Raven EMS Education Program Manual
Trauma Splint Backboard Short (KED) Evaluation Form

Date:

Student name:

Evaluator name:

Steps:

• Take BSI precautions.
• Ensure scene safety: Car in park, engine off, emergency brake on; don helmet and safety vest as required.
• Explain the procedure to the patient (if conscious).
• Take or direct your partner to place or maintain the head in a neutral, in-line position; if resistance or extreme pain is noted, leave the head in the position found.
• Assess CMS in all extremities.
• Apply an appropriately sized extrication collar.
• Position the immobilization device behind the patient.
• Evaluate the torso position and adjust as necessary; lift the device up into the axillary.
• Secure the device to the patient’s torso and tighten the middle, bottom, legs, and top straps.
• Evaluate and pad behind the patient’s head as necessary.
• Secure the patient’s forehead and chin to the device.
• Reassess CMS in all extremities.
• As a unit, move the patient to a long spine board.
• Release the leg straps when the patient is on the long spine board.
• Secure the patient to the backboard and reassess CMS in all extremities.
• Accepts evaluation and criticism professionally.
• Shows willingness to learn/asks appropriate questions.
• Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).

Passing criteria:

• Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
• Fail.
• Fails to take or verbalize infection control precautions prior to performing procedure.
• Did not explain and reassure the patient to allow informed consent.
• Fails to properly apply the extrication device within a 5-minute time limit.
• Does not immediately direct or take manual immobilization before it is maintained mechanically.
• Releases or orders release of manual immobilization before it is maintained mechanically.
• Patient manipulated or moved excessively, causing potential spinal compromise.
• Does not complete immobilization of the torso prior to immobilizing the head.
• Applies the device so that it moves excessively up, down, left, or right on the patient’s torso.
• Torso fixation inhibits chest rise, resulting in respiratory compromise.
• Provides head immobilization that allows for excessive movement.
• Upon completion of immobilization, head is not in neutral, in-line position.
• Does not choose an appropriate extrication tool/technique for the scenario.
• Fails to treat the patient appropriately for the given scenario.
• Does not assess motor, sensory, and distal circulation before putting on a cervical collar.
• Does not assess motor, sensory, and distal circulation after securing the patient in immobilization device.
• Does not reassess motor, sensory, and distal circulation after immobilization onto board is complete.

Comments:

Evaluator signature:
Clear

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