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Medic l ev cu tion on
tr uM
Prepared by
Ribut Agung Nugroho
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Manual Immobilization
Remove Helmet
Rigid Cervical Collar Application
Logrolls Spinal board
Spider strap
Scoop stretcher
Splint
Traction splint
Kendrick Extrication Device
Lifting and Moving Patients
Medical Evacuation on Trauma
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Manual Immobilization
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SPINAL INJURY
The absence of neurological deficits does
not rule out significant spinal injury.
All trauma patient must suspected asspinal injury patient until proven otherwise.
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General principles of spinal immobilization
included :The primary goal is to prevent further injury.
Always use complete spinal immobilization.
Spinal immobilization begins in the initialassessment and must be maintained until the
spine is completely immobilize on long spine
board.
The patient’s head and neck must be placed
in a neutral in line position unless
contraindicated by condition.
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The basic principle to follow is that the
head and neck must be maintained in line
with the line of the body.
Manual in-line immobilization should be
applied without traction.
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Contraindication for moving the patient’s
head to an in-line position are list below :
Resistance to movement
Neck muscle spasm
Increased pain
The presence or increase in neurological
deficit during movement.
Compromise of the airway or ventilation.
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Immobilization from the sitting or
standing patient’s side.Stand along the side of the patient, holding the
back of the head with one hand. Place thumb
and first finger of the other hand on each cheek,
just below the zygomatic arch.Tighten the position of both hands without
moving the head or neck.
Move the head to an in-line position if needed.
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Immobilization from the front of
the sitting or standing patient.• Stand in front of the patient and place the thumb
of each hand on the patient cheeks, just belowthe zygomatic arch.
• Place the little fingers of each hand on theposterior aspect of the patient’s skull.
• Spread the remaining fingers of each hand onthe lateral planes of the head and increase the
strenght of the grip.• Move the head to an in-line position if needed.
.
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Immobilization with a supine
patient
• Kneel or lie at the patient’s head and placethe thumbs of each hand just below thezygomatic arch of each cheek.
• Place the little fingers of each hand on theposterior aspect of the patient’s skull.
• Spread the remaining fingers of each hand
on the lateral planes of the head andincrease the strength of the grip.
• Move the head to an in-line position ifneeded.
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Helmet Removal
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Indications to Leave Helmet
in Place
Good fit, lit tle movement
No current or expected airway
problems
Removal would cause further
injury
Continued…
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Proper immobil ization is able to be
performed
No airway or breathing concerns
Continued…
Indications to Leave Helmet
in Place
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Inabil ity to assess or treat airway
and breathing
Improper fit/movement within
helmet
Continued…
Indications for Removing
Helmet
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Inability to immobilize spine
Cardiac arrest
Indications for Removing
Helmet
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Stabilize head and helmet. Fingers
should be on patient’s mandible.
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Second EMT–B loosens strap.
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Transfer stabilization to second EMT–B.
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Carefully remove the helmet.
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Prevent head from falling once helmet
is removed.
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Begin routine stabilization and
immobilization.
RIGID CERVICAL COLLAR
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RIGID CERVICAL COLLAR
APPLICATION
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RIGID CERVICAL COLLAR
• RCC are designed to protect the cervical
spine from compression and reduce range
of motion (ROM) of head
• They are not provide adequate neck and
head immobilization
• Must be used in conjunction with manual
in-line immobilization or others mechanical
immobilization head rolls, long spinal
board, short spinal board, spider strap
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GUIDELINES OF RCC
APPLICATION
• RCC must not inhibit patient’s ability to
open the mouth or to clear airway in case
vomiting occur.
• RCC must not obstruct airway passages
or ventilations.
• RCC should be applied only after the head
has been brought into neutral in-line
position.
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• Rescuer 1
applies manual
in-lineimmobilization
from behind the
patient andmaintains
throughout the
procedure
STEPS TO APPLY RCC
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• Rescuer 2
measure the
patient’s neckusing fingers and
choose the right
RCC and adjustthe size of RCC
and lock it (for
adjustable RCC)
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• Rescuer 2 slide
the bottom of
RCC underpatient’s neck,
set it around
neck and secureit with velcro
straps
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• Rescuer 1
spread fingers
and maintainsthe support until
patient is
secured to spinalboard with spider
strap and head-
rolls in place
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Logroll
Log roll of the supine patient
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Log – roll of the supine patient
• Rescuer 1 is positioned at the patient’s head,
providing in-line manual stabilization.
