Clinical Guidelines

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PATIENT PACKAGING

REVIEW: January 2015 APPROVAL/ADOPTED: DISTRIBUTION: BASICS Responders RELATED DOCUMENTS: SOP Pelvic Binder AUTHOR: Dr John Ferris Ref: CP-1

Aims: Describe how patients should be packaged for transportation

Background: Packaging is not simply a means of getting a patient to hospital and it should be seen as a fundamental part of the therapeutic process.

Packaging aims to: - Minimise spinal movements - Minimise clot disturbance and repeated blood loss - Maximise fracture splinting - Reduce pain - Maximise patient safety en route - Provide an easily accessible intravenous access point - Enable safe moving and handling thus safe guarding personnel

PROCEDURE There are 2 main options for packaging for transport (Long board is now considered an extrication device only):

1. Scoop 2.

Some patients may be best managed by direct transfer on to trolley e.g. Time-critical patients with isolated penetrating trauma.

The method of packaging used is a matter of clinical judgement, but guidelines are given below.

1. Long Board Indication: Extrication from vehicles or confined spaces – NOT for transport

The long board is primarily an extrication device. It is the device of choice for extricating patients from vehicles or confined spaces either as a rapid controlled or gold standard technique. In combination with collar, blocks, tapes and body straps it provides good immobilisation of cervical spine. It confers less protection to thoraco-lumbar spine, as it does not conform to natural lordosis of spinal column. Long boards are uncomfortable and patients should be removed as soon as possible to minimise pressure on skin. Patients can be “scooped” off long boards once extrication is complete prior to transport.

Clinical Guidelines

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2. Indication: Patients on the ground

Scoop stretcher is useful for patients found on ground. It does not require a full log roll to place patient on device. Once on the scoop, the patient should be transferred on to an ambulance trolley and secured there. Scoop should be sized (telescopic mechanism) and split. A minimum “brace” roll (100) is needed in each direction and each half of the scoop can be positioned and then locked top and bottom. If patient is prone then roll them on to scoop. Obese patients may be difficult to package on to scoop.

Polytraumatised patients should be packaged “scoop to skin” with a pelvic binder placed during the 10 “brace”. Once packaged and secured it is essential to keep the patient warm (bubble wrap is ideal and may be “off the roll” rather than “medical grade” but warm blankets also suffice).

3. Vacuum Mattress Indication: Patients requiring maximal splinting/high quality packaging Patients who will have a long carry out rescue

A vacuum mattress is more comfortable than a long board and provides significant thermal insulation. It is thus a useful option for polytrauma patients found in difficult circumstances, and when cannot be reduced into an anatomical position.

It is not rigid when used for lifting and patients with suspected spinal injuries should therefore be: 1. Scooped off the ground and scoop laid within vac mat with patient on 2. Scoop split and removed with patient left on vac mat only 3. Patient packaged within vac mat with air removed 4. Vac mat with patient inside lifted onto for a lift and carry

IV access If at all possible IV access should be placed on the side most accessible during transportation. Patients will be placed with left hand side flush with bulkhead of ambulance and cannula should be on right side. If transfer via Helimed then patient will have right side against door and access would be better on left.

Rule of thumb Prior to transfer check that: - All equipment secure to patient i.e. ETT, cannula, monitoring - Patient secure to ambulance stretcher - Ambulance stretcher secure to ambulance

Think: “SKIN TO SCOOP”