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FORUMS > EMERGENCY CARE ESSENTIALS FORUM [ REFRESH ]
Thread Title: How many straps?
Created On Fri Sep 22, 2006 11:47 AM
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NSMEDIC
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Fri Sep 22, 2006 11:47 AM

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We presently carry 6, 6' quick connect straps for securing a patient to a backboard, in theory, that's supposed to be enough for 2 patients. While considering switching to plastic coated straps it was brought up that a new medic to our provice says 4 straps/patient is the ITLS standard. (ITLS? ATLS maybe?)

So, what's everyone think? How do you go about strapping people to boards? Cross over the chest and one over the pelvis, cross over the pelvis too? Straight over chest, hips, thighs and legs?


*No duct tape allowed!!!
- on patients anyway.

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despite the rising cost of living, it remains very popular.

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AZCEP
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Fri Sep 22, 2006 1:10 PM

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You can get by with one, but it has to be really long.

There is no ATLS/PHTLS/BTLS standard, because the method of immobilization leaves too much up to chance. It would probably be better to use a couple more than a couple less, but even that will run into problems.

I like having enough to minimally immobilize 3 patients. That way, when I have to do 1 or 2 there is always some extra left over.

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arctickat
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Fri Sep 22, 2006 1:25 PM

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Well, first of all ITLS (International Trauma Life Support) is the new name for BTLS. ITLS doesn't have an actual protocol for strap application because of the different designs for spinal immobilization devices but in our refresher this spring, the recommendation was for three straps minimum. Referencing the point that the spinal cord ends at L3, as long as the pelvis and torso are secured, the spine should be adequately immobilized. (like KED immobilization or short board) Non-rapid method would include 4 straps, five is OK but may be unnecessary. The standard says "secured" to the board. If four secures him, its done.



Our strap application technique is to cross over the torso,(shoulder to pelvis) straight across the pelvis, straight across the thighs, and finally straight across the lower legs, so 5 straps. In a rush we leave out the last strap. Criss-crossing over the pelvis does little to minimize lateral movement of the pelvis. Even though lateral movement on a spine board is difficult to prevent at the best of times I find a strap directly across is more stable.

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Edited: Fri Sep 22, 2006 at 3:44 PM by arctickat

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Lifeteammedic
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Fri Sep 22, 2006 3:39 PM

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We use a four strap technique. We criss-cross across the chest from behind the shoulder diagonally down to the opposite hip. Repeat on the other shoulder. Then one across hips and one across thigh/knee area.




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VanHelsing
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Sat Sep 23, 2006 11:47 AM

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Whats wrong with a spider harness ???

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AZCEP
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You mean besides relying on the previous user to return it to it's neatly folded storage position? Every one I've ever tried to use ended up as a ball of velcro in a storage compartment because of this issue. Add to this the fact that most don't get cleaned or returned to the owners, and they have not been too popular in the U.S.

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VanHelsing
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Sat Sep 23, 2006 11:55 AM

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Yip, I remember the problem from when I used to have to share my equipment....

And I agree on the " not getting washed " thing !

We dont have anything else at the moment, these straps that you all are talking about, havent yet hit our 3rd world country ! and mores the shame !

VH

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Nathan1974
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Sat Sep 23, 2006 7:31 PM

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You should practice at your service. Use as many as it takes to immobilize the patient. We use to straps and the parachute technique.

JEMS has an article in the past on someone in California using 4 pairs of triangle bandages tied to the pins on the backboard.

Laerdal also put out a CD with their products that has recomendations.

You could use one roll of duct tape and just mummy wrap the patient.

Do what it takes to make the patient immobile.

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Davis
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Sat Sep 23, 2006 8:11 PM

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We use 3 straps- crossed from shoulder to hip and one across the thighs. It's a poor set-up.

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Originally posted by: VanHelsing
Whats wrong with a spider harness ???


I'm with you. I think if we were serious about spinal immobilization we'd all use the spider straps.

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HEWITTC4
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Sat Sep 23, 2006 9:33 PM

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You mean besides relying on the previous user to return it to it's neatly folded storage position? Every one I've ever tried to use ended up as a ball of velcro in a storage compartment because of this issue. Add to this the fact that most don't get cleaned or returned to the owners, and they have not been too popular in the U.S.
You obviously haven't seen the disposable spider straps. Link to a picture

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Murphy was an optimist.

