Using ThE KED® Pro
Contents
1. 6OFERNO Users Manual When It s Critical KED Pro Read this Manual January 2011 GLO Pub No 234 3396 00 and Retain for Future Reference Ferno Technical Support Customer service and product support are important aspects of each Ferno product Please have the product serial number available when calling and include it in all written communications For technical support questions Telephone Toll free Telephone 1 800 733 3766 ext 1010 1 937 382 1451 ext 1010 Email quality products ferno com Ferno Customer Relations For ordering assistance or general information CANADA ANDTHE U S A Telephone Toll free Telephone 1 937 382 1451 Fax Toll free 1 888 388 1349 Fax 1 937 382 1191 1 877 733 0911 Internet www ferno com FERNO AUSTRALIA 11 Johnstone Road Brendale Queensland 4500 Internet www ferno com au E mail info ferno com au Phone 61 7 3881 4999 Fax 61 7 3881 1125 EUROPEAN REPRESENTATIVE Ferno UK Limited Stubs Beck Lane Cleckheaton West Yorkshire BD19 4TZ United Kingdom Telephone 44 0 1274 851999 Fax 44 0 1274 851111 www ferno co uk ALL OTHER LOCATIONS For assistance or information please contact your Ferno distributor If you do not have a Ferno distributor please contact Ferno Customer Relations Internet Ferno Washington Inc 70 Weil Way Wilmington Ohio 45177 9371 U S A Telephone 1 937 382 1451 Fax 1 937 382 6569 Internet www ferno com USE2. 3 Secure the patient s head with the head straps see Head Straps page 14 Note The pads can also be used as splint padding 12 KED Pro Fr T a sim Ph 073 205 5055 Sy i f i P A Li a k I N 3 D Figure 13 Using a Modular Pad to Fill a Gap Between the KED Pro and the Patient Ferno Washington Inc 234 3396 00 January 2011 KED Pro 4 8 Lifting Handles The KED Pro is constructed with three lifting handles Figure 14 A Use the handles when adjusting the KED s vertical position on the patient and during technical rescue The two side lifting handles provide the firmest holds for operators to adjust the KED Pro during fitting and when lifting and moving the patient The top lifting handle serves as an extension of the leg straps and offers a firm hold during confined space or vertical rescue to horizontally pull or vertically lift the patient During a Technical Rescue situation attach a lifting bridle to all three lifting handles Adjust the bridle legs so they apply even pressure on all three lifting handles USING THE KED PRO FOR TECHNICAL RESCUE When using the three lifting handles for a vertical lift e The KED Pro is rated for a one person load at 150 kg 330 Ib e Use a suitable lifting bridle with a load capacity of at least 1 500 kg 3 300 Ib or 15Kn The Ferno KED Pro Lifting Bridle is recommended for this application See Accessories page 34 e C
3. USING TWO STRAPS Fasten the bottom strap in the middle buckle and the middle strap in the bottom buckle Figure 49 USING ALL THREE STRAPS Fasten the middle strap in its own buckle Fasten the bottom strap in the top buckle Fasten the top strap in the bottom buckle Figure 50 Note The images on pages 26 28 show a Ferno Model 125 KED and are intended to illustrate principles for use Both the Model 125 KED and KED Pro may be used as illustrated in the images on pages 26 28 26 Figure 48 i Position Torso Straps Beneath Breasts and Above Abdomen Figure 49 Two Strap ___ Configuration Figure 50 Three Strap Configuration Ferno Washington Inc 234 3396 00 January 2011 KED Pro 6 3 Adapting the KED Pro fora Pediatric Patient The patient s size and condition determine how the KED Pro can be adapted for a child In this example of one possible method the child s legs are longer than the KED Pro so the KED Pro and child are placed on a long spine board A folded blanket is placed on the child to fill the gap so the torso flaps can be wrapped and fastened normally Figure 51 6 4 Adapting KED Pro for an Angulated Neck When it is not desirable to straighten the patient s neck fold the head flaps inward Position a rolled towel as needed then place a head strap across the patient s forehead and secure the strap to the KED Pro fastening strips Fi
4. s torso You will tighten the straps just before transferring the patient to a spine board THE TOP GREEN STRAP Leave the top strap unfastened until you are ready to transfer the patient to the long spine board This allows the patient to breathe more freely while you finish applying the KED Pro Important Attaching ALL straps securely is strongly preferred However the patient s condition or rescue situation may require the patient to be removed from the vehicle more quickly than anticipated Within the time permitted by the patient s and rescue conditions fasten as many straps as possible in this order Middle strap Bottom strap Leg straps Head chin straps Top strap 10 KED Pro Top Green Middle Yellow Bottom Red Yd ar Torso Strap Buckle 3 Figure 8 Torso Straps Figure 10 Middle and Bottom Straps Fastened Ferno Washington Inc 234 3396 00 January 2011 KED Pro 4 6 Leg Straps Follow your medical director s guidelines concerning the use of leg straps The leg straps secure the pelvis to the lower portion of the KED Pro to stabilize the lower lumbar area The leg straps also assist in keeping the KED Pro in place during the process of extricating a patient from a vehicle or during a Technical Rescue operation LEG STRAP CONFIGURATIONS The leg straps can be fastened in a criss cross configuration or a same side configuration depending on the patien
