Medical Evacuation on

Trauma

Prepared by
Ribut Agung Nugroho

Medical Evacuation on Trauma

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

Manual Immobilization

SPINAL INJURY
The absence of neurological deficits does
not rule out significant spinal injury.
All trauma patient must suspected as
spinal injury patient until proven otherwise.

General principles of spinal immobilization

included :
The primary goal is to prevent further injury.
Always use complete spinal immobilization.
Spinal immobilization begins in the initial
assessment and must be maintained until the
spine is completely immobilize on long spine
board.
The patients head and neck must be placed
in a neutral in line position unless
contraindicated by condition.

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.

Contraindication for moving the patients

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.

Immobilization from the sitting or

standing patients 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.

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 below
the zygomatic arch.
Place the little fingers of each hand on the
posterior aspect of the patients skull.
Spread the remaining fingers of each hand on
the lateral planes of the head and increase the
strenght of the grip.
Move the head to an in-line position if needed.
.

Immobilization with a supine

patient
Kneel or lie at the patients head and place
the thumbs of each hand just below the
zygomatic arch of each cheek.
Place the little fingers of each hand on the
posterior aspect of the patients skull.
Spread the remaining fingers of each hand
on the lateral planes of the head and
increase the strength of the grip.
Move the head to an in-line position if
needed.

Helmet Removal

Indications to Leave Helmet

in Place
Good fit, little movement
No current or expected airway
problems
Removal would cause further
injury
Continued

Indications to Leave Helmet

in Place
Proper immobilization is able to be
performed
No airway or breathing concerns
Continued

Indications for Removing

Helmet
Inability to assess or treat airway
and breathing
Improper fit/movement within
helmet
Continued

Indications for Removing

Helmet
Inability to immobilize spine
Cardiac arrest

Stabilize head and helmet. Fingers

should be on patients mandible.

Second EMTB loosens strap.

Transfer stabilization to second EMTB.

Carefully remove the helmet.

Prevent head from falling once helmet

is removed.

Begin routine stabilization and

immobilization.

RIGID CERVICAL COLLAR

APPLICATION

RIGID CERVICAL COLLAR

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

GUIDELINES OF RCC
APPLICATION
RCC must not inhibit patients 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.

STEPS TO APPLY RCC

Rescuer 1
applies manual
in-line
immobilization
from behind the
patient and
maintains
throughout the
procedure

 Rescuer 2
measure the
patients neck
using fingers and
choose the right
RCC and adjust
the size of RCC
and lock it (for
adjustable RCC)

 Rescuer 2 slide
the bottom of
RCC under
patients neck,
set it around
neck and secure
it with velcro
straps

 Rescuer 1
spread fingers
and maintains
the support until
patient is
secured to spinal
board with spider
strap and headrolls in place

Logroll

Log roll of the supine patient

Rescuer 1 is positioned at the patients head,
providing in-line manual stabilization.
Rescuer 2 grasps the far of the patient at the shoulder
and wrist.
Rescuer 3 grasps the hips and both lower extremities at
the ankles.
While maintaining immobilization, the rescuers slowly
log-roll the patient onto his or her side perpendicular to
the ground in one organized move.
Rescuer 4 positions the long spine board by placing the
device flat on the ground or at a 30-to40 degree angle
against the patients back.
In one organized move , the rescuers slowly log-roll and
center the patient on the long spine board

Log roll of the prone patient.

Rescuer 1 places his or her in a position that
provides in-line stabilization and that
accommodates rotation of the patient with the
torso.
The long spine board is places on a flat surface
or positioned between the patients back and the
rescuers 2&3 at the patients side.
In one organized move, the patient is rotated
away from the direction of the initial prone
position
In one organized move, the rescuers slowly logroll and center the patient on the long spine
board.
A rigid cervical collar is applied.

SPINE BOARD AND SPIDER

STRAP

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

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

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.

STEP 2
Position the spine board alongside the casualty, on the
opposite side to the rescuer, the top of the board being
about 50cm above the casualtys head.

