Helmet Removal: Standing, Supine, and Prone

Resources Required:

1. Cervical Spine Immobilization Collar (C.S.I.C.)
2. Long Board

1. Standing

   • Approach patient from the front
   • Stabilize at mastoid processes and ramus of mandible
   • Have partner rock the helmet up and off of the patient's head
   • Pass stabilization to partner
   • Measure and apply collar
   • Perform rapid takedown for supine immobilization on long board

2. Supine

   • Have partner stabilize the cervical spine
   • Place fingers at occiput; other hand at chin
   • Partner removes helmet
   • Measure and apply collar

3. Prone

   • Head (wo)man crosses arms and places hands on either side of helmet
   • Lay long board next to patient, for example on the patient's right side
   • Raise patient's (right) arm, while patient is still in prone, to 180
     (straight upward, as if patient were reaching up over his/her head)
   • Logroll patient onto long board for supine immobilization

Rapid Takedown

Resources Required:

1. Long Board
2. Cervical Spine Immobilization Collar (C.S.I.C.)
3. Two Rescuers

Procedure

• Note: Patient is standing at beginning of procedure.
• Approach patient
• Stabilize c-spine; pass stabilization to partner
• Measure and apply collar
• Slip long board between partner's hands (that are stabilizing c-spine).
  Partner is now stabilizing c-spine and board is flat against patient's back
• Both rescuers step to either side of the long board. Each rescuer grasps the long board using the arm closest to board. Using the vertical opening along the side of the board as a handle/grip, grasp the board between patient's arm and patient's torso. The other arm (hand) is placed at patient's forehead to stabilize.
• Lower patient on a 3-count. Verbalize: "One, two, three (then lower patient)".
• Note: the leg closest to the board contacts the ground.

Bleeding, Trauma, Shock: Extremities, Head and Neck

Resources Required:

1. 4x4 Dressing (2)
2. Rolls of Gauze (2)
3. Blanket
4. Oxygen Tank and Mask

• Extremity

  Setup: open [do not tear] dressing/bandage package, place within arm's reach.

  Procedure
  • Note: the arm is used for example purposes.
  • Apply direct pressure with gloved hand
  • If bleeding is still not controlled,
  • Grasp the outside of the dressing to remove it from the package.
    Apply dressing to wound site, so that dressing completely covers wound site
  • If bleeding is still not controlled,
  • Elevate the extremity
  • If bleeding is still not controlled,
  • Apply pressure to pressure point at brachial artery
  • If bleeding is still not controlled,
  • Pass extremity to partner, then wrap the extremity over dressing, proximal to distal.
    After wound is covered once, cover again; this time, twist dressing while wrapping over wound site
    
    • Do this three times over the wound site
    • Continue to wrap extremity until nearing the end of gauze
    • Hook with thumb and tie over wound site
  • Bleeding should now be controlled.
  • Lay patient down; elevate the legs; apply oxygen; cover patient with blanket to maintain body temperature.

• Head Injury

  Resources Required:
  

  1. Triangular Dressing; cravat or regular gauze
  2. 4x4 Dressing or Telfa Pad

  Procedure
  • Place 4x4 pad on injury site
  • Have patient maintain pressure
  • Fold cravat along edge
  • Place edge around forehead, secure it [a knot] around the occiput, then pull the corner of the cravat behind the knot [similar to a bandana or scarf]
  OR
  • Wrap gauze from wound site around and under the chin
  • Wrap until gauze is finished, then tape the end

• Neck Injury

  Resources Required:
  

  1. 4x4 Dressing
  2. Roll of Gauze

  • Apply direct pressure with dressing
  • Loop gauze from wound site under and around the arm on the oposite side, until gauze is finihsed, then tape the end
  OR

  Resources Required:
  

  1. Multitrauma Dressing
  2. Cervical Spine Immobilization Collar (C.S.I.C.)

  • Apply direct pressure with multitrauma dresssing
  • Use cervical collar as pressure dressing
    Note: upon arrival at hospital, be sure to tell doctors that it is not used for cervical immobilization

Traction Splint

Resources Required:

1. Traction Splint
2. Two Rescuers

Note: useful for femur fracture only with no other injuries to the extremity

• Take patient's shoe off; cut away pant leg
• Apply manual traction at/above the knee; pass to partner on 3-count
• Apply ankle strap/brace
• PMS at foot
• Apply manual traction at ankle, then pass to partner
  Note: partner only releases manual traction when all four straps on traction splint are secure
• Walk around (never step over) patient
• Measure opposite leg for traction device
  - From ischial tuberosity (palpate first) to bottom of foot (reaches bottom of kickstand)
• Apply straps above knee, below knee, and above ankle
• Ask partner to raise the extremity
• Open the velcro straps underneath patient's leg (extremity)
• Slide device to ischial tuberosity
• Apply straps
  
  1. Ischial strap
     Apply mechanical ankle traction; pull until client shows signs of relief
  2. Apply other straps
• Take PMS at foot

Joint Injury

Resources Required:

1. Board Splints (2)
2. Cravats (3)

Procedure

• Fracured Humerus
  • Stabilize proximal and distal to injury
  • Pass arm to partner
  • Create sling ala radius / ulna fracture
  • Use 1 1/2" wide cravat across elbow, around back and tied at unaffected side

Note: works for elbow and knee

• "A" Frame Splint
  • Patient seated with knee flexed
  • Loop cravats:
    
    1. Under knee and around splints
    2. Distal ends of splints
    3. Proximal ends of splints
  • Take PMS at ankle

Note: as per NYS DOH requirements, candidates must fulfill the following requirements:

• Assess PMS before and after all splinting procedures
• Ensure that the joint does not bear weight distal to injury site
• Complete the station within a 10 minute time limit.