5. Buckle Tang In Elastic Retainer Ferno Washington Inc 234 3396 00 January 2011 29 Storing the KED Pro KED Pro LEG STRAPS Store the leg straps as follows Storing the leg straps as described here will keep them out l Lengthen the leg strap until about six inches of of the way while sliding the KED Pro between the patient webbing have not passed backward through the buckle and the vehicle seat yet readily available when you want slide to use them Leave the leg straps in their stored position in 2 Beginning at the point where the strap is attached to situations where you choose not to use them the KED Pro wrap the strap down around the bottom The leg pads may be stored on the leg straps as shown here edge of the KED Pro then up and around the inside of or in the accessories pouch of the carrying case the KED Pro Figure 61 3 Turn the buckle under to rest flush against the webbing and secure the strap in place by pressing its hook and loop fastening strip against a fastening strip on the outside of the KED Pro Figure 62 Figure 61 Wrapping the Leg Straps Figure 62 Press the Strap Hook and Loop Material Against the Mating Material on the Outside of the KED Pro 30 Ferno Washington Inc 234 3396 00 January 2011 KED Pro Storing the KED Pro CARRYING CASE POCKETS Modular Pads Store the three modular pads in the large pocket of the carrying case Secure the pads in the elastic keepers insid
6. pressure against the patient s groin Ferno Washington Inc 234 3396 00 January 2011 Aligned Parallel Using the Features Figure 11 Leg Straps Applied In Same Side Configuration Figure 12 Back View Showing Leg Straps Correctly With the Body Midline Leg Strap Anchoring Points Body Midline Il Using the Features 4 7 Modular Pads The three foam filled pads provided are stored in the large carrying case pocket The pads can be used singly or in combination to fill a gap between the KED Pro and the head cervical collar or neck if no collar is used or shoulders The pads can be folded or two pads can be joined using the attached hook and loop fastener The patient s medical condition body structure and head shape determine the need for padding but most patients will not need it when properly positioned in the KED Pro Always follow local protocols and your medical director s guidelines when using padding If you need to apply padding 1 Determine how thick the padding needs to be and choose the appropriate number of pads 2 Slide the pad s between the KED Pro and the patient Figure 13 Depending on the patient s injuries body structure and head shape the pad s may be positioned behind the head only behind the head and neck area or behind head neck area and the tops of the shoulders Always take care to pad without hyperextending or flexing the patient s neck
7. D Pro is moved to the vertical the operator holding the patient s head in neutral alignment lifts his or her elbow slightly to provide clearance for the KED Pro taking care not to move the patient s head 7 Use the lifting handles to center the KED Pro behind the patient Ferno Washington Inc 234 3396 00 January 2011 Using the KED Pro r k _ m m sr o gt ee Figure 23 Sliding the KED Pro At an Angle ar TFET ie esp E i e Es Brn fz o TA j X K i 7 j 1 r H i Ee T i Figure 24 Centering the KED Pro I7 Using the KED Pro 5 6 Applying the Leg Straps If the leg straps are being used l Figure 25 Placing a Leg Strap Under the Patient s Leg 18 One operator continues to hold the patient s head and neck in neutral alignment as the KED Pro is applied If using the leg straps release them from the fastening strips at the top of the KED Pro Figure 25 If the leg pads are not already in place slide the leg pads onto the leg straps with the smooth side of the pad against the patient s leg Pass the leg straps between the car seat and the patient s leg making use of a gap if there is one Using both hands see saw one strap into position under the patient s thigh working upward under the leg and buttock Figure 26 Reach behind the patient and make sure the strap lays straight downward from its anchor
8. RS MANUAL To request additional free users manuals contact Ferno Customer Relations your Ferno distributor or visit www ferno com KED Pro Batch and Serial Number Location Left hand side lifting handle Disclaimer This manual contains general instructions for the use operation and care of this product The instructions are not all inclusive Safe and proper use of this product is solely at the discretion of the user Safety information is included as a service to the user All other safety measures taken by the user should be within and under consideration of applicable regulations It is recommended that training on the proper use of this product be provided before using this product in an actual situation Retain this manual for future reference Include it with the product in the event of transfer to new users Additional free copies are available upon request from Customer Relations Proprietary Notice The information disclosed in this manual is the property of Ferno Washington Inc Wilmington Ohio USA Ferno Washington Inc reserves all patent rights proprietary design rights manufacturing rights reproduction use rights and sales use rights thereto and to any article disclosed therein except to the extent those rights are expressly granted to others or where not applicable to vendor proprietary parts Limited Warranty Statement The products sold by Ferno are covered by a limited warranty whic