• Rescuer 2 grasps the far of the patient at the shoulderand wrist.
• Rescuer 3 grasps the hips and both lower extremities atthe ankles.
• While maintaining immobilization, the rescuers slowlylog-roll the patient onto his or her side perpendicular tothe ground in one organized move.
• Rescuer 4 positions the long spine board by placing thedevice flat on the ground or at a 30-to40 degree angleagainst the patient’s back.
• In one organized move , the rescuers slowly log-roll andcenter the patient on the long spine board
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Log – roll of the prone patient.
• Rescuer 1 places his or her in a position that
provides in-line stabilization and thataccommodates rotation of the patient with thetorso.
• The long spine board is places on a flat surface
or positioned between the patient’s back and therescuers 2&3 at the patient’s side.
• In one organized move, the patient is rotatedaway from the direction of the initial proneposition
• In one organized move, the rescuers slowly log-roll and center the patient on the long spineboard.
• A rigid cervical collar is applied.
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SPINE BOARD AND SPIDER
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SPINE BOARD AND SPIDER
STRAP
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INDICATIONS• The use of a spine board is indicated when a spinal injury is
suspected.• This occurs either when a casualty complains of pain in the
neck and/or back following a traumatic• event or when the mechanism or pattern of injury indicates
possible spinal injury i.e.: a fall from greater than 2 meter
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AIM
• The aim of the spine board is to
immobilize the thoracic and lumbar spine,
providing full spinal immobilization when
used in conjunction with a cervical collar,head blocks and strapping
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Step 1
• Inform and reassure the casualty. Fit the
cervical collar. Place arms against the side
of the body, palms facing in, or fold the
arms across the chest. A figure-of-eight
bandage can be tied around the ankles for
ease when rolling.
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STEP 2
Position the spine board alongside the casualty, on theopposite side to the rescuer, the top of the board beingabout 50cm above the casualty’s head.
STEP 3
• Prepare to log roll the casualty. Rescuer A knees at thehead, rescuer B knees at the mid-thorax and rescuer Cknees at the casualty’s knees.
• When log rolling the casualty, rescuer A maintains supportof the head
and neck, keeping an anatomical alignment. Rescuer Bgrasps the far side of the casualty at the shoulder andwaist. Rescuer C grasps the far side of the casualty at thehip and lower leg or ankles
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Support the head and body and roll the casualty
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STEP 4
• Rescuer A is then in control of the roll, and the casualty is rolledtowards the patrollers, at the time and pace called by rescuer A,ensuring minimal spinal movement. Slide the spine board along and
against the casualty’s back, either flat or slightly angled
STEP 5
• Lower the casualty and the board to the ground together. Maintainingan anatomically neutral position, gently slide the casualty up thespine board to the correct position on the board (in as straight anaxial movement as possible). Without moving the head, applypadding under the occiput (base of the skull) and lumbar spine tomaintain correct positioning
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Slide the spine board along and against the casualty’s back
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STEP 6
• Secure the casualty to the spine board using the straps. Apply strap 1from the shoulder, across the chest, to the opposite pelvic region,strap 2 across the other shoulder, as per strap 1. strap 3 across the
pelvis and strap 4 across the upper legs above the knees.(Alternatively, strap 3 & 4 can be crossed from pelvis to opposite kneearea).
STEP 7• Strap 5 secures the ankles. Further strapping is used across the
chest to secure the arms. Head supports (head blocks, towel rolls,etc) are positioned against the side of the head, from the shoulders,covering the ears.
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Attach straps
STEP 8
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STEP 8
• Secure the casualty’s head and the head support to the
spine board by placing tape, in the following positions.
