Describe the following strategies for extrification:

A. Safe Patient Lifting and moving

Moving and Positioning the Patient
● Take care to avoid injury whenever a patient is moved.
● Practice using equipment.
● Know that certain patient conditions call for special techniques.
Body Mechanics
● Shoulder girdle should be aligned over the pelvis.
● Feet shoulder-width apart.
● Keep backs straight.
● Lift with legs.
● Keep weight close to the body.
● Do not twist.
● Grasp should be made with palms up.
Performing the Power Grip
● A power grip gets the maximum force from the hands.
● Arms and hands face palm up.
● Hands should be at least 10” apart.
● Each hand goes under the handle with the palm facing up and the thumb
extended upward.
● Curl fingers and thumb lightly over the top of the handle.
● Never grasp a litter or backboard with the hands placed palms-down over the
handle.
Performing the Power Lift
● Tighten the back in normal upright position.
● Spread the legs apart about 5”.
● Grasp with arms extended downside of body.
● Adjust the orientation and position.
● Reposition feet.
● Lift by straightening legs.
Weight and Distribution
● Patient will be heavier on head end.
● Patients on a backboard or stretcher should be diamond carried.
Diamond Carry
● Four EMRs lift device while facing patient.
● EMR at foot end turns around to face forward.
● EMR at sides turn.
● Four EMRs face same direction when walking.
One-Handed Carrying
● Face each other and use both hands.
● Lift the backboard to carrying height.
 ● Turn in the direction when walking and switch to using one hand.
Carrying Backboard or Cot on Stairs
● Strap patient securely to the backboard.
● Carry patient down stairs foot end first, head end elevated.
● Carry patient up stairs head end first.
Using a Stair Chair
● Secure patient to stair chair with straps.
● Rescuers take their places: one at head, one at foot.
● Rescuer at the head gives directions.
● Third rescuer precedes.
Robinson Orthopedic Stretcher
● Adjust stretcher length.
● Lift patient slightly and slide stretcher into place, one side at a time.
● Lock stretcher ends together.
● Secure patient and transfer to the cot.
General Considerations
● Plan the move.
● Look for options that cause the least strain.
Directions and Commands
● Anticipate and understand every move.
● Moves must be coordinated.
● Orders should be given in two parts.
Additional Guidelines
● Find out how much the patient weights.
● Know how much you can safely lift.
● Communicate with your partners.
● Do not attempt to lift a patient who weighs over 250lbs with fewer than four
rescuers.
● Avoid unnecessary lifting or carrying.
Principles of Safe Reaching and Pulling
● Back should always be locked and straight.
● Avoid any twisting of the back.
● Avoid hyperextending the back.
● When pulling a patient on the ground, kneel to minimize the distance.
● Use a sheet or blanket if dragging a patient across a bed.
● Unless on a backboard, transfer patient from the cot to a bed with a body drag.
● Kneel as close as possible to patient when performing a log roll.
● Elevate wheeled ambulance cot or stretcher before moving.
● Never push an object with the elbows locked.
● Do not push or pull from an overhead position.
Emergency Moves
 ● Performed if there is some potential danger for you or the patient.
● Performed if necessary to reach another patient who needs lifesaving care.
● Performed if unable to properly assess patient due to location.
Emergency Drags
● Clothes Drag
● Blanket Drag
● Arm Drag
● Arm-to-Arm
One-Person Rapid Extrication
One-Rescuer Drags, Carries and Lifts
● Front cradle
● Fire fighter’s drag
● One-person walking assist
● Fire fighter’s carry
● Pack strap
Urgent Moves
● Use to move a patient who has potentially unstable injuries.
● Use the rapid extrication technique to move patients seated in a vehicle.
When to Use Rapid Extrication Technique?
● Vehicle or scene is unsafe.
● Patient cannot be properly assessed.
● Patient requires immediate care.
● Patient’s condition requires immediate transport.
● Patient is blocking access to another seriously injured patient.
Rapid Extrication
● Provide in-line support and apply cervical collar.
● Rotate patient as a unit.
● Lower patient to the backboard.
Nonurgent Moves
● Direct ground lift
● Extremely lift.
Transfer Moves
● Direct carry
● Draw sheet method
D.Use of Kendric Extrication Device (KED)

The Kendrick Extrication Device (KED) is a device that is used in vehicle extrication to
remove a patient from a motor vehicle. A KED is generally only used on stable patients;
unstable patients are extricated with rapid extrication techniques without applying a
KED. KED wraps a person's head, back, shoulders, and torso in a semi-rigid brace,
immobilizing the head, neck and spine.

