Re:Kendrick Extracation Device in pulmonary compromise
Thank you for taking the time to read and respond to our paper and for usefully highlighting the possible application of the Kendrick Extrication Device (KED) in such circumstances.
We can confirm that had nebulisation been required prior to extrication from the premises that the application of the KED would have been considered. In our case however the initial position of the patient enabled a simple rearward immobilisation onto a back board (with no risk of rotational movement) one of the "several acceptable means of back support" recommended in current UK prehospital care guidance.(1)
The immobilisation system and device was selected and applied prior to deterioration and on the presumption that the acute alcohol intoxication was masking a head injury. We were therefore keen to immobilise and extricate promptly. The authors would have been required to predict the 'type' of deterioration and subsequent need for nebulisation for the KED to have been applied 'prophylactically'. Furthermore, the paper you reference(2) correctly points out that the fitting of the KED takes time and recommends its use only "in the event of non-life-threatening injuries and if the vital signs are stable". Our patient became clinically unstable post immobilisation, with oxygen saturations decreasing markedly during extrication. Had the decision been made to apply the KED after full immobilisation on the back board (enabling the patient to sit upright) this, undoubtedly, would have delayed treatment and transportation to definitive care. As the application of the KED can extend on scene times, the authors would be cautious in supporting its prophylactic use 'just in case' the patient required to be positioned for nebulisation.
Current guidelines(1) and recent research(3) suggest there are a number of immobilisation options available with the most appropriate often being determined by the circumstances. Our improvised nebulisation device enabled the patient to remain supine, not 'prone' as you suggested (achieving uncompromised spinal care), receive nebulised salbutamol (effectively treating a bilateral expiratory wheeze), and be transported expeditiously (without delay) to the emergency department for definitive care.
1. Joint Royal College Ambulance Liason Committee. UK Ambulance Service Clinical Practice Guidelines (2006): Neck and Back Trauma. London: JRCALC, 2006.Castellano, J. (2007). Prehospital management of spinal cord injuries. Emergencies. 19 (1), 25-31.
2. Castellano, J. (2007). Prehospital management of spinal cord injuries. Emergencies. 19 (1), 25-31.
3. Luscombe MD, Williams J. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J 2003;20:476-478.
Conflict of Interest: