A Para-fetus came to me yesterday with a question. It seems that the young one was in paramedic class yesterday, and the instructor asked them if they knew when it was appropriate to use a Kendrick Extrication Device. The student replied, "To move patients while stabilizing the spine, for example, to remove a patient from a car after the roof has been cut off."
To which the Instructor replied, "If you have to cut the roof off, the patient is probably too critical to bother using a KED."
Ummm, it is called the Kendrick Extrication Device. You know, to extricate patients with. This is plainly an instructor trying to impress his class with his encyclopedic knowledge. If you want to get into the discussion of hemodynamic instability, and the decision to perform rapid extrication, fine. What I don't understand is why you would make a blanket statement like that.
Some people who instruct need to think carefully about what you are teaching students before you speak. For reference, here is how I make the decision:
All patients die from the same cause: hypoperfusion. Every death is caused by a failure of the body to perfuse the brain. Therefore, anything that threatens that is a serious concern. A good rule of thumb is to perform a rapid extrication on a patient who is critically unstable and in danger of hypoperfusion.
These patients are easily spotted:
Altered level of consciousness
Systolic BP <90mm Hg (in other words, lack of a radial pulse)
Breathing rate less than 10 or more than 30
Serious, uncontrolled hemorrhaging
Most other patients can wait the extra 3 minutes or so to stabilize the Cspine, especially if the patient's mechanism of injury or clinical signs suggest Cspine injury.