NREMT Practical Skills Test :

Spinal Immobilization (Seated)

We want to prepare you, not only for the NREMT Written Exam, but also for the practical skills tests!
This is one of the least used pieces of equipment in the field, but is part of the testing, so we need to be proficient with it. Today, we will help each other learn or relearn when and how to use it!



NREMT Skill Sheet

To download your own copy, right click and choose "Save as..." NREMT Test Prep - Seated ImmobNREMT skills test - seated immobilization
Important Note: Remember that the whole point of this is to immobilize the spine. While you're applying it, really make sure the head, neck and spine stay aligned!



Applying the KED

“My Baby Looks Hot Tonight” (Middle, Bottom, Legs, Head, Top)

After placing the flat device behind the seated patient, the first strap that is secured is the middle torso strap. According to the K.E.D. users’ manual securing this strap secures the greatest area of the device and therefore provides the greatest stability while securing the rest of the device. Next the bottom torso strap is secured, however the top torso strap is not secured until just prior to moving the patient to the long spine board. This is to allow the patient to breathe easily while the rest of the device is secured. Following the bottom torso strap the leg straps are secured. These may be applied in a “criss-cross” fashion (according to the KED users’ manual this is the most commonly used method), or applied by securing them to their respective sides. If there is any evidence of a groin injury the “criss-cross” method cannot be used. Following application of the leg straps the void between the head and device is padded as needed and the head is secured. Finally, just prior to moving the patient to a long spine board the top strap is secured. Some schools teach this order by remembering the phrase “My Baby Looks Hot Tonight” or “Money Buys Lots of Hot Toys”, where the beginning of each word stands for Middle torso strap, Bottom torso strap, Leg straps, Head strap and Top torso strap. We don’t know of any real evidence pointing to the benefit of securing the torso straps in any certain order, but this is the traditional way it is taught, so here’s a visual representation.

My baby looks hot tonight


 How to Crush the NREMT Skill Station - Seated Spinal Immobilization

The most common reasons for failure:

  1. Failure to direct manual c-spine immobilization. Immediate failure.
  2. Failure to keep C-Spine immobilized through entire scenario.
  3. Failure to assess distal PMS before AND after application. Big one!
  4. Securing the head first. Yes, this happens often. Don’t secure the head first.

Station Tip: Do not take manual C-spine. Direct your (sometimes imaginary) partner to do it. Verbalize to him to maintain C-spine no matter what until the appropriate sized collar is secured. This makes it impossible for you to get lazy with the head and be failed. Understand that you still need to be able to control this in real life and that this tip is just for testing!


Visual Walkthrough
Here’s a video for you visual learners showing a walkthrough of the KED station. The straps are not in the right order, but that’s not a critical item for failure. Since these students are more attractive than in the other videos, we chose this one! You’re welcome.



More Tips for passing the KED Station. (Seated Spinal Immoblization)

  1. Direct someone to take and keep manual c-spine
  2. Check distal PMS before and after application
  3. Remember, “My Baby Looks Hot Tonight” (see earlier post)
  4. Pad the voids… especially behind the head/neck.
  5. Act like a pro and they grade you like a pro. Go in with confidence, or reschedule your test. Don’t hope for an easy test. Go in, do everything perfectly, and walk out… like a boss.


Questions and Comments from Facebook Skills Saturday posts at on April 6th, 2013

Do you ever use the KED? In what situations is it best used?

  • Bethany Beard Smaller kids who need to be boarded but who are to big for the peds board
  • Adam Anderson Rather do a rapid extrication with a towel rolled up. Same concept just faster
    • What do you do with the rolled up towel?
    • Adam Anderson Around the shoulders by the c-collar, drapes in front of them and crosses making an x. you then take then ends under the armpits so you have handles. works great with critical pt’s
    • Sounds like a great rapid extrication technique! Thanks for sharing!
  • Sandy Alspaugh Scott I’ve used ot for hip fractures only so far
  • Michael Callahan Use it in the nursing home all the time for hip fractures
  • Teresa Sluss well stablizer for mva with people still sitting and c-spine is in play, broken hip stablizer, ped backboard or pampus at to keep the infant as stable as possible so some types of treatment can be done. Quite honestly I don’t understand why it is not used most of the time in a MVA great stablizer of the back/neck and head plus c-collar. Its a great tool at our disposal why not use it. I usually cring at ems taking a pt out of a car with just the long board under thir butt only. We have it use it. Did I say it was a great multipurpose tool
  • Linda Hudson Unstable pelvic fx’s.
  • Mindy Kluck I was testing NR skill and had quite a few candidates come through that totally rocked using it. There is a medical director who requires it used on all MVCs. Better have a good excuse for not having one on your patient.
  • Brian Steinert I’ve seen Health Care Providers use it for hip/ pelvic fractures.
  • Christopher Phelps Use it for hips as well….have one ER doc at our small community hospital that doesn’t like it, but it’s only one and it’s not my medical director…
  •  Jimmy Smith Its in our SOP to use it on all PT still in vehicles involved in mvc’s.
    • Protocol – The best reason of all. (To stay licensed!)
  •  Ray-Laural Beaty Have seen it used to support a broken arm. Turn it 90 degrees and have the kid lay on it with the arm laying on the extended portion.

In what way would a KED do a better job than a diaper splint in immobilizing a hip fracture, if at all?

  • Adam Anderson love the diaper splint, but maybe I have an old-school mentality
  • Linda Hudson The KED is much easier to use, with minimal patient movement. I LOVE the KED!!!
  • Hollie Floyd It’s rigid and will hold it’s form allowing less movement which can cause further damage
  • Tina Dexter KED works great!
  • Ashlee Lynn Kasprzak The KED is much easier to use, with minimal patient movement. I love the KED.
  • Lets play devil’s advocate: As far as a diaper splint goes, it doesn’t get any simpler. Throw a sheet around them, see-saw it to desired area and tie them up! Most hip fractures are found in patients who are supine, and not really seated. Would you still use a KED? Doesn’t putting the KED under them, and then tying the legs up with straps put them in a far more awkward and uncomfortable position than KED? Why or why not?
  • Linda Hudson You can also “see saw” the KED. I’m gonna stick to my guns on this one. Been using it since we first got them. After 33+ years, I’ve found that some “new fangled” gadgets really do work better. (We practiced, and practiced, and practiced with it). Another under used piece of equipment is the Reeves Stretcher.
    • Hmm, never thought of see-sawing the KED on a supine patient. Good point!
  •  Cierra Kurtzweil I personally am not a fan of the KED. I think it’s a pain in the butt and takes far too long with too much movement, so I personally would buddy splint the legs together padding voids and use frac straps to splint them together. From that point use the scoop stretcher to move them as you can easily scoop them up, yet again with minimal movement.
    • LOVE LOVE LOVE that you brought up the scoop stretcher idea for hip fractures. This is an excellent tip!