1. #1
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    Default Roof Removal re-visited

    I did some searching and found some discussion way back in '02 on this topic, and I would like to see if opinions have changed any. Forgive me if I missed a more recent discussion.
    Have more departments began roof removal as a "common" practice? The older threads seem to echo the same type of concern, that removing a roof early on lead to more difficult door removal due to lack of structural integrity, ie. no purchase points strong enough to push doors off.
    With techniques and training turning more toward cutting rather than spreading, leading to cutting hinges and nader pins to remove doors, has this become less of an issue?
    I attended a seminar recently that visited a study done by the W.H.O. that although U.S. rescuers rank very high in the prevention/management of Cervical injuries, we are low ranked on the same for Lower spine injuries. Several reasons were cited, one major being patient removal techniques. The standard door removal and rotation onto a back board was highlighted. One of many solutions that was strongly recommended was vertical patient removal. This was shown as way of optimally maintaining total alignment, while the other technique should be used only when medically necessary due to time restraints. I have done vertical removal, both at competition and on scene, but the latter is not very often.
    It was stated that many European brigades have standardized roof removal as a first step, for many reasons. Safer access for rescuers, removal of undeployed devices, and for more stabilized patient removal.

    I am not looking to change anyones practices, but feedback and counterpoints from some of the experienced members would be appreciated.

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    I wish I could get a hold of the info you mentioned, this backs up what I was saying in the "Who should do rescue" thread. We need to incorperate more Patient care and extraction into our extrication classes. So many extrication classes are strictly how to cut up cars. The whole idea is not the cutting of the car it is the safe removal of the victim. How many times have we seen rescuers pop a door, lift the vics legs up over the consol and twist them aroud onto a back board. Looking at the cars of today, this takes a lot of twisting because in the newer cars the seat actually sets behind the B post. And yes most are good at protecting C-spine, preventing paralization, but the whole idea is total spine alignement not just upper spine. Though this is quick, how long will the patient suffer with lower back pain compared to the time it takes to do a roof removal.
    Many I know have quit using them but I personally am still a big fan of the KED and Short board. and a vertical lift, or a roof removal and lay the seat back and slide a long board under them and lift them out to the rear of the vehicle.
    As for the door, I personally would pop the door before removing the roof, this would give the rescuer more working ability, and yes you would not lose structual integraty, but if some one did remove the roof first, we need to practise using the back up tools we have. So many times all we think is the tools we practice with. but though we have lost structural integraty we can still perchase the nator pin, pop or cut it and swing the door open. In Zmags advertisment we see were they use a strip to pull the door completly back against the fender, what need is there to cut the hinges.
    I think the main thing we need is to stress three things in our classes, #1 total spine alignement, #2 Move the metal not the patient, #3 there is more tools and techniques in our tool box than just the ones we use every day.
    Last edited by LeeJunkins; 06-30-2006 at 11:13 AM.
    http://www.midsouthrescue.org
    Is it time to change our training yet ?

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    leejunkins,
    great response, I am a big fan of KED but to many times today people fuss and say it takes to long to properly place the KED. People are afraid to answer to MD "I took13 min instead of 10min. becuase the pt had c-spine complaint. I did not want to cuase futher injury."
    I have to say I'm guilty of the c-collar but spin them at the hips to get out.
    I am trying to push my way back as AIC I'm responsible for pt. care=KED.
    TRAIN ON THE KED.
    I do agree there needs to be more pt. "care" taught in VEH EX classes.
    now the teachings are going to no vehicular shift while working, and EMS due your job. It wouldn't be that much to teach, C-collar AND KED to the first responder and emt -b level personel as just as important as the backboard.

    One greif I get is the question of who's going to tell insurance why the car is totaled now after pt. removal when there was minor damage after collision;

    Remove the vehicle from the pt, preserve the pt's CNS.

    has anyone else gotten greif on said question?

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    thanks for the replies. they are kind of what I have been hearing when having this conversation verbally.
    As for KED's, I hesitated to mention them on a firefighter forum, because they are usually looked at as EMS "tools" since they are not typically carried on a truck. However, the study I mentioned, cited lack of use of the KED type device as another cause. Do you think that if we and EMS especially, trained with them more, they might not take so long to put on? I work with EMT classes and rookie FF's quite a bit, and some have seen the device once, when an instructor held up the green bag during initial training, and never have used it. I don't want to start an arguement, but has EMS got so far into ALS that basic steps are being lost?
    It may become the FF/rescue personnel's task to make the decision to use the device. The EMT that then stops the use is putting themselves at a huge liability if the patient is injured.
    I was always told that for the most part when tools are used on a car(hydraulic), the car is almost always totalled. So I am not sure if removing a roof for better patient care should be a concern in that area, but I could be wrong. I have also seen presentations by Holmatro and Todd Hoffman with slides showing that even after on a minor accident, with much SRS deployment, the cost of replacing the systems along with cosmetic damage pushes the vehicle into total loss catagory.
    Not to challenge anyones theories, but I do not answer to insurance companies and have not yet heard of anyone being challenged.
    Last edited by hrtrescue10; 07-01-2006 at 02:30 PM.

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    I have never heard of insurance or anyone else questioning extrication techniques either. I saw that roof removal, vertical board technique I guess in the early 90's, I think through the Carbusters video series. We've tried it a few times and it works pretty well. Regarding the whole "who should do rescue" thread, NJ still teaches KED in your initial and Core recert, but I haven't seen one used on the street in years. Once everyone got the "rapid takedown" training that is all they use. I suggested using one a few years ago to the EMS that was working with us and they blew it off, it was one of those wrecks where you really felt there was something more to it than standard issue "neck pain"

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    I work with EMT classes and rookie FF's quite a bit, and some have seen the device once, when an instructor held up the green bag during initial training, and never have used it. I don't want to start an arguement, but has EMS got so far into ALS that basic steps are being lost?
    It may become the FF/rescue personnel's task to make the decision to use the device. The EMT that then stops the use is putting themselves at a huge liability if the patient is injured.