Long Bone Fractures: Radius/Ulna or Tib/Fib Fracture

• Radius / Ulna Fracture

  Resources Required:
  

  1. 1 Short Splint
  2. 5 Cravats
  3. 1 Roll of Gauze
  4. 4x4 Pads (2)

  Note: only attempt to straighten once, and only if there is no distal pulse

  • Grasp proximal and distal ends; attempt to traction once
  • Place arm into position of function [pronated]
    Ask patient to grasp a roll of gauze, or curl fingers into "grasping" position around gauze
  • Place arm on soft side of the board; board should be even with the elbow
  • Fold cravats into approximately 1 1/2-inch wide bands
  • Take PMS at extremity
  • Position first cravat over knuckles, between thumb and board
  • At bottom of board, create surgeon's knot, then another knot
  • Wrap and tie again promixal to injury site, and just distal to elbow
  • Elevate/cross arm over opposite shoulder
  • Place cravat against patient's chest, point of cravat at patient's elbow
  • Tie cravat at side of patient's neck
  • Graps end of cravat at elbow; twist so that it conforms to the elbow (creating a "pouch" for the elbow to sit in) and tuck in
  • Take a new cravat around affected shoulder/across to wrist that is on board; then tie under arm pit
  • Take PMS for extremity

  Note: for all knots, place padding between knot and patient's body

• Tib / Fib Fracture

  Resources Required:
  

  1. 4 Cravats
  2. 2 Board Splints
  3. 2 Multitrauma Dressings + 1 one more; the "crotch pad" (see below)
  4. 2 Rescuers

  • Stabilize at knee and ankle
  • Verbalize: "My partner will remove sock and shoe and perform PMS check"
  • Pass extremity to partner
  • Use three cravats
    Pass cravats behind the knee, then distribute them
    1. One cravat inferior to crotch
    2. One cravat 2" above knee
    3. One cravat 2" below knee
  • Use one board splint
    
    • Apply between patient's legs, against the leg; soft side toward patient's skin
    • Place multitrauma dressing between board and patient's body for padding
    • Cover with "crotch pad" and put board into position (snugly, not tightly)
  • Use other board at outside aspect of leg (covered with multitrauma dressing)
  • Tie cravats at crotch, above, and below knee
    Create surgeon's knots at outside of board
  • Use last cravat proximal to ankle
    Tuck ends of knots into space between leg and board
  • Take PMS at ankle

Note: as per NYS DOH requirements, candidates must fulfill the following requirements:

• Assess PMS before and after all splinting procedures
• Did not excessively move the injured extremity
• Complete the station within a 10 minute time limit.

Supine Immobilization

Resources Required:

1. Cervical Spine Immobilization Collar (C.S.I.C.)
2. Three Straps
   • Two nine-foot straps
   • One six-foot strap
3. Headbed (Mark II)
4. Two Rescuers

• Measure and apply collar
• On head (wo)man's count, logroll patient to lateral recumbent position (sidelying)
• Have partner slide board onto patient's back while patient is still sidelying
  Note: guideline for board placement -- ears should be aligned between first two horiztonal openings in the long board
• Roll patient back to supine position
  Note: if patient needs to be adjusted, this must be performed by two rescuers. Why? So that the patient moves as one unit.
  
  Explanation: one rescuer grasps the shoulders, the other grasps the hips and client is moved on a three-count.
• Apply straps
  
  1. Straps start with button facing down
  2. Loop each strap through vertical openings along the side of the board
  3. Pull each strap across the patient
  4. When all straps have been looped and pulled across, move to other side of board
  5. Close buckle for each strap
     
     Application Guidelines
     • Chest: Buckle off to the side of patient in case of need for CPR
     • Hips: Straps around bony parts of pelvis (iliac crest)
     • Legs: Straps proximal to the knees
     • Head: At forehead [if incorrect, please advise in journal comments]
• Apply headbed
• Test P.M.S. for extremities
• Note: if patient is unconscious, secure patient's arms at their sides while securing the hips

Note: as per NYS DOH requirements, candidates must fulfill the following requirements:

• Not release or order release of manual immobilization before it was maintained mechanically
• Ensure that patient was not manipulated or moved excessively to cause potential spinal compromise
• Patient was well-secured, thus obviating risk of spinal compromise
• Head immobilization does not allow for excessive movement
• Upon completion of immobilization, head is in the neutral position
• Immobilized the torso before the head
  Note: This was contradicted by instructor during practical session
• Complete the station within a 10 minute time limit.