A Kendrick extrication device (KED) is a device used in

extrication Vehicle extrication is the process of removing a patient from a vehicle which has been involved in a motor vehicle collision. Patients who have not already exited a crashed vehicle may be medically (cannot exit a vehicle due to their injuries) or ...

of victims of

traffic collision A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tr ...

s from

motor vehicle A motor vehicle, also known as a motorized vehicle, automotive vehicle, automobile, or road vehicle, is a self-propelled land vehicle, commonly wheeled, that does not operate on railway track, rails (such as trains or trams), does not fly (such ...

s. Commonly carried on

ambulance An ambulance is a medically-equipped vehicle used to transport patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to ...

s, a KED is typically used by an

emergency medical technician An emergency medical technician (often, more simply, EMT) is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and som ...

paramedic A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), ...

, or another

first responder A first responder is a person with specialized training who is among the first to arrive and provide assistance or incident resolution at the scene of an emergency. First responders typically include Law enforcement, law enforcement officers (co ...

. It was originally designed for extrication of race car drivers. Typically used in conjunction with a

cervical collar A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, although they should not be rou ...

, a KED is a semi-rigid brace that secures the head,

neck The neck is the part of the body in many vertebrates that connects the head to the torso. It supports the weight of the head and protects the nerves that transmit sensory and motor information between the brain and the rest of the body. Addition ...

and

torso The torso or trunk is an anatomical terminology, anatomical term for the central part, or the core (anatomy), core, of the body (biology), body of many animals (including human beings), from which the head, neck, limb (anatomy), limbs, tail an ...

in an anatomically neutral position. Its use is claimed to reduce the possibility of additional injuries to these regions during extrication, although its value has been questioned, as there is a lack of evidence to support its use. The original KED was designed by Richard Kendrick in 1978.

Description

Typically there are two head

strap A strap, sometimes also called strop, is an elongated flap or ribbon, usually of leather or other flexible materials. Thin straps are used as part of clothing or baggage, or bedding such as a sleeping bag. See for example spaghetti strap, s ...

s, three torso straps, and two legs straps which are used to adequately secure the KED to the victim. Unlike a

long spine board A spinal board, is a patient handling device used primarily in pre-hospital trauma (medicine), trauma care. It is designed to provide rigid support during movement of a person with suspected spinal or limb injuries. They are most commonly used b ...

litter Litter consists of waste products that have been discarded incorrectly, without consent, at an unsuitable location. The waste is objects, often man-made, such as aluminum cans, paper cups, food wrappers, cardboard boxes or plastic bottles, but ...

, the KED uses a series of wooden or

polymer A polymer () is a chemical substance, substance or material that consists of very large molecules, or macromolecules, that are constituted by many repeat unit, repeating subunits derived from one or more species of monomers. Due to their br ...

bars in a

nylon Nylon is a family of synthetic polymers characterised by amide linkages, typically connecting aliphatic or Polyamide#Classification, semi-aromatic groups. Nylons are generally brownish in color and can possess a soft texture, with some varieti ...

jacket, allowing the responders to immobilize the neck and upper

spine Spine or spinal may refer to: Science Biology * Spinal column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoology), ...

and remove the victim from the vehicle or other confined space. Although a KED can also be used to immobilize infants and children, it is preferable to use specifically designed

pediatric Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth ...

immobilization devices whenever possible. If a KED is used to immobilize an infant or child, appropriate padding must be used to ensure complete immobilization in a manner that does not obscure the

thorax The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main di ...

and

abdomen The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...

, thereby preventing continued assessment of these vital areas.

Application

The device can be quickly and easily inserted into the seat of a vehicle by a single rescuer, allows access to the

airway The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory ...

and conforms to any body size. A KED is typically used only on hemodynamically stable victims; unstable victims are extricated using rapid extrication techniques without the prior application of the KED. Once the KED is slid into position, it is secured to the victim with straps in order to prevent movement. The first strap that is secured is the middle torso strap. According to the KED users' manual securing this strap secures the greatest area of the device and therefore provides the greatest stability while securing the rest of the device. Next the bottom torso strap is secured, however the top torso strap is not secured until just prior to moving the patient to the long spine board. This is to allow the patient to breathe easily while the rest of the device is secured. Following the bottom torso strap the leg straps are secured. These may be applied in a "criss-cross" fashion (according to the KED users' manual this is the most commonly used method), or applied by securing them to their respective sides. If there is any evidence of a groin injury the "criss-cross" method cannot be used. Following application of the leg straps the void between the head and device is padded as needed and the head is secured. Finally, just prior to moving the patient to a long spine board the top strap is secured. Some schools teach this order by remembering phrases such as "My Baby Looks Hot Tonight", where the beginning of each word stands for Middle torso strap, Bottom torso strap, Leg straps, Head strap and Top torso strap. The head pad can bring the head too far forward for the side panels to fully immobilize it. Care must be taken to secure the head properly to maintain neutral immobilization. If the head is too far forward, the head is brought back to meet the KED unless crepitus, pain or resistance is met. If these symptoms are present, the head is immobilized in the position found. There has been debate surrounding the exact order of applying the torso straps, with some saying that the order does not matter as long as the torso is secured before the head. The KED users' manual is sometimes used in these debates: it states the reason the top strap is last is a function of breathing and not the process of immobilization itself.KED User's Manual
2001, p. 11

Value

There is controversy about whether the use of a KED is actually appropriate in prehospital care. A 2015 article in the '' Journal of Paramedic Practice'' said that although the device has been used since the 1970s, its "overall appropriateness in patient care should be viewed with caution" and there is a "lack of evidence to support its use". A 1988 article in the ''

Canadian Medical Association Journal The ''Canadian Medical Association Journal'' (French ''Journal de l'Association Médicale Canadienne'') is a peer-reviewed open-access general medical journal published by the Canadian Medical Association. It publishes original clinical research ...

'' said the device had "yet to be evaluated for its immobilization of the cervical spine" and that "the role and performance of the device in transferring patients by road or air ... must be addressed".

Rapid extrication without a KED

During rapid extrication, the patient is not immobilized by a KED, but rather taken directly out of the car onto a back board. Reasons for using this technique include: *The scene is unsafe *The patient's condition is unstable *The patient is blocking access to another victim.

References

{{Emergency medical services Emergency medical equipment Medical transport devices Rescue equipment