STEP 3
Prepare to log roll the casualty. Rescuer A knees at the
head, rescuer B knees at the mid-thorax and rescuer C
knees at the casualtys knees.
When log rolling the casualty, rescuer A maintains support
of the head
and neck, keeping an anatomical alignment. Rescuer B
grasps the far side of the casualty at the shoulder and
waist. Rescuer C grasps the far side of the casualty at the
hip and lower leg or ankles

Support the head and body and roll the casualty

STEP 4
Rescuer A is then in control of the roll, and the casualty is rolled
towards the patrollers, at the time and pace called by rescuer A,
ensuring minimal spinal movement. Slide the spine board along and
against the casualtys back, either flat or slightly angled

STEP 5
Lower the casualty and the board to the ground together. Maintaining
an anatomically neutral position, gently slide the casualty up the
spine board to the correct position on the board (in as straight an
axial movement as possible). Without moving the head, apply
padding under the occiput (base of the skull) and lumbar spine to
maintain correct positioning

Slide the spine board along and against the casualtys back

STEP 6
Secure the casualty to the spine board using the straps. Apply strap 1
from 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 knee
area).

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.

Attach straps

STEP 8
Secure the casualtys head and the head support to the
spine board by placing tape, in the following positions.
(a) across the casualtys 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
APPLICATION

INTRODUCTION
Initially designed in the late 1960s, 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

PROCEDURE
Step 1
Extend the Scoop
Stretcher to the
correct length before
splitting.

PROCEDURE
Step 2

For measuring the device,

position the Scoop Stretcher
so that a Shoulder speed clip
attachment point lies1 cm
below the level of the patients
shoulders.

PROCEDURE
Step 2

Loosen the leg extension

locks and adjust the leg
section to the correct length
(heels of patients feet level
with the bottom of the foot
plate). Re-tighten locks to
finger pressure only.

PROCEDURE
Step 3

Split Scoop Stretcher in half and place appropriate sections

on either side of the patient

PROCEDURE
Step 4

To apply the Scoop

Stretcher, both nurses
now move to same side
of the patient.

PROCEDURE
Step 5

Nurse 1 at the patients

chest, grasps patients
clothing at the shoulder with
their upper hand and gently
pulls the clothing tight
laterally to prevent pinching
during the Scoop Stretcher
application. Nurse 1s lower
hand is placed on the side
of the Scoop Stretcher
lower down

PROCEDURE
Step 5

Nurse 2 at the patients

pelvis grasps the patients
clothing at the patients
bottom with his upper hand
and gently pulls the clothing
tight laterally to prevent
pinching during the Scoop
Stretcher application. Nurse
2s lower hand is placed on
the side of the Scoop
Stretcher at the leg
extension pole. It has been
shown that when Nurse try
other hand placements,
application is not as easy or
as quick

PROCEDURE
Step 5

The side of the Scoop

Stretcher is slowly and
gently slid under the patient
until it is approximately halfway under the patient

PROCEDURE
Step 6

Both Nurses move to the

opposite side of the patient
and carry out step 5 again until
the locking mechanisms at the
head and foot ends are
touching

PROCEDURE
Step 7

Both nurses now move to

the head end of the Scoop
Stretcher. Whilst nurse 1
closes the head locking
mechanism, 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

PROCEDURE
Step 8

nurse 2 moves to the foot

end of the Scoop Stretcher
and closes the foot locking
mechanism. At the same
time, nurses 1 straddles
over the patient and pulls
the clothing laterally at the
patients pelvis, while
helping to close the locks by
pushing his heels against
the extension poles

PROCEDURE
Step 9

The patient can now be

immobilized to the Scoop
Stretcher for transport If the
patient is supine on the
Scoop 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
patients spinal column

WOODEN SPLINT

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.

Principles of splinting

Using the Sam Splint

Check PMSC and control major bleeding.

Shape the splint to the limb. Youll want to immobilize the joint above and the joint
below the injury. With the example of a forearm injury, the splint extends below the
wrist (immobilizing it) and above the elbow (immobilizing it). Make no attempt to
straighten a suspected fracture while using this splint. Splint it exactly as its 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.

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 so
tight that blood flow through the limb is obstructed. Commonly-used
wrapping materials include Coban, Ace Bandages, Roll gauze, and
Adhesive tape.

For upper extremity injuries, place a sling on the patient to keep the
arm elevated and immobile. A chest strap across the arm in a sling
will keep the arm tight against the chest.

