1. Pre-Hospital Emergency Care Course
Safe patient handling
Packaging and extrication
Last reviewed Dec 2009

2. Objectives To show packaging equipment available
To understand the implications of patient handling on non-compressible bleeding and spinal injuries
To understand the difference between routine and rapid extrication
To note the value of self-extrication

3. High index of suspicion!
IF YOU DO NOT THINK ABOUT THE POSSIBILITY OF A SPINAL INJURY
YOU WILL MISS IT!!
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Refer participants to check the definitions, incidence data and who should/should not be immobilised in the spinal injury and stabilisation section of the manual.

4. Recognition Mechanism of injury Pain in neck/spine
Pins & needles/numbness in limbs
No pain response below level of injury
Flaccid limbs
Diaphragmatic breathing
Neurogenic shock (hypotension with bradycardia)
When the mechanism of injury raises the possibility of spinal damage
Where there is pain/tenderness in the spine
Where there are neurological signs related to spinal injury
Where there is an altered level of consciousness, intoxication or distracting injury elsewhere

5. MILS
Do not underestimate the value of manual in-line stabilisation – this can be maintained until patent needs to be packaged for transfer. Similarly, if collar is not right, or cannot be fitted safely in-situ, maintain MILS until safe to apply collar properly.

6. Immobilisation equipment
Equipment available from ambulance – every front line ambulance in Scotland carries a scoop stretcher and vacuum mattress.
Collars in Sandpiper Bag to apply IF time while waiting for crew arrival.
All these will be shown in the spinal immobilisation station later plus during simulations.

7. Implications of patient movement
Prone patient moves involved in packaging for transport
Next 4 slides show impact or rotational moves associated with packaging for transport. Cautions both for non-compressible bleeds as well as spinal injuries.
150 degrees of motion

8. Rotational shifts using spinal board
On Spinal Board
150o
90o
Total = 330o
At hospital
On Spinal Board
Using board
90o
Grand Total = 510o

9. Net effect Tongue & secretions fall back & block airway
Dislodgement of clot
Loss of tamponade
Movement at
Sacro iliac joint
Fall in blood pressure
Tongue & secretions fall back & block airway

10. Rotational shifts using scoop stretcher
Left blade in
Right blade in
150o
10o
On scoop
Counter traction
Left blade out
Right blade out
In hospital
Scoop reduces rotational moves by 340 degrees!!! Hugely significant. 0o
Total pre-hospital = 170o
Total = 170o

11. Extrication device
Long board for sliding patients out of difficult places
Not for routine patient transport
Scoop off long board to vaccuum mattress
Long or spinal board should only be used to assist extrication from difficult location.

12. RCSEd guidance on extrication
PLAN A = Routine extrication, patient stable and time to plan.
PLAN B - Urgent extrication, concern over patient condition and need for rapid transfer to care.
Snatch rescue eg: fire / immediate danger /cardiac arrest
Manual mentions Plan A (ie routine) and Plan B (ie emergency) extrications. These are fire service terms – we will cover options for medical inputs.

13. Transportation Patient & equipment are reassessed before leaving scene
Journey < 30 mins. On scoop / board
Journey > 30 mins. On vacuum mattress
Inform receiving unit of time the casualty was placed on scoop/board if used
Specialist transport to spinal unit?
Pre-alert A/E unit
Important to identify if vacuum mattress is available in your area, all Scottish Ambulance Service A&E vehicles carry one.
If not available do not delay transportation to wait for one to be brought to scene. Note length of time patient is on scoop and inform receiving unit.
ONLY transport on scoop if total time on this (including arrival and transfer to receiving resus room) is less than mins. Very difficult to achieve in rural Scotland!

14. Spinal injury & extrication
Video clips
2 videos to show – one is stable patient and assessed as no significant neck or spine injury and encouraged to self extricate from car
- other is unconscious patient requiring rapid side-extrication from car as circulation problems require urgent transport

15. Summary Assessment and management of chest injuries
Packaging equipment available
Implications of patient handling on non-compressible bleeding and spinal injuries
Routine vs. rapid extrication
Relevance of self-extrication