has. Hope to see and learn more in the future here in this post.


Thanks!
Lisa

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We dance where others fear to go.

[nubs84]

I run with an ALS squad in Western Montgomery Cnty. in Pennsylvania. Both of our rigs are equiped with KED devices, however the only time I ever see them used is when myself or my partners use them. They are a valuble tool and one that should be used more often. Being the type of area we serve, there are many low speed accidents, the pts. involved in these mva's should be pakaged with the KED but too often they are not. Too many providers are not up to speed on there PHTLS protocols and often do rapid extrications when they really should take the time and properly pakage their patients.


R.J.DeSantis
FF/EMT
Sta. 84/324

[Penrose Andrews]

We are a BLS department and have two KEDS there times when the KED has saved us from major headaces. We just used one a few weeks ago when we had a S-10 head on with a compac pickup at 65mph the pt in the S-10 was out of blazer but both pts in the compac need to be extracted and with out the KED life would have been a nightmare.
Fire fighter/first responder Curtis Andrews
Penrose fire and rescue Penrose CO.

[EMT79JFU]

the KED boards are widely used for car accidents and now mostly the short boards we use for protection between where we are cutting the car and the patient.

[SilverCity4]

The ambulance service I worked for in the past used KEDs all the time.

We carry them on the fire department now, and the ambulance service that serves our district uses them.

They definately have their place in the world of EMS (and that idea about immobilizing a hip was great! Gonna have to try that), but I personally hate messing with them in the traditional way. I find it hard to believe that SOMEONE out there hasn't come up with a similar system that is a little easier to use (really, haven't we all thought about it?).

Anyway, until that day comes, I'll continue to use them, and hopefully come up with something better. I'd sell a million of 'em.

[911WACKER]

I always use the KED when a pt. is in a seated position and wants or needs to be transported, all tyhe agency's in this area use them often and heaven forbid you take one in the ER and the doc gets wind of rapid extrication when its not warranted. Always better to to take 2 minutes to apply the KED than get a money crazy lawyer a new case!!!!! :D :D :D :D

[jasonnremtb]

just a thought on the use of the KED for hip imm.

i have spoke with numerous other ems professionals, and MD's, when i first came out of school, both in er and ortho and they have given me the thought that a KED for hip imm. is not the best method simple due to the fact that there is an sizable ammount of movement during the application of the KED, they left me "kinda hanging" with no alternitive, so my thoughts is a scoop stretcher,no pt movment at all, the way we do it is to place a pillow over the front of the waist/hip area and pad the side voids with sheets. and secure the pillow in place with 3 in. tape, then spider straps, and the normal head imm. :rolleyes:

[mbyrne]

Use Of K.E.D For K9,s
A number of years ago while on a Wilderness
Emt course , we were shown how to use the K.E.D. for S.A.R. K9,s who may have been injured in falls. Another use to Keep in mind.

Be Good and If you can,t be good be carefull.

[redvafire]

We have short boards but in the 6 years. We use the KED only when it is a pretty significant accident, and the best way to stablize and get them out. You know what I mean about significant accidents, the person is trapped, rollover and stuff like that. Regular fender benders, C-spine control and lay on backboard and strap down and go.

:D
Tanya

OWL VFD
Station 14
Virginia

[RIT 6M350]

My EMT Instructor gave us an easy way to remember the strap order on the KED last night. "My Baby Looks Hot Tonight"
My - Middle
Baby - Bottom
Looks - Legs
Hot - Head
Tonight - Top
Just my 2 cents. :)

-Sean
RIT Ambulance 6M350
Driver/Medic Trainee

[KyraE]

Here in California, you must pass the KED sled skill to get cert'd (I dunno if that's the case in other states). Throughout all our training on KED's, my teachers continually reiterated the absurdity of being tested on the KED, as they've only seen it used twice in the field (and they are both 20 year veteran FF/Medics). Our ambulances carry them, but hardly ever use them. The argument is that if the MOI is great enough to indicate total spinal immoblization, there's usually other S/S that require rapid extrication (eg. a collar and board) such as lowered LOC, lacking ABC's, concerning vitals, etc. During our extication training, the FF skipped the KED and said "I'll show you the REAL way to get a vic out of a car." I don't have much time in the field so I can't really say much about my personal opinion, but that's what I've heard from some pretty experienced individuals

[Jim LeBlanc]