(a) across the casualty’s eyebrows and(b) across the cervical collar, ensuring that both pieces of tape are
brought completely around the back of the spine board.
support the head and strapping firmly
SCOOP STRETCHER
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SCOOP STRETCHER
APPLICATION
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INTRODUCTION
Initially designed in the late 1960’s, the Scoop Stretcher is an
English concept offering a way of lifting a patient in the
position they are found, whether they are in a supine, prone or
lateral position. If correct techniques are applied, there will be
minimal movement of the patient during the application,
especially in comparison to other methods including the log
roll, straddle lift or using the Jordon Lifting Frame
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PROCEDURE
Step 1
Extend the Scoop
Stretcher to the
correct length beforesplitting.
PROCEDURE
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PROCEDURE
Step 2
For measuring the device,
position the Scoop Stretcherso that a Shoulder speed clip
attachment point lies1 cm
below the level of the patient’s
shoulders.
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PROCEDURE
Step 2 • Loosen the leg extensionlocks and adjust the leg
section to the correct length
(heels of patient’s feet levelwith the bottom of the foot
plate). Re-tighten locks to
finger pressure only.
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PROCEDURE
Split Scoop Stretcher in half and place appropriate sections
on either side of the patient
Step 3
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PROCEDURE
Step 4 • To apply the Scoop
Stretcher, both nurses
now move to same side
of the patient.
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PROCEDURE
Step 5 • Nurse 1 at the patient’schest, grasps patient’s
clothing at the shoulder with
their upper hand and gentlypulls the clothing tight
laterally to prevent pinching
during the Scoop Stretcher
application. Nurse 1’s lower
hand is placed on the side
of the Scoop Stretcher
lower down
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PROCEDURE
Step 5
• Nurse 2 at the patient’spelvis grasps the patient’sclothing at the patient’sbottom with his upper handand gently pulls the clothing
tight laterally to preventpinching during the ScoopStretcher application. Nurse2’s lower hand is placed onthe side of the Scoop
Stretcher at the legextension pole. It has beenshown that when Nurse tryother hand placements,application is not as easy or
as quick
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PROCEDURE
Step 5 The side of the ScoopStretcher is slowly and
gently slid under the patient
until it is approximately half-way under the patient
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PROCEDURE
Step 6 • Both Nurses move to theopposite side of the patient
and carry out step 5 again until
the locking mechanisms at thehead and foot ends are
touching
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PROCEDURE
Step 7 • Both nurses now move tothe head end of the Scoop
Stretcher. Whilst nurse 1
closes the head lockingmechanism, nurse 2 places
lateral inward pressure on
the sides of the Scoop
Stretcher - no more than 30
cm from the locking pin - to
allow the 2 halves of the
lock to come together easily
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PROCEDURE
Step 8 • nurse 2 moves to the footend of the Scoop Stretcher
and closes the foot locking
mechanism. At the sametime, nurses 1 straddles
over the patient and pulls
the clothing laterally at the
patient’s pelvis, while
helping to close the locks by
pushing his heels against
the extension poles
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PROCEDURE
Step 9 • The patient can now beimmobilized to the Scoop
Stretcher for transport If the
patient is supine on theScoop Stretcher, place the
Scoop Stretcher on the
Ambulance stretcher with
the head of the stretcher
pre-raised one notch so that
there is no pressure on the
patient’s spinal column
WOODEN SPLINT
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WOODEN SPLINT
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Definition
• A thin sliver of wood used to prevent
motion of a joint or of the ends of a
fractured bone or to support or restrict any
desireable part.
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Principles of splinting
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Using the Sam Splint• Check PMSC and control major bleeding.
• Shape the splint to the limb. You’ll want to immobilize the joint above and the jointbelow the injury. With the example of a forearm injury, the splint extends below thewrist (immobilizing it) and above the elbow (immobilizing it). Make no attempt tostraighten a suspected fracture while using this splint. Splint it exactly as it’s found.
• Bend the splint into a U-shape. This cradles the arm, giving greater protection and
making the splint more comfortable. It also give the splint greater structural strength.
Sam Splint cont
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Sam Splint cont.
• Wrap the splint and the limb with a roller bandage so that the splint
and the limb are firmly bonded together. Don't make the wrapping sotight that blood flow through the limb is obstructed. Commonly-usedwrapping materials include Coban, Ace Bandages, Roll gauze, and Adhesive tape.
• For upper extremity injuries, place a sling on the patient to keep thearm elevated and immobile. A chest strap across the arm in a slingwill keep the arm tight against the chest.