FYI
When securing the splint to the limb,
remember that you need to keep an open
area for monitoring pulse, motor, sensation
and circulation.
For open fractures or other open wounds, the
application of the splint is the same.
However, you may need to apply sterile
bandages or dressings to the open wounds
before placing the splint in place.
For lower extremity applications, you may
need to use two splints instead of one. Two
splints can be overlapped at one end and
taped in place with adhesive tape.
To increase structural strength, after curving
the splint in a "U" shape, bend the edges
down slightly.

Rapid Form
Immobilizer
Assess the pulse, motor, sensation
and circulation of the injured area.
For splinting to be effective, the joints above and below
the fracture must be immobilized.
If possible, remove any clothing that may impede the
splint's ability to work properly.
If there are open wounds or exposed bone, bandage
appropriately.
The injured area must be manually stabilized, which
prevents movement. This can be done by simply holding
the affected area, preventing movement above and
below it. For example, for a radius/ulna fracture, the arm
should be held at the wrist and elbow.

Rapid Form
Immobilizer
When using vacuum splints,
place the injured extremity
inside the splint.
Use the pump to draw air out of the splint, which
compresses it, making it rigid. It also conforms to
the patient and reduces pressure on the area.
When using vacuum splints, make sure to keep
the patient's fingers and/or toes exposed to
assess motor function and capillary refill.
The splint should be checked periodically during
transport to ensure there are no leaks. Leaks in
the splint diminish its rigidity and effectiveness.

Traction Splint Application

Traction Splint Application

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.

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

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

Application of the Traction Splint

1 - Take appropriate body substance isolation precautions.

2 - Apply manual stabilization

Apply manual stabilization to the leg above and
below the injury site. This is designed to stabilize
the bone ends and reduce further injury.

3 - Explain the procedure to the patient

The athlete may be very anxious about this procedure.
You need to properly communicate to the athlete what
you will be doing.

4 - Remove clothing from the area

Remove the clothing to expose the entire leg, then
remove the shoe and sock from the effected extremity.

Traction Splint Cont.

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 splint
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.

8. Apply the traction splint
Slide the traction splint under the patients 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 patients thigh to prevent over tightening.

Traction Splint cont.

9. Apply mechanical traction
Attach the mechanical traction device to the ankle hitch. Avoid using too much
traction, which may overstretch the leg, but use enough traction to maintain limb
alignment. Many patients will have reduced pain and muscle spasms once adequate
mechanical 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 top
of the thigh just below the ischial strap. Do not fasten a strap directly over the
injury site. Excess straps should be secured underneath the splint to provide
additional support. Recheck the ischial strap to assure that it has not loosened.
11. Reassess distal pulses, motor, and sensory function distal to the
injury site 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.

Kendrick Extrication Device

Kendrick Extrication Device

The Kendrick Extrication Device (KED) is designed to
immobilize a patient found in a sitting position. It is most
commonly used in automobile accidents where the patient is
stable. If the patient is unstable, you will need to perform a
Rapid Extrication.

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 collar.
4. The KED is slide into position behind the patient.

Procedural Protocols cont.

5. The KED is wrapped around the patient, and the middle
strap is secured.
(The KED should be snug beneath the patients 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 patients head is secured into the KED.

Procedural Protocols cont.

10. All of the straps are tightened down.
11. The patients wrist and legs are secured.
12. A long spine board is placed under the patients buttocks.
13. Remove patient from the vehicle and transferred to the spine board.
14. Disconnect the leg straps, allowing the patients
legs to lay flat on the long spine board.
15. Refer to the securing a patient to the long
spine board.
*** Reminder ***
- Neurological and vascular checks should be
performed on the patient prior to and after extrication.
-If the patients becomes unstable at any time, refer to a
Rapid Extrication Protocol.

Lifting and Moving Patients

What is the role of the First

Responder?
Whenever possible, you should not move
patient.
Keeping your patient at rest is the best
course of action.

When do you move a patient?

1. Only if there is an immediate danger to
patient 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

Techniques

Body Mechanics
1. Proper use of your body to facilitate lifting
and 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

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 any
moves 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

Patients

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

One-rescuer
drags
1)Clothes drag
2)Incline drag
3)Shoulder drag
4)Foot drag
5)Firefighter's
drag
6) Blanket drag

One-rescuer
moves
1)One-rescuer
assist
Two-rescuer
2)Cradle carry
moves
3)Pack strap carry 1)Two-rescuer
4)Firefighter's
assist
carry
2)Firefighter's
5) Piggy back
carry with assist
carry