Kendrick Extrication Device
The Kendrick Extrication Device (K.E.D.) is a device that is used in vehicle extrication to remove victims of traffic collisions from motor vehicles. Commonly carried on ambulances, the K.E.D. is typically applied by an emergency medical technician, paramedic, or another first responder. Typically used in conjunction with a cervical collar, the K.E.D. is a semi-rigid brace that secures the head, neck and torso in an anatomically neutral position. This position reduces the possibility of additional injuries to these regions during extrication. The original K.E.D. was designed by Richard Kendrick in 1978.
Typically there are two head straps, three torso straps, and two legs straps which are used to adequately secure the K.E.D. to the victim. Unlike a long spine board or litter, the K.E.D. uses a series of wooden or polymer bars in a nylon jacket, allowing the responders to immobilize the neck and upper spine and remove the victim from the vehicle or other confined space. Although the K.E.D. can also be used to immobilize infants and children, it is preferable to use specifically designed pediatric immobilization devices whenever possible. If the K.E.D. is used to immobilize an infant or child, appropriate padding must be used to ensure complete immobilization in a manner that does not obscure the thorax and abdomen, thereby preventing continued assessment of these vital areas.
The device can be quickly and easily inserted into the seat of a vehicle by a single rescuer, allows access to the airway and conforms to any body size. The K.E.D. is typically used only on hemodynamically stable victims; unstable victims are extricated using rapid extrication techniques without the prior application of the K.E.D.
Once the K.E.D. is slid into position, it is secured to the victim with straps in order to prevent movement. The first strap that is secured is the middle torso strap. According to the K.E.D. users' manual securing this strap secures the greatest area of the device and therefore provides the greatest stability while securing the rest of the device. Next the bottom torso strap is secured, however the top torso strap is not secured until just prior to moving the patient to the long spine board. This is to allow the patient to breathe easily while the rest of the device is secured. Following the bottom torso strap the leg straps are secured. These may be applied in a "criss-cross" fashion (according to the K.E.D. users' manual this is the most commonly used method), or applied by securing them to their respective sides. If there is any evidence of a groin injury the "criss-cross" method cannot be used. Following application of the leg straps the void between the head and device is padded as needed and the head is secured. Finally, just prior to moving the patient to a long spine board the top strap is secured. Some schools teach this order by remembering the phrase "My Baby Looks Hot Tonight" or "Money Buys Lots of Hot Toys", where the beginning of each word stands for Middle torso strap, Bottom torso strap, Leg straps, Head strap and Top torso strap.
The head pad can bring the head too far forward for the side panels to fully immobilize it. Care must be taken to secure the head properly to maintain neutral immobilization. If the head is too far forward, the head is brought back to meet the K.E.D. unless crepitus, pain or resistance is met. If these symptoms are present, the head is immobilized in the position found.
It is worth noting that there is debate and controversy surrounding the exact order of applying the torso straps, with some saying that the order does not matter, as long as the torso is secured before the head. The K.E.D. users' manual is sometimes used in this justification with the explanation that it states the reason the top strap is last is a function of breathing, and not the process of immobilization itself. Furthermore, they will reference the concept that the critical factor in any immobilization process is that the head is immobilized last, and the order of immobilization prior to that process does not make a difference in terms of the immobilization itself.
This view is somewhat supported, and likely promulgated by EMS certification organizations such as the National Registry of EMTs in the United States. In their assessment of seated spinal immobilization (not written for any one specific device)it is stated that the torso must be immobilized before the head. Moreover, one of the critical criteria that can result in failure of the assessment is if the head is immobilized before the torso is sufficiently secured. The use of sufficiently is of course subjective, but a strict interpretation of this may lead one to infer that all the torso straps must be secured before the head.
An exhaustive search of the literature for peer reviewed scientific data regarding the positive or negative effects of application of the K.E.D. straps in any specific order found no results. It is likely such data does not exist, and that there are valid arguments on both sides of the issue. However, best practices indicate that the manufacturer's directions should be followed whenever using any piece of medical equipment. That being said, whenever the EMS professional is in doubt about a medical procedure it is advisable to contact your local medical director.
During rapid extrication, the patient is not immobilized by a K.E.D., but rather taken directly out of the car onto a back board. Reasons for using this technique include:
- The scene is unsafe
- The patients condition is unstable
- The patient is blocking you from gaining access to another victim.
- K.E.D. Patent http://www.google.sc/patents/US4211218
- Karbi, OA; Caspari, DA; Tator, CH (1988). "Extrication, immobilization and radiologic investigation of patients with cervical spine injuries". Canadian Medical Association Journal 139 (7): 617–21. PMC 1268249. PMID 3046734. Retrieved 2010-10-30.
- K.E.D. Users' Manual http://www.888maes911.com/KED_User_Manual.pdf
- K.E.D User's Manual, 2001, p. 11 http://www.888maes911.com/KED_User_Manual.pdf
- NREMT Seated Spinal Immobilization Evaluation https://www.nremt.org/nremt/downloads/EMT%20Spinal%20Immobilization%20(Seated%20Patient).pdf
- "Rapid Extrication". New York State Department of Health. Web. 1 Aug. 2013.
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