clinical practice procedures: trauma/immobilisation/extrication … · 2020. 2. 14. · the...

While the QAS has attempted to contact all copyright owners, this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged.

All feedback and suggestions are welcome. Please forward to: [email protected]

Disclaimer

The Digital Clinical Practice Manual is expressly intended for use by QAS paramedics when performing duties and delivering ambulance services for, and on behalf of, the QAS.

The QAS disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this manual, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable.

© State of Queensland (Queensland Ambulance Service) 2020.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives V4.0 International License

You are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute the State of Queensland, Queensland Ambulance Service and comply with the licence terms. If you alter the work, you may not share or distribute the modified work. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/deed.en

For copyright permissions beyond the scope of this license please contact: [email protected]

Policy code CPP_TR_IEJ_0215Date February, 2015Purpose To ensure a consistent procedural approach for the immobilisation/extrication jacket.Scope Applies to Queensland Ambulance Service (QAS) clinical staff.Health care setting Pre-hospital assessment and treatment.

Population Applies to all ages unless stated otherwise.Source of funding Internal – 100%Author Clinical Quality & Patient Safety Unit, QASReview date February, 2018Information security UNCLASSIFIED – Queensland Government Information Security Classification Framework.URL https://ambulance.qld.gov.au/clinical.html

Clinical Practice Procedures: Trauma/Immobilisation/extrication jacket

https://ambulance.qld.gov.au/clinical.html

757QUEENSLAND AMBULANCE SERVICE

Immobilisation/extrication jacket

The NEANN Immobilisation and Extrication Jacket ( NIEJ ) is a device used to minimise spinal movement and assist  with extrication from confined spaces.[1]

Indications

Contraindications

• When the patient is actual time critical  and the application of the NIEJ will delay

transport.

Complications

• Chest straps that are too tight tend  to interfere with respiratory effort.

• Groin straps need to be firmly secured  to minimise jacket and neck movement  during extrication.

• Incorrect head padding can lead to  C-spine hyperextension or hyperflexion.

• Immobilising the head without properly  securing the torso section may cause  C-spine movement.

• To facilitate safe extrication from  a confined space

February, 2015

Figure 3.105

UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED

Procedure – Immobilisation/extrication jacket


1. Explain the procedure to the patient and gain consent.

2. Prepare the NIEJ – remove from the carry case and unroll. Set aside the

lumbar support, head supports and groin pads.

3. C-collar immobilisation should  always be used in conjunction  with NIEJ. Also ensure that  MILS is maintained during  the application of the  C-collar and the NIEJ.




4. Slide the NEIJ round the back of the patient, so that it is no higher than the top of the patient’s head. If this is not possible, position jacket firmly in the patient’s armpits.

5. Ensure the chest flaps of the device  are snug under the patient’s arms.  (Adjust carefully for children and  pregnant patients).

7. Raise the patient’s arms to shoulder height, then position the chest flaps   against the chest. Apply straps from top to bottom (green, yellow, then red).

6. Release the groin  straps from back of  the NIEJ and hold  both straps together, ensuring they are not twisted. Pull the groin  straps down either side between the patient and chest flap. Slide both  straps under the legs  and buttocks until they  are in the gluteal fold.  Pull groin straps and leave.

8. The green straps should cross the chest, unless the patient  has chest injuries or breathing difficulty. For the latter cases,  the straps can run vertically.

9. For patients  that need to  be lifted using the NIEJ, slide the blue groin pads onto each black  leg strap.




10. Use the appropriate amount of head pads to prevent  hyperextension.

11. Connect the leg straps to the buckles on  the same side  and tighten  by pulling.

12. Recheck  straps  to confirm comfortable  but firm fit.

13. Secure the head support by applying the 25 millimetre collar strap.  Do not place the strap on the jaw line as it may deform the collar  or put pressure on jaw.

15. Tighten the strap ensuring the foam pad is centred on the forehead  by placing thumbs on the centre of the forehead and pulling both  ends with equal force. Velcro® into place.

16. Carefully extricate the patient, maintaining spinal alignment and  minimising body twisting. If necessary, the groin straps may be  loosened but not removed.

17. Provide further treatment as necessary and remove the NIEJ  on arrival at hospital.

14. Apply the 50 millimetre forehead strap by attaching  the side hook velcro tabs  to the head flaps with  the sliders level with  the front of the head  flaps, ensuring that  the bottom of the  forehead strap  aligns with  the bottom  of patient’s  eyebrows.



Specialised uses of the NIEJ

• Pregnant patients: The chest flaps of the NIEJ may be folded inwards, leaving the abdomen exposed. Exercise care in the placement of the restraints, which should only be tensioned  to provide support.

• Paediatric patients: Adjustments may be made by placing blankets or towels on either side of the patient to ensure support.

• Hip immobilisation: Invert the NIEJ and secure the chest flaps over the pelvic area. Secure the head flaps around the legs, just below the knees and use the lumbar support as padding between the knees. Use a triangular bandage to secure the ankles, wrapped in a figure of eight.

Additional information

• The NIEJ remains in situ during transit to facilitate a log roll in the case of vomiting.

NOTE: The superseded version of this device, the KED,

may currently remain in use at some stations. Primarily,

principles remain the same between each piece of

equipment other than strap application. Chest straps  on the KED are applied: middle (yellow), bottom (red),

legs (black) and finally the upper (green) which is left

until just prior to lifting the patient. Leg straps are  applied with a sawing motion under the legs, pulling  the ends of the straps up between the legs and attaching

with the white buckles on the opposite side. In groin

injury the straps are passed around each leg and  secured on the same side.[2]

e

The green shoulder straps should cross the chest. However if the patient  has chest injuries or breathing difficulty the straps can run vertically.


clinical practice procedures: trauma/immobilisation/extrication … · 2020. 2. 14. · the...

Documents