Features of Kendric Extrication Device

-Provides both immobilization and comfort with a built-in plywood spine board along the
back
- It is applied to the injured rib.
- Three color-coded body straps with quick-clip, snap-lock buckles make it simple to
apply in low light or cramped areas.
- When used in conjunction with a cervical collar, it provides immobilization in sitting
position until patient can be transferred to a long spine board.
- Comes complete with two reusable, plastic-coated head/chin straps, neck pad and
durable carrying case.

E. Dressing and Bandaging

Dressing is the use of any sterile material used to directly cover a wound. It can be
made out of cloth gauze or any available material.

Types
● Adhesive dressing, this type of dressings are used for dressing small cuts and
grazes. They consist of a gauze or cellulose pad and an adhesive backing.
● Non adhesive dressing is a type of dressing used to dress large size area wound
unlike that of adhesive dressing.

Bandage on the other hand, is something used to hold a dressing in place. Tight
bandages can be used to slow blood loss from an extremity.

Kind of Dressing
● Gauze bandages usually in roles of 1 meter long and 3, 5 or 8 cm wide.
● Elastic/compression bandage of woven material in various widths and lengths.
● Triangular bandages - can be used as roller bandages, compression bandage,
sling or tourniquet
● Other emergency bandages can be formed from handkerchiefs, household linen,
belts, ties, socks or stockings.

Applying a dressing and bandage

 ● Make sure hands are clean.
● Clean or disinfect the injury/wound
● Hold dressing by one corner and place over wound.
○ Do not slide over wound
○ Do not touch dressing
● Carefully cover with bandage
○ Bandage should be clean.
○ Ensure that the bandage are not too tight. Signs that a bandage may be
too tight includes blue tinge on fingernails or toenails, blue or pale skin
color, tingling, coldness, inability to move the affected part, and inability to
feel a pulse that could previously be felt.

F. Stabilization (DURING RAPID EXTRICATION)

Stabilization involves providing all the medical care necessary to make sure
the patient's condition will not deteriorate and their vital signs are within the healthy
range. Stabilization is often carried out by the first person to arrive on the scene, EMTs,
or nurses, either before or soon after the patient is admitted to the hospital. Patient
comfort measures include managing bleeding, preparing for adequate evacuation,
keeping patients warm with blankets, and relaxing them by showing genuine care for
their well-being and by offering personal attention.

Rapid extrication is indicated when the scene is unsafe, a patient is unstable,

or a critical patient is blocked by another less critical patient.

The rapid extrication technique is designed to move a patient in a series of

coordinated movements from the sitting position to the supine position on a long
backboard while always maintaining stabilization and support for the head/neck, torso,
and pelvis.
Indications for the use of rapid extrication:

• The scene is unsafe

• Unstable patient condition warrants immediate movement and transport
• Patient blocks you from accessing another, more serious, patient

The Rapid Extrication technique requires a minimum of three (3) rescuers who
are trained in this procedure.

• Take appropriate body substance isolation precautions.

• Instruct the patient not to move their head and to hold still.

Make sure you fully explain the procedure to the patient so they
understand what is about to occur.

• Manual inline stabilization

Rescuer #1 positions themselves behind the patient, brings the patient’s

head in to a neutral position, and maintains inline stabilization of the
cervical spine.

• Assess pulse, motor, sensory

Assess pulses, motor function, and sensory function in all extremities.

• Rescuer #2 applies the appropriately sized cervical collar

• Position equipment and prepare to move the patient

Rescuer #3 places the long backboard near the door of the vehicle and
then moves into the seat next to the patient. Rescuer #2, standing next to
the patient, supports the patient’s chest and back as rescuer #3 frees the
patient’s legs.

• Rotating the patient

At the direction of rescuer #1, who is maintaining inline stabilization, all
rescuers begin to rotate the patient in several short, coordinated moves
until the patient’s back is in the open doorway and his/her feet are on the
opposite seat. If rescuer #1 is unable to maintain inline stabilization
throughout this step (i.e. the “B” post of the vehicle is in the way), then
another available rescuer or bystander should take over manual inline
stabilization from outside of the vehicle while rescuer #1 exits the vehicle
to continue manual inline stabilization.
• Move patient to the long backboard

The end of the long backboard is placed on the seat next to the patient’s
buttocks while another rescuer or bystanders support the other end of the
long backboard. At the direction of the rescuer maintaining inline
stabilization, the patient is lowered onto the long backboard in one
movement. The rescuers then slide the patient, as one unit, into position
on the long backboard in short coordinated moves.