    I really think every one on both sides needs to know as much as possible about every tool we have. every MVA is different, and only experiance can tell you what tool or technique to use. Like he said for a long time now most people have been teaching, rapid extraction, speed, get them out and get them to truma. Some times that is the right thing to do. But look at the changes in todays vehicles, when that was being taught the doors were a lot larger openings, the seats were a lot farther forward, and the cars were different, you could look at a car and see the machanisum of injury. Today we have crumple zones, it is hard to tell how much speed or force was applyed to do the damage. Yes todays cars are much safer and less injuries accures, But why put that liablity on yourself, though they look alright can we really tell. Yes we are going to get some people that are just looking for a law suit, this is where Happy Pappy the clown comes out in me, I will put them in a C collar, KED, Back Board, Head strap, Chin Strap, the works, but if I was wrong about them, then every thing I did is that much better on my part. so it never hurts to do it right.

    As for the Ins. Patient Care is the only law, and that decession belongs to the rescuer in charge. there is nothing Ins. can do about it and once we touch the car with a tool it is an automatic total. If you pop a door then go a head and do what is best for the crew and patient. At least thats the way it is here.
    http://www.midsouthrescue.org
    Is it time to change our training yet ?

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    sorry , submitted twice
    Last edited by LeeJunkins; 07-05-2006 at 01:51 PM.
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    As for KED's, I hesitated to mention them on a firefighter forum, because they are usually looked at as EMS "tools" since they are not typically carried on a truck. However, the study I mentioned, cited lack of use of the KED type device as another cause. Do you think that if we and EMS especially, trained with them more, they might not take so long to put on?

    I have thought about that all week end, and it is basically the same here.
    But, I have never understood why. I am both EMT and FF, here FD dose all extrication but most do not carry a KED on the truck, The ambulances are all equipped with them and never use them.
    As an EMT the only thing I have ever used one for is, They are great for cradling a baby.
    As a rescuer I have used them in confined space, when we did not have the luxury of having a skid stretcher or stokes. I use them in many places you did not have room for a backboard.
    I know and we can see on these forums, it is different every where we go.
    Here FD is first response for EMS. FD dose all patient packaging, others EMS dose all patient care.
    In extrication they are great for doing a vertical lift, I think about the thread we were talking about the roof flap, if you hook the leg straps, you can lift the patient straight up out of the car, unhook the leg straps and lay them on the backboard. In a side resting roll over a short board is great, but there is still some chance of side movement with a KED there is no chance of spinal movement you can lift, twist, pull, do what ever is needed to remove the victim from the car and the time involved is 3 buckles and 2 velcro straps.
    My point is how many people ever find a job in the same area that they went to school in? If we are going to teach people we need to give them all the tools and techniques they may need.
    As for the trucks it dose not matter who dose rescue, put the tools on the trucks that are going to use them, no matter what the sign on the side says.
    http://www.midsouthrescue.org
    Is it time to change our training yet ?

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    "BLS before ALS" is a rule a smart medic taught me while I was in medic class. That includes the use of a KED. Other than the few times I've used it, I can honestly say I've never seen one used by a crew (except on a ped that was swallowed by an LSB, even then they move the patient to the KED instead of applying it right), even on serious accidents with unconscious patients or patients with spine complaints. I'm not a big advocate of the "it takes too much time to put it on" excuses. Especially when extrication is involved. While we're cutting, someone is inside holding c-spine while everyone else watches. Why can't someone be clipping KED straps while we're cutting? Besides, if you're familiar with the KED, it doesn't take any longer to put it on than it does to start an IV, intubate, or do any of the other things we "have" to get done. I'd almost bet it'd be quicker a lot of times compared to trying to wiggle a flacid patient out of the vehicle.

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    Default Sorry this is answer to next post HIT WRONG BUTTON

    Quote Originally Posted by chavoman
    In an extrication, there shouldn't be anyone standing around. You should be multi tasking. It would be pretty hard to get the KED on someone who is trapped. If they are stable then it is worth getting the proper access before dealing with the patient and if they are red then the last thing to worry about is a KED. When extricating, depending on how many personnel you have there should be six persons doing a task. and that includes 2 with patient. Not always will a KED work, it all depends on the situation. If you have to intubate then using the KED isn't on your mind.
    Let's put things in persective, we are not talking about putting a KED on the patient while they are traped in the car, we are talking about using it to remove the patient instead of twisting and turning them,(after the door is poped,or the roof removed.

    We also agree with you that " Not always will a KED work, it all depends on the situation"but as we see all through this thread most are not even trained to use one and they can be one of the best tools in our box when they should be used.
    Last edited by LeeJunkins; 07-20-2006 at 08:16 PM. Reason: wrong place
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    In an extrication, there shouldn't be anyone standing around. You should be multi tasking. It would be pretty hard to get the KED on someone who is trapped. If they are stable then it is worth getting the proper access before dealing with the patient and if they are red then the last thing to worry about is a KED. When extricating, depending on how many personnel you have there should be six persons doing a task. and that includes 2 with patient. Not always will a KED work, it all depends on the situation. If you have to intubate then using the KED isn't on your mind.

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    Removing the roof is my first choice.
    Many times all you need to do is cut the roof and slide the pt onto a LBB.

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