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Spinal Immobilization — Seated Patient (KED)

Category: Procedures Sources: raw/nremt/psychomotor-skills.md Last updated: 2026-04-03

Overview

Spinal immobilization of a seated patient uses a Kendrick Extrication Device (KED) or equivalent short spine board to stabilize the cervical and thoracic spine before moving a patient from a seated position (typically a vehicle) to a long backboard. The seated protocol is most commonly applied in vehicle extrication. The KED wraps around the patient's torso and head while they are still in position, preventing spinal movement during the transfer.

Key Points

  • KED indications: Patient seated in a vehicle (or chair) with MOI suggesting spinal injury who needs to be moved from seated to supine — MVCs, seated falls, other axial-load mechanisms.
  • Exception — immediate extrication: If the scene is unsafe (fire, vehicle instability, hazmat), patient needs immediate airway management, or the patient is in cardiac arrest → perform rapid extrication to long board without KED. Speed of removal outweighs the procedural benefit.
  • PMS assessment: Same requirement as spinal-immobilization-supine — assess pulse, motor, and sensation in all four extremities BEFORE and AFTER immobilization.
  • C-collar first: Apply cervical collar before KED application (same sizing and fit criteria as supine protocol).
  • Strap order — body before head: Torso straps before head straps. The body anchors to the KED; the head anchors to the body.
  • Padding the void: There is typically a gap between the patient's head and the KED head section — fill this void with padding to prevent the head from snapping backward when the device is tilted.

Assessment Relevance

Need for seated immobilization is identified during scene-size-up (MVC, mechanism, vehicle damage pattern). Confirmation comes during primary-assessment (neurological status, LOC) and history-taking (neck/back pain, numbness, tingling).

Perform the patient assessment before applying the KED whenever the scene is safe and patient condition allows. A focused neurological check during secondary-assessment establishes the PMS baseline that will be trended during reassessment and handed off to the receiving facility.

Procedures

Initial Approach

  1. Assign Rescuer 1 to manual c-spine stabilization immediately on approach to vehicle.
  2. Perform initial assessment and history-taking while Rescuer 2 prepares equipment.
  3. Assess baseline PMS — all 4 extremities.

C-Collar

  1. Measure and apply appropriate-sized cervical collar without releasing manual stabilization.

KED Application

  1. Slide KED behind the patient — insert from the side if door is accessible; work it down behind the torso and up behind the head.
  2. Open and position KED flaps around the torso.
  3. Torso straps first (color-coded on most KEDs):
  4. Middle strap first: secure snugly across mid-chest
  5. Bottom strap: secure across lower chest/abdomen
  6. Top strap: secure across upper chest (leave somewhat loose to allow breathing)
  7. Check: no impairment of chest rise
  8. Leg straps: Route under thighs and connect.
  9. Head section: Pad the void behind the occiput as needed.
  10. Head straps: Secure forehead strap and chin strap. Do not obstruct airway or compress the neck.
  11. Reassess ABCs — confirm chest rise is adequate with KED in place.

Transfer to Long Board

  1. Rotate patient to doorway; swing legs out of vehicle.
  2. Lower patient onto pre-positioned long backboard.
  3. Secure KED-plus-patient to long board.
  4. Final strap across chest, hips, and legs.
  5. Reassess PMS — all 4 extremities post-immobilization.
  6. Compare post to pre — any changes indicate possible cord compromise; document and expedite transport.

NM Protocol Notes

  • NM EMS protocols follow selective immobilization criteria (as with supine protocol). A seated patient with minor low-speed MVC, no midline spinal tenderness, no neurological complaints, and normal LOC may not require KED/immobilization. Confirm with medical director.
  • Rapid extrication without KED is appropriate when: fire or explosion risk, vehicle instability, cardiac arrest, deteriorating condition, patient needs immediate intervention not possible in vehicle.
  • In NM rural environments, extrication from off-road vehicles (ATVs, UTVs, trucks in fields) is common. Principles are the same; improvisation may be needed.

NREMT Relevance

Spinal immobilization (seated) is a standalone NREMT psychomotor skill station. Examiners assess: - Manual stabilization maintained throughout - Baseline PMS before collar and KED application - Correct C-collar application - Correct strap order: torso straps before head straps - Void padding behind occiput - Adequate torso security without impairing breathing - Transfer to long board - Post-immobilization PMS reassessment

Critical failures: releasing manual stabilization before head is secured; applying head straps before torso straps; omitting PMS assessment; KED that impairs chest rise.

  • spinal-immobilization-supine — the receiving protocol after KED transfer; same PMS and board-strapping principles apply
  • scene-size-up — MOI and scene safety determine whether KED protocol or rapid extrication is used
  • primary-assessment — LOC and neurological status guide decision-making
  • secondary-assessment — PMS assessment is part of the neurological exam
  • reassessment — PMS trending during transport; communicate changes to receiving facility

Sources

  • raw/nremt/psychomotor-skills.md — Spinal Immobilization (Seated — KED or Equivalent)