Edited: Sat Sep 23, 2006 at 9:36 PM by HEWITTC4

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oldfart
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Sat Sep 23, 2006 11:29 PM

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love the spider straps but we cant keep them. other services steal them because they like them too and best of all their free

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oldfart
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Sat Sep 23, 2006 11:29 PM

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duct tape works really well also

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CBEMT
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Most basic classes around here are taught the 3-strap.

I was later taught, and now use, the 4-strap- 2 criss-crossing the chest, one hips, and a figure-eight at the feet.

I try to keep enough for 2 patients, but the idiot that is in charge of supply at our company will re-distribute them if he finds any more than 4 straps per truck. Doesn't pay attention to whether or not a truck with a non-speedclick board has non-speedclick straps either.



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jayffemt
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Sun Sep 24, 2006 8:36 AM

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We use spider straps. I don't think anyone here would consider the individual straps unless it was unavoidable. I've only used the single straps on pts who were too obese for the spider straps.

Folding them is simple, fold each strap back on itself, and use just one of the straps to bundle them all together.

They will go through the washing machine if you're careful, all the velcro needs to be covered by folding the straps on themselves, and they don't tolerate bleach well.

The basic classes here are taught with the spider straps, and they can be used on the spinal station at the state test.

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stridor
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Sun Sep 24, 2006 8:43 AM

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I love spider straps. When the last crew folded them, and they have been cleaned and treated well, they are great. So many times however, they are a ball of velcro, mud, blood and grass.

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TUEFRTguy
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Sun Sep 24, 2006 11:41 AM

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I never liked spider straps and found them much slower then quick conect. They have fewer buckles but are more work to set out and i've never seen a set that wasn't in a pile. would just running them throught he washer really clean them, especialy if they were folded over on each other?? one reason all the sheets are white is so they can be bleached to kill pathogens,

in temrs of how amny buckles i've never seen or told about an actual rule, but the standard here is cris-cross the chest, and either criss cross the pelvis or a single across, just below the pelvis, the problem comes when the patient is too small to tighten the strap all the way,the you criss cross the pelvis to use up more starp. and then secure the legs so they don't flop around, either with the 4th strap or with 3" tape if you criss corssed the pelvis.

the plactis straps tend to stiffen in the cold and crack easly, so not may services use them up here.


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MJMC4404
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Most basic classes around here are taught the 3-strap.

I was later taught, and now use, the 4-strap- 2 criss-crossing the chest, one hips, and a figure-eight at the feet.



Sounds like a good technique. A variation of this, and Pt chest size is a determining factor, is to use one x-strap over the shoulders and underarms. Of course does not work with speed clips, but will if you use a 9' strap. So in case you are ever short a strap (for whatever reason).

Check the link below though, I came across this today on the web. I do not question the x-strap technique, only that I feel the straps are attched to low on the backboard to accomplish anything but keeping the Pt from sliding up off the head on of the board, there does not appear to be any lateral immobilization. If I find this on a scene, I simply move the straps higher prior to moving. If someone asks why, I explain that it is the same concept as the KED, straps need to be in/close to the armpits. Usually this goes over very well and without hard feelings.

Photo edited so that department names / Pt face not visible.

Click here


Anyone who decides to try using any x-strap technique because of what they have read in this forum...PLEASE PLEASE PLEASE practice at "home" first. It does take some getting use to.

In regards to spider straps-- I liked them when I had them. Only problem was the velcro ball, and people who would steal, otherwise got the job done with an A+


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HEWITTC4
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Your link isn't working.

Also, I would strongly recommend everyone urge their employers to start buying the disposible spider straps. They are great.

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Murphy was an optimist.

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arctickat
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Here is MJMC4404's link, All ya had to do is edit out the extraneous image link stuff.

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Si is est non infractus , operor non restituo is.

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arctickat
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Sun Sep 24, 2006 7:02 PM

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A have cut and paste this message from a post in The student Center from NMEMT. It seemed more appropriate since we're discussing spider straps here...

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I just wanted your guys option on the proper way to use spider straps and why? 1. I have some medics who liked to do the top strap and over the shoulders vertical going through the two holes at the horizontal top, and do the second straps going under the shoulders on the first two holes on the vertical side of the back board.

Picture

2. Or I've had other medics go over the shoulders, but through the first two holes on the vertical side of the back board. Then do the second straps under the shoulders and go through the same holes as the first two straps on the vertical side of the back board. I couldn't find any pictures to demonstrate this.


