How to use an upside-down KED for a hip injury patient
She's a sweet little old lady who has fallen and can't get up. The reason she can't get up is obvious; a shortened and internally rotated left leg. Complicating matters, she has had the misfortune of falling in a cramped bathroom, between the tub and the toilet.
Normally, you'd grab your handy scoop stretcher and handle your business, or if this were in a nursing home, you'd choke back the pointless lecture on not moving injured patients, do a gentle sheet transfer from her bed to your cot, and thank the nurse for all her, ummm… help.
Neither of those techniques will work for your patient, so what do you do when you must package that hip fracture in tight confines?
Easy, just grab your Kendrick Extrication Device.
Now, I'm pretty sure this trick doesn't appear in any of Ferno's training literature on the KED, but I did mention the technique to Rick Kendrick over beers at an EMS conference once, and he chuckled.
Hey, that's as good as official approval in my book.
Now, many of you seasoned medics have heard of or used some variation of this trick, but most of the newbies haven't. All you do is flip your KED upside down and apply it that way. Doesn't matter if they're lying on their side or supine, you can make it fit, and it makes a dandy improvised pelvic binder.
Picture your patient lying on the floor. You've already started an IV and given her a dose of rapid-acting analgesic (You do give analgesics before you do something as painful as splinting a hip, right?), and you're ready to position the KED. In a coordinated move with your partner, slide the upside-down KED under her hips until the bottom edge of the device is positioned over her lower back, say about 3 inches above her iliac crests.
Take your handy dandy head padding supplied with the device and pad her injured hip with that. Add additional padding between her legs, and tighten the torso straps around her hips and upper thighs. Now take those head flaps, and wrap them around her calves, and strap them in place with the head straps.
Voila! Now you have her hip splinted, and you have two handy carrying straps to left her by. Simply grab those straps, use your other hand to clasp your partner's under the lady's legs, and carefully move her onto the stretcher. Don't forget to check distal sensory, motor and circulatory function in her feet, just like you'd do after any splinting maneuver.
You can either leave her splinted as-is for the transport, or position your scoop stretcher on your cot before gently lowering her onto it. I've found that the technique works so well to splint and move the patient that the scoop stretcher is usually unnecessary.
Give this trick a try next time you have to splint a hip fracture in cramped quarters, and let me know how it works out for you and your patient!
Head portion of the KED can be secured to both of the patient's legs or just one. (Photo courtesy of Eastern Kentucky University Paramedic Program)
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