Protocols regarding extrication of potential spinal injury patients from POV's showin

[JJEDRN]

Protocols regarding extrication of potential spinal injury patients from POV’s showing up at your ED.

I need some assist. I need to present a protocol to be established for our ED for extrication of injured patient’s from their POV’s (Privately Owned Vehicles) which show up at our ED Door.

Obviously, the ideal situation would be for the driver to have simply phoned EMS and allow those with expertise in Pre-Hospital Management to work their magic. (We have an excellent and well trained EMS system in the county in which our hospital is located! There are generally at least a couple of trucks at the ED, but not when always…)

We serve a 5-6 county region, and some patients, their family and friends, just simply load & go…it’s a mountainous area, and MVC’s & ATV injuries occur frequently.

We are fortunate in that most of our ED Techs are EMT Basics, we have a couple of RNs that are also working Paramedics, and have a couple of Flight Paramedics that work in our ED.

I am current in PHTLS and TNCC , as are a few of my co-workers. btw I personally feel that it would benefit all of us to be proficient in extrication skills.

I am saying all of this, because I realize that having professional EMS to handle these situations would be ideal, but sometimes care simply cannot, nor should not, be delayed.

We obviously have C-collars on hand, a backboard with appropriate straps, and Multigrip Head Immobilizer or CID’s on hand.

I plan to add a KED, or Kendrick Extrication Device to our gear.

Also in the planning is instruction related to the above. One of the Paramedics that work in the Ed was also my PHTLS Instructor.

The bottom line is that we are trying to Proactive , not just Reactive .

So please lend me a hand. If you have any insight, or any Protocols regarding extrication, or just your qualified opinions, I’d appreciate hearing them.

Feel free to PM or e-mail me, if you’d like.

Thanks in advance.

Regards,

JJ

[EricJRN, MSN, RN]

i'll see if i can find the picture of the new that week police vehicle which was roof and door chopped because a police officer was daft enough to sit someone from an RTC in his vehicle rather than back in their own or down on the ground ...

But what makes that a funny photo is that the rescue personnel apparently went so far outside the standard of care (gold standard or otherwise) in cutting up the car. To me, sounds more like interagency strife than something that was done out of genuine concern for a patient.

A graduate of a prehospital care/EMS program, or even someone who spent a weekend at BTLS, should be able to work with a team and move a patient as a unit to avoid twisting.

[ZippyGBR, BSN, RN]

But what makes that a funny photo is that the rescue personnel apparently went so far outside the standard of care (gold standard or otherwise) in cutting up the car. To me, sounds more like interagency strife than something that was done out of genuine concern for a patient.

they did not depart fro mthestandard of care, the current teaching in the Uk is that in a none time critical situation the standard of care is that the patient does not come out the side

it is also notable that such 'strife' in the Uk tends to be confined to banter and the occaisional bit of light hearted 'violence' such as high powered water pistols or flour bombs ... and of course 'brick a bobby night' where other emergnecy services personnel get to play 'rioters' for PSU training

the only out the side none time critical extrication i've been involved with involved a 'banger racing' car - where the entire side was take n off bec ause taking the roof off would achieve nothing given the rollover hoop , fuel cell and cooling radiator structure in those vehicles

A graduate of a prehospital care/EMS program, or even someone who spent a weekend at BTLS, should be able to work with a team and move a patient as a unit to avoid twisting.

as a PHTLS priovider and someone who supervises newly and recnetly qualified Ambulance attendants i would suggest that that is a great over simplification - the risk / benefit analysis pays off in time critical extrication - it does not in none time criticla extrication.

[EricJRN, MSN, RN]

Are you removing the steering wheel in these cases? I'm just not seeing how the straight line concept can be achieved any better that way, if the patient's hips and knees are both bent 90 degrees as in a sitting position.

It's interesting to note the differences between countries. Maybe it has to do with the customer service initiatives in place at many US hospitals, but I just don't think you'll find (written policy or unwritten) any emergency room here that is willing to call the fire department for extrication tools when the patient isn't entrapped and presents at the ER doors.