Seated Spinal Immobilization (KED)

Seated Spinal Immobilization is included in this California-based EMT program as it is required for skills verification for California Registration. It is no longer required for National NREMT registration.

A short backboard immobilization device should be used on a patient found in a sitting or semi-sitting position with suspected cervical spinal injuries. Exceptions to this are when a patient needs to be rapidly extricated or moved. Review the criteria for rapid extrication.

These instructions are for a KED spinal immobilization device. Any commercially manufactured short backboard device must be used and applied according to the manufacturer’s guidelines. All rescuers should fully understand the guidelines and instructions from the manufacture for the device they are using.

Setup

• Ensure you are wearing appropriate PPE.
• Instruct the patient not to move their head and to hold still
• Make sure you fully explain the procedure to the patient if conscious.

Manual inline stabilization

• Have a rescuer position themselves behind the patient and maintain inline stabilization of the cervical spine.
• Assess pulse, motor, sensory function in all extremities.
• Measure, size and apply the appropriately sized cervical collar

Positioning the KED

• Prepare the KED device for placement by positioning all strapping so it will not become entangled during application of the device.
• Move patient forward slightly to position the device behind him/her by having one rescuer place a forearm on the patient’s chest with the hand on the front of the cervical collar and the and the other hand on the patient’s back. At the count of the rescuer holding manual inline stabilization, guide the patient forward only enough to adequately position the device behind the patient.
• With the patient sitting forward slightly, slide the short backboard behind the patient and between the arms of the rescuer holding manual inline stabilization.
• Once the short backboard is properly positioned behind the patient and all straps are in position move the patient back to the device. This will be completed in the same manner as when you moved the patient forward.

Secure the patient to the short backboard

• Secure the patient’s torso and legs to the short backboard.
• Have the patient inhale deeply and hold their breath as you tighten the torso straps. This will assure that the straps are not too tight to where they will impede the patient’s respirations.
• Secure the patient’s head after the torso and legs are secured.
• Maintain manual inline stabilization until the head is properly secured. The patient’s head should be in the neutral position. (Some patient’s, but not all, will require padding placed between their head and the short backboard so their head is secured in the neutral position.)
• After the immobilization has been completed, reassess all four (4) extremities for distal pulse, motor function and sensory function.

After extrication from the vehicle, immobilize the patient on a long backboard for complete spinal immobilization. A short backboard immobilization device is designed to immobilize the cervical spine only. A long backboard must be used in conjunction with the short backboard device to completely immobilize the spine of a patient.

KED Application  Take and maintain manual cervical support  Manual cervical support must be maintained by the assistant until patient is fully immobilized in KED, by the lead.  Perform CMS in all 4 extremities  Upper extremities at the same time and lower extremities at the same time  Measure and apply appropriate c-collar  Once c-collar is in place, have the patient place their hands on the “steering wheel”  At this point, the patient will most likely not be sitting up in a straight/upright position  One way to accomplish this is to stand to the side of the patient. With the one hand, place the palm against the patient’s back. With the other arm, have it come across the patient’s chest and grab the front of the c-collar. While supporting the back, take the arm/hand in the front and gently pull the patient up in a straight position. Once the patient is in this straight position, it will allow for easier application of the KED  Position KED device behind patient  KED should be centered and resting directly underneath the armpits  Once KED has been positioned behind patient, have patient remain in straight upright position. Do not have patient recline back in chair.  Secure the 3 trunk straps (does not matter in what order)  Straps should be snug against the trunk, but not too snug to inhibit breathing  When securing the straps, caution should be used as to not jerk or make sudden movements that will cause excessive patient manipulation  Secure the two leg/groin straps  Straps should rest in the crease between the thigh and hip. Straps should be snug. Padding can be applied.  When positioning straps, straps should be placed underneath the leg and pulled in a zig-zag fashion to their correct location  Secure head 25  If necessary, padding may be placed behind head. Patient should be properly aligned and straight before considering the use of padding.  Head is secured with 2-3 inch tape. Tape will need to go across forehead and across the chin area (over the c-collar, not on the actual skin).  It is a good idea to use one continuous piece of tape and have the tape overlap itself. When using two separate pieces of tape, the tape tends to not stick to the KED material  Recheck CMS in all 4 extremities  Patient lifted onto a backboard. This is a minimum of a 2-person job. A student will need to be on each side of the patient. One hand will grasp the handle attached to the KED and the other hand will go underneath the patient’s legs. The hands underneath the patient’s legs should be grasped together and held tight while lifting. The patient is then lifted and placed on the backboard.  The leg straps are released and legs assisted to the straight position on the backboard  Patient fully immobilized to the backboard (verbalized for testing and BLS skills)  CMS rechecked in all 4 extremities