I beleive a lot of medics have become complacent about potential spinal injuries. Sure, the # 1 complaint at the MVA's we attend is back and neck pain and we know that there is no spine or spinal cord injury, however, I do not play God when it comes to patients lives. I do not want to be the one to paralyze someone. Most medics today should be concerned about the ambulance chasing lawyers. Should they improperly package someone with a spinal cord injury or cause a spinal cord injury, you can be sure they will be hearing from the patients lawyer. Don't get me wrong, I don't enjoy using the KED, knowing that as soon as I drop my patient in the ER the doctor will have it off, but he can make that decision. If by my using the KED it prevents further injury, I have done my job, if I don't use it and it causes further injury I am negligent! I feel that the lack of use of the KED is mainly a case of medic laziness and incompetence in their use of their equipment. The KED is just another tool to help immobilize a very difficult and fragile group of bones, as is a C-collar! CYA!!!

[ALSfirefighter]

Manny,

Clearing a patients C-spine in the field is not playing God. It is a trained skill. While I do recommend the KED and its use. The fact that medics and in my area, BLS clearing c-spine is not complacency, it is the norm. With a very good written protocol these actions have been proven to be effective. I do not and have not ever gone around thinking of some lawyer drooling about an action I took. I worry about patient care. Fact is it is very difficult to prove negligence if you document correctly and you followed protocol, and there were no obvious signs of spinal injury. ie, MOI, pain to the spinal processes, deformity, etc. Also the fact that backboards are not body conforming. Which in turn has caused patients to suffer slipped discs, pressure wounds, etc. It also aids the ER with congestion with the protocols, and utilizing the same skills that many doctors do of clearing c-spine without x-rays.

Secondly, you mentioned improper immobilization, which can be argued with every patient packaged and they lose neurological function to any degree.

Also, I take difference in your comment about laziness, and incompetance of equipment. Simple neck and back pain MVA, and applying a KED is a BLS skill. In fact if the bus is close they will cancel us before we even arrive on-scene. If it is in your opinion that imcompetance is a factor for your medics, then you have a QA/QI/Training problem. Its not rocket science, that's why all the straps are color coded. Also, the bones of the spine are actually quite strong. Its the discs inbetween them that are fragile, especially when god placed our 8 pound heads on top.

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The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of. :D

[Emtsparky9837]

Ive been an EMT for two years and I have never used the KED at an accident. I believe there a delay in care whether te patiet is stable or the only need for a KED would be if the patient has had a history of back injurys. The only time i have used the KED is for hip i jurys in which it works like a charm.

[Weruj1]

bump//////////

[dburnemti]

Another point on this KED issue. If you are applying this to an unstable MVC Pt with multi system trauma then how are you achieving your goal of 10 min scene time for " the golden hour". The only time I have ever used the KED is for an extrication that we had to remove the roof of the car and we had time to apply it as the process was being done. If there is any sign of significant MOI I choose Rapid extrication over the KED. Our medical director has never had a problem with this approach.

[MetalMedic]

Anyone using the SPEED BOARD or a similar item in place of the KED?

[Spencer534]

We tried out the speedboard for a few weeks and used it on maybe 3 calls. I still had the same complaint I have about the KED and maybe ya'll can help me. I find that I move the pt's spine more using a KED than if I just put the backboard at their bottom and slide them around onto it. I am not talking about entanglement or strange patient positioning, but just run of the mill MVC with neck or back pain. I went back to our EMS training officer and he and I looked up the manufacturer's recommended procedures for placement of the KED and found we were doing it right. Does anyone find the same? Are we moving the pt more using the KED?

[bridgeportfd]

I have been an EMT for a litte over a year and have used KEDS multiple times. They are a big help in removing patients from vehicles accidents..especially when you are short on help as odd as that may sound. As far as knowing how to use them correclty i feel its one of those issues that you must practice doing to make sure your do it right and also practicing applying the KED it maks the entire process go quicker and more efficient.

[azemsdiva]

Originally posted by Weruj1
bump//////////


DAMN U SURE HIT A LOT OF BUMPS!!!:D

[Spencer534]

I agree you need to practice the KED just as all other skills. I still think that you move the spine more when you put it on. You have to push the shoulder's forward to place the rigid part behind them. How do you do that without moving the spine? As for better with fewer personnel, it does give you more to grab hold of, however, I think you can do a backboard with the same amount of people. You still have to do everything with the backboard whether or not you use the KED.

