Prehospital Care in Malaysia and Kendrick Extrication Device

This talk was the first lecturer that I gave during the Prehospital Care course that I conducted for the Red Crescent volunteers of Penang Branch Malaysia. This slide was prepared based on a commentary journal article that I wrote together with Dr. Hiang Chuan Chan from Kuching Sarawak.

Red Crescent members demonstrating the use of KED. They have a designated Kancil car to be used for their training purposes. One of the fastest way to slip in a spinal board for rapid extrication is through the back bonnet door

These guys and gals from the Penang Red Crescent are really a nice group of people - they are warm and friendly, and I learned much from them even as I shared with them whatever that I know. In fact, they were more "expert", in fixing devices like immobilizing the spine using Kendrick Extrication Device (KED) (picture below).

Image: Wikipedia, filed under Wikimedia Commons

KED is a device designed by Rick Kendrick back in the 1978-79 that allows for total spinal immobilisation during extrication. In fact, Rick Kendrick has invented the latest version known as the KOED (Kendrick Other Extrication Device).

Advantages of KED:

• Because KED is designed to enclose the torso and cervical spine in a rigid frame, it prevents flexion, extension and rotation movements of the spine.
• KED can be quickly and easily inserted into the seat of a vehicle by a single rescuer, and thereby, allows access to the airway even in a restrained space such as being trapped in a vehicle.

Disadvantage of KED

• KED may take time to secure; in my estimation, at least two minutes in order to properly maintain the cervical spine and at the same time to properly tighten up the straps. Therefore, KED should typically be used only on hemodynamically stable victims; unstable victims may need to be extricated using rapid extrication techniques without the prior application of the KED.

One of the issues we were discussing during the Prehospital Care course in Red Crescent Penang is

should you bring the leg straps under the leg, criss-cross to the other side for strapping,

or

should you just strap it around the same side?

When I did a bit of search from the internet, it seems that this issue is a rather debatable issue until now among the community of prehospital care providers (read a forum here).

Well, according to the inventor himself, Rick Kendrick, it really doesn't matter (watch the video below)

The bottom line is:

If you suspect a groin injury, do not criss-cross the straps; just strap them on the same side.

And if you suspect a pelvic injury, it is advisable not to strap at all in case that you exert too much external rotatory movement that may aggravate an open book pelvic injury.

Otherwise, you may wish to cross them if you are comfortable with that. I personally find criss-crossing the straps a rather unnecessary and tedious steps, especially for female victims as you do not want to "accidentally" touch unnecessary regions.

Here is a video clip where the operator did not cross the leg straps:

And here is another clip where the operator criss-crossed the straps:

Hope that shed some light on the KED.

Another thing about the Red Crescent team that impressed me is their rather simple but innovative alternative to commercial splints.

This, I believe, is an effective and economical solution if you have limited fund to buy commercial splints like the Hare traction. After all, if you are only transporting for a short distance of time, what different would that make between self made splints and commercial splints? All you want is a solid enough splint for immobilization, reduce movement and thus reduce pain and swelling (as a temporary measure).