• Secure patient to the backboard

Secure the patient’s torso first and remember to secure the bony portions
of the body. Run one 9’ strap through the hole closest to the patient's
underarm and across the chest to the corresponding hole on the other
side. Bring the strap back under the patient's arms to meet the buckle,
which should be secured and positioned off the center of the chest. Have
the patient inhale deeply and hold their breath (if possible) and then
tighten the strap. This will assure that the strap does not impede the
patient’s respirations. The patient’s arms should not be strapped in at this
point.

Now secure the pelvis by locating a hole closest to the center of the pelvis.
Run the strap through the hole, across the pelvis and to the corresponding
hole on the opposite side. Bring the strap back across the pelvis to meet
the buckle. The legs may be secured in a similar way or you may use
cravats if necessary.

Once the torso and legs are secured, you can begin to secure the head.
Be sure that whichever head immobilization device you use allows you to
secure the patient’s head in a neutral position. Do not remove manual in-
line stabilization of the head until the head is completely immobilized to
the long backboard.

• After the immobilization has been completed, reassess all four (4) extremities for
distal pulse, motor function and sensory function.

• During transport continue to check the straps to assure they have not come
loose.
 The first provider provides in-line manual support of the
head and cervical spine.

The second provider gives commands, applies a cervical

collar, and performs the primary assessment.

The second provider supports the torso. The third

provider frees the patient's legs from the pedals and moves
the legs together, without moving the pelvis or spine.
 The second provider and the third provider rotate the patient as a unit in several
short, coordinated moves. The first provider (relieved by the fourth provider as needed)
supports the patient's head and neck during rotation (and later steps).

The first (or fourth) provider places the backboard on the

seat against the patient's buttocks. (Use of a backboard may
depend on local protocols.)

The third provider moves to an effective position for

sliding the patient. The second and the third providers slide
the patient along the backboard in coordinated 8-to-12-inch
(20-to-30-cm) moves until the patient's hips rest on the
backboard.

The third provider exits the vehicle, moves to the

backboard opposite the second provider, and they continue
to slide the patient until the patient is fully on the backboard.

Yung explanation, ano mas better

The first (or fourth) provider continues to stabilize the head and neck while the second
provider and the third provider carry the patient away from the vehicle and onto the
prepared stretcher.

Several variations of rapid extrication are possible, including using assistance

from bystanders. However, whichever technique is used must be used in a way
as to not compromise the spine.

G. Restraints
Restraints are devices used in healthcare settings to prevent patients from
causing harm to themselves or others when alternative interventions are not effective. A
restraint is a device, method, or process that is used for the specific purpose of
restricting a patient’s freedom of movement without the permission of the person.
 Restraints can be classified as physical or chemical restraints or the use of
seclusion. Physical restraints include “any manual method, physical or mechanical
device, material, or equipment that immobilizes or reduces the ability of a patient to
move his or her arms, legs, body, or head freely.”
Chemical restraints involve using medication to control behavior or to restrict the
client’s freedom of movement and is not a standard treatment for the client’s medical or
psychological condition.
An environmental restraint is a restrictive practice that restricts a person's free
access to all parts of their environment, including items and activities.
Types of Restraints:
● Side Rails and Enclosed Beds
○ The purpose of raising the side rails is to
prevent a patient from voluntarily getting out of
bed or attempting to exit the bed. However, if
the purpose of raising the side rails is to prevent
the patient from inadvertently falling out of bed,
then it is not considered a restraint. If a patient
does not have the physical capacity to get out of
bed, regardless if side rails are raised or not,
then the use of side rails is not considered a restraint.

● Hand Mitts
○ The mitt prevents contractures and keeps the confused
patient from tearing at IV lines or picking at wounds, yet
still allows them to move about freely in bed.

● Limb restraints
○ Generally made of cloth, may be used to immobilize a
limb, primarily for therapeutic reasons (e.g., to maintain
an intravenous infusion). Commonly used with children,
elbow restraints (e.g., No-No’s) prevent flexion of the
joint so that tubing, connections, catheters, and
bandages cannot be reached
● Vest and belt restraint
○ Vest and belt restraints are some of the more common
restraints that are designed to secure a patient to either a
 seated position, a bed, or simply to keep the arms secure to their torso, as
with a straight jacket.

Reference:
https://gafacom.website/first-aid-dressing-and-bandages/