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FYI
• When securing the splint to the limb,remember that you need to keep an openarea for monitoring pulse, motor, sensationand circulation.
• For open fractures or other open wounds, theapplication of the splint is the same.However, you may need to apply sterilebandages or dressings to the open woundsbefore placing the splint in place.
• For lower extremity applications, you mayneed to use two splints instead of one. Two
splints can be overlapped at one end andtaped in place with adhesive tape.
• To increase structural strength, after curvingthe splint in a "U" shape, bend the edgesdown slightly.
Rapid Form
http://www.cudaapparel.com/images/category/DaynaU/DU_Georgia_logo.jpg
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Rapid Form
Immobilizer• Assess the pulse, motor, sensation
and circulation of the injured area.
• For splinting to be effective, the joints above and belowthe fracture must be immobilized.
• If possible, remove any clothing that may impede thesplint's ability to work properly.
• If there are open wounds or exposed bone, bandageappropriately.
• The injured area must be manually stabilized, whichprevents movement. This can be done by simply holdingthe affected area, preventing movement above andbelow it. For example, for a radius/ulna fracture, the armshould be held at the wrist and elbow.
Rapid Form
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Rapid Form
Immobilizer• When using vacuum splints,
place the injured extremityinside the splint.
• Use the pump to draw air out of the splint, which
compresses it, making it rigid. It also conforms tothe patient and reduces pressure on the area.
• When using vacuum splints, make sure to keepthe patient's fingers and/or toes exposed toassess motor function and capillary refill.
• The splint should be checked periodically duringtransport to ensure there are no leaks. Leaks inthe splint diminish its rigidity and effectiveness.
Traction Splint Application
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Traction Splint Application
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Traction Splint Application
NOTE: Is to be used only for a painful, swollen, deformed mid thigh injury with NO lower leg injury.This information is designed to be used as a guide for an “Ischial” type traction splint. There
are several different types of commercially made traction splints available. This information
may differ for the device that you use.
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Why a Traction Splint?The theory behind the traction splint is that it reduces
potential blood loss by separating and aligning the
fracture segments through traction. This serves to keep
the thigh at its normal length and relatively normal
circumference - thus decreasing the potential space for
blood loss.
Contraindications for the use
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Contraindications for the use
of a Traction Splint
1 - Partial amputation or avulsion with bone separation,
or the distal limb is connected only by marginal tissue.
2 - Injury is close to the knee
3 - Injury to the knee
4 - Injury to the hip
5 - Injury to the pelvis
6 - Lower leg or ankle injury
A li ti f th T ti S li t
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Application of the Traction Splint
1 - Take appropr iate body substance isolation precautions.
2 - Apply manual stabilization Apply manual stabilization to the leg above andbelow the injury site. This is designed to stabilizethe bone ends and reduce further injury.
3 - Explain the procedure to the patientThe athlete may be very anxious about this procedure.You need to properly communicate to the athlete whatyou will be doing.
4 - Remove clothing from the areaRemove the clothing to expose the entire leg, thenremove the shoe and sock from the effected extremity.
Traction Splint Cont.
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p
5 - Assess pulse, motor, and sensory function distal to the injury and
compare to the opposite (non-injured) extremity.
6 - Apply the ankle hitch
After the ankle hitch is in place, elevate the leg while supporting the
ankle.
7 - Measure the traction spl int
Adjust the traction splint to the proper length. The non-injured leg should be
used to measure the length of the traction splint. The traction splint should
be adjusted to 12 inches longer than the non-injured leg.
Traction Splint cont
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Traction Splint cont.
8. Apply the traction splintSlide the traction splint under the patient’s injured leg, the ischial ring of
the traction splint must be against the bony prominence of the ischial
tuberosity. If equipped with a kickstand at the end of the traction splint,
extend it once the traction splint is in place. Pad the groin and gently, but
securely apply the ischial strap. You should be able to fit two fingers
between the ischial strap and the patient’s thigh to prevent over tightening.
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Traction Splint cont.
9. Apply mechanical traction Attach the mechanical traction device to the ankle hitch. Avoid using too muchtraction, which may overstretch the leg, but use enough traction to maintain limbalignment. Many patients will have reduced pain and muscle spasms once adequatemechanical traction is applied.