Thanks,
Steve


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Si is est non infractus , operor non restituo is.

Village Drunk

Edited: Sun Sep 24, 2006 at 7:04 PM by arctickat

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CotSurferB
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Sun Sep 24, 2006 11:14 PM

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Not long ago I saw a set of quick clip spyder straps that another service in the area had made on their own. The problem of them becoming a big ball still existed as well as losing the clip assemblies if not removed and put back together right. But it seemed to work okay considering those 2 flaws.

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CBEMT
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Sounds like a good technique. A variation of this, and Pt chest size is a determining factor, is to use one x-strap over the shoulders and underarms. Of course does not work with speed clips, but will if you use a 9' strap. So in case you are ever short a strap (for whatever reason).


It's great, I love it. Of course, first time I used it with a new partner fresh out of B school, he kinda had a deer in the headlights look, because he'd never seen anything like it before! I purposely assigned him to manual stabilization so he could watch!

My company, when it does actually buy straps, buys the 7-footers, so I'm not sure the one-strap X would work, but I'll see if I can play with it and make something work.

I now help out teaching lab sessions for the instructor who taught me the 4-strap, and I make it a habit to demonstrate on one student in each group, and then tilt the board on end- showing that if done correctly, the patient will not move!

Quote

Check the link below though, I came across this today on the web. I do not question the x-strap technique, only that I feel the straps are attched to low on the backboard to accomplish anything but keeping the Pt from sliding up off the head on of the board, there does not appear to be any lateral immobilization.


You're absolutely right- WAY too low. Even when tightened, that arrangement will allow far too much movement. Also, we teach that all buckles should be at the patient's sides and not on the chest or hips whenever possible, for comfort.



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Edited: Mon Sep 25, 2006 at 12:44 AM by CBEMT

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rainmedic4194
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2. Or I've had other medics go over the shoulders, but through the first two holes on the vertical side of the back board. Then do the second straps under the shoulders and go through the same holes as the first two straps on the vertical side of the back board. I couldn't find any pictures to demonstrate this.


I work for a municipal third service, so what gets used depends on which BLS agency I'm assisting. Most but not all use spider straps. When they do, I try to encourage them to apply them the way suggested above - the first straps go over the shoulders and into a hole on the side of the board, not the top, the second straps go under the shoulders and into the same hole. This creates a really nice cradle around the shoulders, helping with both vertical and lateral movement. Or at least in theory.

Just think...soon the obsession with spinal immobilization will be beat down with real science and we won't have to worry about discussions like this.

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oldfart
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Spider straps work well on combative patients also. You know the ones attempting suicide and refusing treatment and they just want to be a butt and fight with you. The only combative pt it has not held was a PCP pt who was out of touch.

We no longer have the spyder straps secondary to cost and losing them. We have tried the plastic straps and they were worthless. We know have 6ft long straps with seatbelt type buckles. You can get a couple good wraps out of one strap if you do them right. Can even get a crisscross out of one.


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CBEMT
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Just think...soon the obsession with spinal immobilization will be beat down with real science and we won't have to worry about discussions like this.


Even the Selective Spinal Immobilization protocols that are out there still require that some patients be immobilized.



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rainmedic4194
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Originally posted by: CBEMT
Quote

Just think...soon the obsession with spinal immobilization will be beat down with real science and we won't have to worry about discussions like this.


Even the Selective Spinal Immobilization protocols that are out there still require that some patients be immobilized.


Yeah, I know it. I was just saying that the current obsession with how to best immobilize in all these different situations will be so much less. Of course, there's always the flip side that someday maybe we won't be so good at immobilization because it will become a more rarely used skill. I guess that would be no good either.

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Nathan1974
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If you use 9 foot open ended friction straps then you will only need two straps per patient. Use parachute method. Open ended give you the ability to adapt to every situation and they are disposable. You may need a third strap if patient combative. So you can strap down the legs.

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rookie2006basic
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no duct tape? what about gauze? some gauze can go around the patient, throught the holes on the board, through their belt loops, over head blocks, and pretty much secure any patient combative or not. straps are better, usually three per patient, but you can make do with just about anything. even a sheet if thats all you had

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CBEMT
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Gauze? Jeesh... I hope not!



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rookie2006basic
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if thats what you have when loading the patient on scene outside of the unit somewhere it will do. very effective for combative patients. anything is better than nothing, but straps are the best. any number of them

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