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Article: KTD - Kendrick Traction Device
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EdS
Bushcrafter (boy, I've got a lot to say!)
For what they where designed for the KTD is a great bit of kit. However, the KTD is only designed as traction device for femoral fractures, not an immobilisation splint, and in reality will require at least 2 people to apply it. In additon, you are going to be hard push to be able to fit one to a casaulty with out significant analgesia such a Entonox.
Before using one of these you are going to have to do a decent casaulty survey and know what you are doing to prevent rupturing the femoral artery and be able to monitor the casualty
In the UK you would be better off managing the casualy well unlit paramedics, MRT (who carry them anyway) etc arrive on site.
But for remote location it might be worth considering, but with a fractured femor and no analgesia you still might struggle to fit one.
Before using one of these you are going to have to do a decent casaulty survey and know what you are doing to prevent rupturing the femoral artery and be able to monitor the casualty
In the UK you would be better off managing the casualy well unlit paramedics, MRT (who carry them anyway) etc arrive on site.
But for remote location it might be worth considering, but with a fractured femor and no analgesia you still might struggle to fit one.
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Whilst I agree that it's primary function is a femoral split.
It has other applications
[video=youtube;9BSSlbmKA-w]http://www.youtube.com/watch?v=9BSSlbmKA-w[/video]
It has other applications
[video=youtube;9BSSlbmKA-w]http://www.youtube.com/watch?v=9BSSlbmKA-w[/video]
EdS
Bushcrafter (boy, I've got a lot to say!)
that video is scary - awful casualty care and you still need at least 2 people to use them in the real word, and analgesia or a person with a very high pain threshold. The set up for multiple pelvic fractures done like that is likely to kill the casualty.
They don't really work very well as arm splints (better than nothing) as they are not rigid enough on their own with only the points of lashing. And you can easily bend them with little movement.
Whilst they are light they are not very robust - hence the old Thomas splint is still use underground.
They don't really work very well as arm splints (better than nothing) as they are not rigid enough on their own with only the points of lashing. And you can easily bend them with little movement.
Whilst they are light they are not very robust - hence the old Thomas splint is still use underground.
EdS while i agree with the quality of casualty care in the video leaves alot to be desired (and the oscar winning acting) being a demo video im sure thats not what they were aiming for. While I partially agree with some points here, others im not so sure about.
The KTD is indeed a very good piece of kit and is gaining growing popularity in pre hospital care as it is lightweight, compact, simple to use and I hate to say it 'cheap' in comparison to other manufactured traction devices such as the thomas, sager or donway splints. Its use in the UK out of frontline ambulances or MRT is ltd, mainly by the fairly speedy response of the above mentioned professionals.
There are three main issues which advocate the use of traction splintage in femur fractures, 1.The reduction of a femur fracture by using traction significantly reduces the cavity caused in the muscle compartment by displaced bone, thus also reducing the volume of blood lost from the bodies circulation significantly, upto 2 litres of blood per leg in a closed fracture, more if open. This blood loss will cause hypovolaemic shock, which will result in a fatal outcome
2. the reduction of neurovascular compromise distal to the injury and possibly the reduction of compartment syndrome risks.
3. pain is an interesting argument both for and against its use, in an ideal world no patient should be denied analgesia, and one would argue that if you were to be using such devices you should also have pain relief available, however splintage constitutes one of the three 'P's of pain, physical support, the other two being psychological and pharmacological. Splintage reduces pain, its proven, so the application of a traction device is possible and is done without pain relief, its not the ideal situation, but a patient may well thank you later on.
However as mentioned a good patient assessment is essential and one of the key factors is never let an overt source of patient pain distract you from more serious or life threatening condition, and in any book hypovolaemia pips pain everytime.
My personal verdict is that it is probably to heavy to carry anywhere you are likely to actually need it in the uk, and for the average person it is prohibitively expensive, furthermore buggering around applying it could distract a less experienced person from more serious problems or easier more effective treatments. Its a judgement call based on risk assessments, cost, weight and training/experience. I would agree with wayne that its lovely to have alternative methods using bits of stick carabiners and rucksack straps, but when the do hits the fan most people lose the ability to lash something effective up.
And i didnt mean to deliver a dissertation oops.
daryl
The KTD is indeed a very good piece of kit and is gaining growing popularity in pre hospital care as it is lightweight, compact, simple to use and I hate to say it 'cheap' in comparison to other manufactured traction devices such as the thomas, sager or donway splints. Its use in the UK out of frontline ambulances or MRT is ltd, mainly by the fairly speedy response of the above mentioned professionals.
There are three main issues which advocate the use of traction splintage in femur fractures, 1.The reduction of a femur fracture by using traction significantly reduces the cavity caused in the muscle compartment by displaced bone, thus also reducing the volume of blood lost from the bodies circulation significantly, upto 2 litres of blood per leg in a closed fracture, more if open. This blood loss will cause hypovolaemic shock, which will result in a fatal outcome
2. the reduction of neurovascular compromise distal to the injury and possibly the reduction of compartment syndrome risks.
