Looking for some rescue info

[Trog]

Does anyone have documents on the following:

a) how to make a spinboard / backboard

b) how to use a SKEDCO stretcher

I would really appreciate it. Thanks!

[Tim White]

Send me an e-mail to southeast@ncrc.info and I'll send you a PDF of the SKED owners instruction manual.

[Cindy Heazlit]

Actually Tim et al,

The instructions are available on the Skedco site.

SKED instructions:
http://www.skedco.com/PDF_Files/Sked_Instruction.pdf

Oregon Spine Splint instructions:
http://www.skedco.com/PDF_Files/OSS_Instruction_2004.pdf

[Tim White]

Cindy- Thanks for the link. :)

[Trog]

Thanks everyone!

:)

[Stridergdm]

If I can add a couple of comments.

The PDFs do show how to strap a patient in, etc.

However, I'd HIGHLY recommend hands-on practice in addition to reading the directions.

For example, simply knowing how to feed the straps through the buckles can make it easier to tighten and less uncomfortable for the patient.

And it'll take a few times to start to realize how tight things need to be, the best order for doing some steps, etc.

For example, I can't emphasis how important it is to make sure things are nice and tight when rigging for vertical lifting, otherwise the patient can and will shift and may end up much more uncomfortable than you intended.

And of course there's all the in-cave practice movement. It's actually sort of interesting the more practice you get, the more of an eye you get for where a sked will and won't fit. I've students to get patients through more than one tight spot where they swore there was no room and there ended up being room to spare.

Finally a reminder: If you're rigging for vertical work, as I reminded my OCR class the other week, you are lifting a living, breathing human being who is currently not-broken. The goal is to finish the lift with the "patient" in the same condition. (they did manage to do so

[Trog]

thanks for the tips Stridergdm :)

we did a rescue simulation with the skedco a few days ago and it worked out well. Yes, hand-on practice is important and it did eliminate all the underground guesswork that might have occured if we didn't try everything on the surface first.

We also learned that the skedco works best with a spineboard, whether the victim has a back injury or not. It keeps the victim from being squeezed when hauling or carrying him or her in the stretcher.

So far all of our hauling with a live "victim" was done with the skedco in a horizontal position, using the 2 hauling straps. We have yet to try it in a vertical position.

[Trog]

sorry, double post..

[NZcaver]

Trog - Good point! I assume when you talk about using a "spine board" with the Sked, you mean the Oregon Spine Splint?

I'm mentioning this because I've seen some teams use different spinal stabilization devices with a Sked, or sometimes none at all. Devices like the Ferno KED (Kendrick Extrication Device) are less appropriate for using with a Sked, mainly because they don't have a shoulderboard. Therefore the patient's shoulders get squeezed inwards when they are trussed up like a burrito and dragged through a cave.

Skedco has this page explaining a host of reasons why they feel their OSS is better than a KED...
http://www.skedco.com/comparison.htm

Point number 11 talks about the shoulderboard. I just noticed point number 4 says the OSS has a collar strap - rather than a chin strap. That's obviously a street EMT thing, because from what I've seen a rigid C-collar isn't generally used in a wilderness/cave rescue context. I've always used this "collar" strap to secure a patient's chin, and it seems to work fine. Anyone have any comments on that?

Stridergdm - Great advice! Glad to see you up on the DB at last. I'm still looking for an OSS for you...

[Trog]

the spine board we used was about 1.6 feet by 6 feet of 1 inch plywood. looks a lot like this

http://www.be-safe.co.za/paramedical/st ... eBoard.jpg

one of the teams we practiced with made one themselves and it worked quite well in keeping the casualty from being crushed by the skedco when we started transporting her. We also tried the KED but personally I think the spineboard does a better job of protecting the victim.

[speloman]

The KED is Great for Extricating a Patient out of confiend spaces, Like the Drivers Seat of a car, or a hole in a cave and short distance carrying, even when using a Ked it is still best to place the pt on a spine board prior to using a stokes or a Sked for better Spine care and even comfort. The KED used with a spine is excelent for imobilzing the head expessially when being carried and jarred through a cave or a mountain side.

