Medical Evacuation on Trauma

8/19/2019 Medical Evacuation on Trauma

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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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APPLICATION


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• 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

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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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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.



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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.



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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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Medical Evacuation on Trauma

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