3. pain is an interesting argument both for and against its use, in an ideal world no patient should be denied analgesia, and one would argue that if you were to be using such devices you should also have pain relief available, however splintage constitutes one of the three 'P's of pain, physical support, the other two being psychological and pharmacological. Splintage reduces pain, its proven, so the application of a traction device is possible and is done without pain relief, its not the ideal situation, but a patient may well thank you later on.
However as mentioned a good patient assessment is essential and one of the key factors is never let an overt source of patient pain distract you from more serious or life threatening condition, and in any book hypovolaemia pips pain everytime.
My personal verdict is that it is probably to heavy to carry anywhere you are likely to actually need it in the uk, and for the average person it is prohibitively expensive, furthermore buggering around applying it could distract a less experienced person from more serious problems or easier more effective treatments. Its a judgement call based on risk assessments, cost, weight and training/experience. I would agree with wayne that its lovely to have alternative methods using bits of stick carabiners and rucksack straps, but when the do hits the fan most people lose the ability to lash something effective up.
And i didnt mean to deliver a dissertation oops.
daryl
EdS
Bushcrafter (boy, I've got a lot to say!)
Daryl - all fair points and to be honest we are all pretty much singing from the same hymn sheet. 
Having used them in "the wilds" they are not as robust say there hard sell implies (for gods sake don't accidentally knee on one!) and they make getting someone into a stretcher a right git of job.
As I said as a portable traction splint for the femur they are pretty much class leaders - easier, lighter and more effective than the dreaded Thomas. For the other uses I'd say they of limited use and I personally would be very hesitant about using one as a pelvic split. Much better to use a proper pelvic sling like the SAM splint one - easier, lighter and designed for the job.
That said when needs must...
Now where did I put the duck tape and walking pole.
Having used them in "the wilds" they are not as robust say there hard sell implies (for gods sake don't accidentally knee on one!) and they make getting someone into a stretcher a right git of job.
As I said as a portable traction splint for the femur they are pretty much class leaders - easier, lighter and more effective than the dreaded Thomas. For the other uses I'd say they of limited use and I personally would be very hesitant about using one as a pelvic split. Much better to use a proper pelvic sling like the SAM splint one - easier, lighter and designed for the job.
That said when needs must...
Now where did I put the duck tape and walking pole.
Ahhhhhhhh duck tape, the wilderness and urban medics best friend I spend a lot of my time lashing up bits of ambulance that fall off on an all too regular basis with it!!!!
EdS
Bushcrafter (boy, I've got a lot to say!)
With injuries of this nature, I'd be wary about using a device like this untrained as many people have pointed out above.
Internal bleeding around this location will kill in minutes regardless of what aid you'll give. Certainly nicking the artery by applying poor traction is a risk. Whereas immobilising the casualty and keeping them warm whilst awaiting full support of an air ambulance is far more recommended.
If you're in deepest Peru, it's probably worth a shot.
Internal bleeding around this location will kill in minutes regardless of what aid you'll give. Certainly nicking the artery by applying poor traction is a risk. Whereas immobilising the casualty and keeping them warm whilst awaiting full support of an air ambulance is far more recommended.
If you're in deepest Peru, it's probably worth a shot.
I wasn't suggesting that its used by untrained people. If you're leading groups in remote locations then you should have a decent level of first aid training beyond FAW.
Any level of first aid above FAW you will need to join an ambulance service. I did a FAW course in 2001 asked the trainer to do a more higher level and he told me to become an EMT so that is why I have been a paramedic for the last 10 years. FAW is the standard level and anything "advanced" is situation specific so wilderness first aid is FAW in the woods with a bit more indepth info on how to treat in the outside and cas evac to the waiting ambulance.
So as said these should only be used by trained EMS staff. Other than FAW the next best bit of kit is a Phone, Radio or PLB to call for help.
Just my 2c worth
So as said these should only be used by trained EMS staff. Other than FAW the next best bit of kit is a Phone, Radio or PLB to call for help.
Just my 2c worth
Having used this device and trained hundreds of people in its use, I have the following points to wade in with:
1. The KTD is an easy device to apply and the training needed to apply it correctly is not intense.
2. No-one dies from a fracture, even a major fracture such as a femur, unless it accompanied by visible arterial haemorrhaging in which case applying a KTS before managing the bleed would be negligent.
3. Never say never in medicine. However 'nicking' the artery is unlikely and even if it did occur it would only be a problem if the fracture was associated with an open wound and the blood had an exit from the confined space of the upper thigh, which brings me back to point 2 above.
4. One does not need this device in order to apply traction in the field. There are a number of methods of improvisation. I have built a traction device using all natural materials.
5. The biggest barrier to any treatment of a fractured femur is not the practicality of putting on a splint, either traction or otherwise, but the victim them self. Gaining patient co-operation without the assistance of pharmacology requires a patient, team approach and lots of reassurance. Traction once applied can be very effective at relieving pain.
6. Timing of application depends on your situation and where you are. If the MRT is a phone call away then perhaps there is no need to apply traction. However if you don't know or you are a few hours from rescue or evacuation then IF one has the training, AND you have consent and co-operation from the victim then it will be invaluable.
7. The KTD can be used for shaft fractures of the upper and lower leg and the humerus. It should not of course be used near or on a joint such as ankle or knee.
When I figure out how to add pictures I will post some of the splint in action in training and operationally.
Regards
Doc DC
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