[speloman]

:quote:OSS has a collar strap - rather than a chin strap. That's obviously a street EMT thing, because from what I've seen a rigid C-collar isn't generally used in a wilderness/cave rescue context. I've always used this "collar" strap to secure a patient's chin, and it seems to work fine. Anyone have any comments on that?:Quote:

I do beleave they are one of the same thing just excluding the C- Collar. Please correct me if I mis understood you. I Used to be a street EMT full time and it was always called a chin strap where I worked. Plenty of Duct tape was the key it actually worked better than the thing that came in the head bed kit. I think were talking about the same thing correct me if I am wrong. I usually carry a C-collar in my cave pack EMT habbit so if I had to remove a pt from a cave with suspected spine injury its there.

[NZcaver]

Speleoman - Yes, that was my point!

The chin strap and collar strap are basically the same thing. They are a soft strap with a slot cut out of the middle to accommodate either the patient's chin or C-collar. I mentioned it in my previous post because Skedco makes a point of their OSS having a "collar strap, not a chin strap" - when there is really no difference! And often, at least in cave rescue, the C-collar isn't used - so their "collar strap" becomes a chin strap anyway.

Like you say, duct tape (or surgical tape) is also a must-have. You're pretty dedicated carrying a C-collar in your cave pack - even I don't go quite that far! However I do carry a piece of flexible plastic cut from a big soda bottle that works as a C-collar/splint in a pinch. And I keep a token C-collar and other supplies in my Sked/OSS bag, just in case.

I'm all for keeping the patient as comfortable as possible, especially during the rigors of a cave rescue. I believe that's the main reason for avoiding traditional C-collars in cave rescue, and why general Wilderness Protocols now tend to de-emphasize their use. I've found the OSS with shoulder board provides good spinal stabilization and reasonable insulation and protection for a patient in a Sked, negating most reasons to use a C-collar or rigid spine board when transporting patients for prolonged periods.

It's interesting that Trog mentioned using the spine board in a Sked, instead of the OSS. I've never seen that done before. It obviously works, but it does seem counter-productive to transport a heavy, rigid, full-length spine board into a cave to use in conjunction with a light, flexible Sked stretcher. I would think an OSS, a tarp, and couple of blankets would be a better choice. Just a thought.

[RescueMan]

I'm all for keeping the patient as comfortable as possible, especially during the rigors of a cave rescue. I believe that's the main reason for avoiding traditional C-collars in cave rescue, and why general Wilderness Protocols now tend to de-emphasize their use. I've found the OSS with shoulder board provides good spinal stabilization and reasonable insulation and protection for a patient in a Sked, negating most reasons to use a C-collar or rigid spine board when transporting patients for prolonged periods.

Comfort is important, though almost impossible to achieve. But not as important as C-spine immobilization if the mechanism of injury or physical exam indicates a possible compromise of the cervical spine.

Skedco requires that the OSS be used in conjunction with a C-collar to maintain proper stabilization. In a wilderness setting there are a variety of ways to improvise a C-collar (SAM splint, horse collar blanket roll, foam pad), but wilderness protocols don't "de-emphasize their use" only allow for ruling out spinal injury. If spinal injury cannot be ruled out, the protocol is to use some form of cervical immobilization. An OSS alone comes close but does not fully satisfy that requirement.

- Robert, WEMT

[NZcaver]

In a wilderness setting there are a variety of ways to improvise a C-collar (SAM splint, horse collar blanket roll, foam pad), but wilderness protocols don't "de-emphasize their use" only allow for ruling out spinal injury. If spinal injury cannot be ruled out, the protocol is to use some form of cervical immobilization. An OSS alone comes close but does not fully satisfy that requirement.

Hi Robert - you are, of course, quite correct. Thank you for conveying what I meant to say.

I would like to amend my previous comment to this - "the WEMTs who instructed my WFR course this year tended to de-emphasize the use of C-collars in wilderness medicine." This initially surprised me, and I took some convincing to understand their reasoning. They toted the horse collar as a more practical alternative to the C-collar in wilderness environments, but strangely I don't recall us practicing with them or any other C-collar version during the course. Hence my de-emphasis comment.

Anyway, Season's Greetings to you and your canine compadre.