[parafire81]

If the patient does not meet exclusion criteria for c-spine clearance and they are stable...the KED gets used..END OF STORY!

To those of you using the KED on severe MOI, unstable, multi-system trauma patients, TAKE A PHTLS CLASS!!!

[dburnemti]

I have BTLS and have the same opinion. Especially being a BLS service.

[CH47Doc]

My EMT Instructor gave us an easy way to remember the strap order on the KED last night. "My Baby Looks Hot Tonight"
My - Middle
Baby - Bottom
Looks - Legs
Hot - Head
Tonight - Top
Just my 2 cents. :)

-Sean
RIT Ambulance 6M350
Driver/Medic Trainee


we use the KED's alot mostly on MVA's but quite frequently on kids as well. just a thought on hip fractures, you ever apply the KED and then transfer to a scoop? make sure to pad between the legs with a buch of towels/blankets to keep legs from shifting..

[CH47Doc]

also a good idea to NOT apply the leg straps until pt is supine on a board or if you feel you must, leave very loose. straps will shift and tighten ALOT if totally secured prior to extrication.

[dburnemti]

also a good idea to NOT apply the leg straps until pt is supine on a board or if you feel you must, leave very loose. straps will shift and tighten ALOT if totally secured prior to extrication.

If you cold just clarify what you mean by NOT doing up the leg straps? Were you refering to using in a Pelvic Fx situation or extrication?

[CH47Doc]

extrication, if in fact they do have a pelvic fx/hip fx youre putting alot of strain on the pelvic region. im talkin about if you have to lift them vertically ie. over the headrest. even if the have no lower extremity trauma and you apply the leg straps youre gonna pinch a nut when you start to shift them around.

[CH47Doc]

youve never had a pt complaining of back pain with point tenderness in an mva?? i GOTTA work with you...:/

[CH47Doc]

are you sliding it from the side or from the top down behind the pt? if youre lucky enough to have some overhead clearance try sliding it from the vertical. also instead of pushing on the shoulders to move the pt forward (which rolls the spine) try pushing a little lower like around the lower parts of the scapulas (while someone maintains c-spine w/ a collar applied). if the neck holder does it right you can actually use 3-4 fingers of each hand to hold near the clavicles (if stabilizing from the rear) making sure the pt doesnt roll his/her shoulders and still hold the neck.

[FireMedAS]

If you use a KED device prior to EMS arriving at the scene (or prior to transferring care to other providers) you should perform a good exam FIRST. Nothing is worse than showing up at a scene, and the KED is already applied, and you ask about injuries and breath sounds and get a blank stare.

[montet202]

I was as skepticle as all of you are going to be, but we use the KED for rapid extrication. Yes that is right...rapid extrication. Nobody believes me untill I show them. A good freind of mine was shown this method in North Eastern Washington while teaching a PHTLS class. Two of the backwoods volunteers showed him how to do it stating that they have develloped the tecnique out of neccessity due to lack of manpower.

With two people you can get a Pt out of a car far faster and with little or NO spinal movement.

Obviously you don't screw with straps and the neck pad thing. This is a rapid extrication and with one person from the front of the Pt holding c-spine the other slides the KED in behind and takes over c-spine by holding the Pt's head between the head flaps of the KED. The EMT in the front then grabs the two black side straps (That lie over the Pt's flanks on the KED) and pulls the Pt tight to them, pivots the Pt out and carries them away to the BB. Once on the board I roll the sides down and out of the way and strap the Pt as I normaly would W/O the KED. The rolled down sides also act as padding taking up space. On large Pts the sides can be left alone because you should have enough space left to acces the Pt's chest and Abd.

Try it with an open mind. It may take a few tries, but it works. I have done it several time and not only am no longer skeptical like you surely are, but I swear by it.

[Booger911]

My service here in Ontario carry and use the KED not as much as we should, when I started years ago we had the deadliest stretch of 400 series highway (interstate to my south of the border naighbours). We average a major MVC for everday of the year in 4 months alone. I got very good a using the KED for rapid extrication the same way montet202 described. It works great and should be used way more than we do. If the patient is in a vehicle and has neck and or back pain use it, you will have to manipualte the patient to get them out so why not protect them from the start. When the patient is turned and placed on the Fx board there is a high risk of injury from the movement from either accidental twisting of the patient or the patient trying to assist you. The KED prevents both of these from happening.. I always remember the 1st rule of EMS "DO NO HARM" :D