10. Secure the leg to the traction splint
Fasten the series of support straps. One strap should be just above the ankle hitch,one strap just below the knee, one strap just above the knee, and one strap at the topof the thigh just below the ischial strap. Do not fasten a strap directly over theinjury site. Excess straps should be secured underneath the splint to provideadditional support. Recheck the ischial strap to assure that it has not loosened.
11. Reassess distal pulses, motor , and sensory funct ion distal to the
injury si te and compare to the opposite non injured extremity.
12. Prepare the patient for transport
The patient should now be secured to a long backboard to provide further
immobilization of the hip. The traction splint should also be secured to the long
backboard to prevent excessive movement.
Kendrick Extrication Device
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Kendrick Extrication Device
Kendrick Extrication Device
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Kendrick Extrication DeviceThe Kendrick Extrication Device (KED) is designed to
immobilize a patient found in a sitting position. It is mostcommonly used in automobile accidents where the patient isstable. If the patient is unstable, you will need to perform aRapid Extrication.
P d l P t l
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Procedural Protocols
1. Rescuer One should be positioned behind the patient to stabilize the
head and neck.
2. Rescuer Two checks neurological and vascular response of all
extremities.
3. Rescuer Two measures and applies the cervical col lar.
4. The KED is slide into posit ion behind the patient.
P d l P t l t
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Procedural Protocols cont.
5. The KED is wrapped around the patient, and the middlestrap is secured.
(The KED should be snug beneath the patient’s armpits)
6. The bottom strap is secured next.
7. The top strap of the KED is secured.8. Each leg strap is wrapped around the leg and secured.
9. The patient’s head is secured into the KED.
P d l P t l t
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Procedural Protocols cont.
10. All of the straps are tightened down.11. The patient’s wr ist and legs are secured.
12. A long spine board is placed under the patient’s buttocks.
13. Remove patient from the vehicle and transferred to the spine board.
14. Disconnect the leg straps, allowing the patient’s
legs to lay flat on the long spine board.
15. Refer to the securing a patient to the longspine board.
*** Reminder ***
- Neurological and vascular checks should be
performed on the patient prior to and after extrication.
-If the patient’s becomes unstable at any time, refer to a
Rapid Extrication Protocol.
Lifting and Moving Patients
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Lifting and Moving Patients
What is the role of the First
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What is the role of the First
Responder?
• Whenever possible, you should not movepatient.
• Keeping your patient at rest is the best
course of action.
Wh d ti t?
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When do you move a patient?
1.Only if there is an immediate danger topatient or others if not moved
2.In order to prevent further injury
3.To assist other EMS responders to lift and
move patient
Body Mechanics and Lifting
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Body Mechanics and Lifting
Techniques
B d M h i
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Body Mechanics
1.Proper use of your body to facilitate liftingand moving
2.Lift with partner whose strength and height
are similar to yours.
3.Communicate with partner and patient
throughout move.
Follow these rules to prevent
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p
injury:
1.Position your feet properly.2.Use your legs not back to lift. Keep
back straight and bend knees.
3.Never twist or attempt to make anymoves other than lift.
4.When lifting with one hand, do not
compensate.5.When carrying patient on stairs, use a
stair chair.
Moving and Positioning
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g g
Patients
E
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Emergency moves
1. There are times when an emergency move is necessary. – There is immediate danger to patient if not moved.
– Lifesaving care cannot be given because of patient's location or
position.
– You are unable to gain access to other patients who need
lifesaving care.
2. Emergency moves provide little protection to patient.
3. Greatest danger is possibility of making a spinal injury worse.
4. Extreme care must be taken to move the body in one
Types of emergency moves
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Types of emergency moves
One-rescuerdrags
1)Clothes drag
2)Incline drag
3)Shoulder drag4)Foot drag
5)Firefighter's
drag
6) Blanket drag
One-rescuer
moves
1)One-rescuer
assist2)Cradle carry
3)Pack strap carry
4)Firefighter's
carry5) Piggy back
carry
Two-rescuermoves
1)Two-rescuer
assist
2)Firefighter'scarry with assist
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