9. THE KED PRO 5 1 Before Placing the KED Pro in Service Personnel who will work with the KED Pro need to read this manual Confirm that the KED Pro undamaged and fully functional See Inspecting the KED Pro page 33 Two Trained Operators Required Minimum 5 2 General Guidelines for Use Medical advice is beyond the parameters of this manual It is the users responsibility to ensure safe practices for the patient and themselves This manual illustrates use of the KED Pro in an ideal setting and should be considered as a guideline only Other and sometimes unusual settings and circumstances will occur in the field and the KED Pro can be adapted to many of them It is the responsibility of qualified Emergency Medical Service personnel to assess the patient s condition and determine the proper equipment and procedures to use Follow your medical director s guidelines and local medical protocols when using the KED Pro Optimum use of the KED Pro includes one operator manually stabilizing the patient s head and neck two operators applying the KED Pro and a fourth operator managing the long spine board In situations where there are only two or three trained operators available one operator manually stabilizes the head and neck while the other s applies the KED Pro Follow standard emergency patient handling procedures when applying and using the KED Pro Maintain manual stabilizat
10. Two Trained Operators Required 150 kg 330 Ib Technical Rescue Load Limit General Use Load Limit Ferno Washington Inc 234 3396 00 January 2011 KED Pro Operator Skills and Training 2 OPERATOR SKILLS AND TRAINING 2 1 Skills Operators using the KED Pro need e a working knowledge of emergency patient handling procedures e the ability to assist the patient 2 2 Training Operator trainees need to Untrained operators can cause injury or be e read and understand this manual injured Permit only trained personnel to apply e be trained on the use of the KED Pro the KED Pro e practice with the KED Pro before using it with a patient e record their training information A sample training Important record sheet is provided on page 35 Technical Rescue procedures require special skills e receive professional instruction and training in and are potentially hazardous activities No rescue Technical Rescue procedures before using the KED personnel should attempt such rescue procedures Pona Technical Rescues maton unless they have received professional instruction and training Ferno Washington Inc 234 3396 00 January 2011 5 About the KED Pro KED Pro 3 ABOUT THE KED PRO 3 1 Description The KED Pro is an emergency patient handling device designed to aid in the immobilization short transfer movement and technical rescue of patients with suspected spinal cervical i
11. Using the KED Pro With an Anti Shock Garment The KED Pro will not interfere with or limit the use of a pneumatic anti shock garment Figure 56 28 KED Pro Figure 5 55 5 Stabilizing the Pelvis Figure 56 Adapting for Use With an Anti Shock Garment Ferno Washington Inc 234 3396 00 January 2011 KED Pro Storing the KED Pro 7 STORING THE KED PRO 7 1 Storing the KED Pro If you properly prepare the KED Pro before placing it in its carrying case you will be able to unpack and deploy it for use quickly and smoothly TORSO STRAPS Fold each torso strap accordion style and secure it in its elastic retainer as follows 1 Lengthen the strap until only three or four finger widths of webbing have not passed backward through the male half of the buckle 2 Turn the male half of the buckle flush against the webbing Figure 57 3 Make the first fold beneath the buckle Figure 58 and continue folding the strap accordion fashion Figure 59 Figure 57 Turning the Buckle Flush With the Webbing 4 When all the webbing is folded secure it in the elastic keeper Figure 60 5 Make sure to position the folded strap so the keeper wraps around the center of the male buckle half This will enable you to pull the strap free without tangles Figure 58 Making the First Fold and have the buckle in your hand in a single motion Figure 59 Folding Accordion Fashion Figure 60
12. any articles wallet belt etc that could interfere with sliding the KED Pro between the patient and the vehicle seat 3 With the buckles toward the seat grasp the KED Pro at the top of the head flap and the top corner of the torso flap closest to the patient Ensure the leg straps are on the patient side of the KED Pro Do not loosen the leg straps before placing the KED Pro behind the patient 4 Tilt the KED Pro at about a 45 degree angle and slide it behind the patient Figure 23 Note Use the KED Pro 5 vertical rigidity as an aid when sliding it behind the patient Tilting the KED Pro at a 45 degree angle provides a rigid leading edge to slip between the patient and seat prevents the KED Pro from rolling up and allows the KED Pro to clear the vehicle roofline 5 The second operator and any assistants work the KED Pro down between the patient and the back of the seat and then into the vertical position Figure 24 Work the KED Pro far enough down to clear the vehicle roofline and be positioned behind the patient s head when the KED Pro is tipped to the vertical Note n certain exceptional situations such as a bucket seat or racecar seat the operators may need to move the patient forward just enough i e a hand 8 thickness to reduce friction so the KED Pro slides smoothly between the patient and seat Coordinate this effort with the operator stabilizing the patients head 6 While the KE
13. carrying case by pulling the two loops away from one another then insert the KED Pro into the carrying case Figure 70 and Figure 71 Close the carrying case by pressing the hook and loop fastening strips together Figure 72 The carrying case has adjustable shoulder straps to allow the KED Pro to be carried as a backpack Figure 73 Figure 71 Storing the Carrying Case KED Pro Figure 73 Carrying Case Shoulder Straps Ferno Washington Inc 234 3396 00 January 2011 KED Pro Maintenance 8 MAINTENANCE 8 1 Maintenance Schedule The KED Pro requires regular maintenance Set up and follow a maintenance schedule The table at right represents minimum intervals for maintenance Keep maintenance records A sample maintenance record sheet is provided on page 35 When using maintenance products follow the manufacturers directions and read the manufacturers material safety data sheets You can purchase a recommended disinfectant from your Ferno distributor or Ferno Customer Relations page 2 8 2 Disinfecting and Cleaning the KED Pro Note Do NOT immerse the KED Pro in liquid To clean 1 Lay all the pieces of the KED Pro on a clean surface and rinse off with warm water 2 Lightly scrub the KED Pro and modular pads with a mild soap solution and a medium bristle brush Wash the head straps with the soap solution and a clean sponge 3 Rinse all the pieces with warm water To d
14. d flaps Figure 16 Note Placing the strap ends at a downward angle minimizes the chance that the strap can slip upward on the forehead APPLYING THE LOWER STRAP Methods for applying the lower strap are described below but there are alternate methods Use and secure the strap according to your medical director s guidelines 1 Grasp the strap with both hands and turn the center pad fully inside out exposing the rubber 2 Select one of the following o If using a cervical collar attach the strap across the neck area of the collar beneath the chin of the cervical collar o If using a cervical collar attach the strap across the chin of the cervical collar Figure 16 o Attach the strap over the patient s chin if not using a cervical collar 3 Position the strap ends horizontally or just above the horizontal and secure them to the fastening strips on the head flaps 4 Make sure the strap placement does not prevent the patient from opening his her mouth If using the KED Pro with the head flaps shortened fold the head flaps toward the outside of the KED Pro away from the patient s head as shown in Figure 16 and Figure 17 14 KED Pro Figures 15 A and 15 B Exposing the Head Strap Rubber Figure 17 Head Straps Attached With Head Flaps Folded Back Ferno Washington Inc 234 3396 00 January 2011 Read the Users Manual KED Pro Using the KED Pro 5 USING
15. d restraints the Long 11 Secure the spine board on the cot with the cot restraints Spine Board 12 Tighten the shoulder strap An unrestrained patient can fall off the spine board or cot and be injured Use restraints to secure the patient on the spine board and cot 24 Ferno Washington Inc 234 3396 00 January 2011 KED Pro 5 13 Straps for a Standing Take Down Optional The take down straps are used to secure a standing patient in the KED Pro These straps are for use for a patient who is standing but complains of neck or back pain The two orange take down straps are shorter than the shoulder strap and have male and female buckles made of plastic To apply the KED Pro and take down straps to a standing patient a minimum of two operators is required One operator stands in front of the patient while the other works from behind the patient l Front Operator Apply a cervical collar to the patient Steady the patient as the KED Pro is applied Rear Operator While the Front Operator steadies the patient wrap the KED Pro around the patient from behind Front Operator Position the KED Pro flaps under the patient s arms and buckle and tighten the straps in this order o Middle strap yellow Bottom strap red Leg straps Head chin straps Top strap green O O O O Rear Operator Position a long spine board against the patient s back Front Operator Continue to support the pat
16. e at an angle to the strap with one hand and pull the strap backward through it with the other hand Figure 6 4 4 Releasing the Straps If torso and leg straps were properly configured for storage they can be released quickly and without tangles when they are needed For instructions on configuring the straps for storage see Storing the KED Pro page 29 and page 30 TORSO STRAPS Grasp the male half of the buckle Figure 7 and pull it from the elastic keeper LEG STRAPS If you are going to use the leg straps leave them in the storage configuration until the KED Pro has been placed behind the patient but not wrapped and fastened Free the straps from the hook and loop fastener on the KED Pro head flaps slide the leg straps from behind the patient and lay them with the male halves within your reach If you are not going to use the leg straps leave them attached in the storage configuration where they will not interfere with applying the KED Pro Ferno Washington Inc 234 3396 00 January 2011 Using the Features BN Hold Buckle Male Half at an Angle i P Ti ket Re ice EEEE j P eretet ertetek keeper eere i om a A z dag ii Elastic Keeper o rp p y gt I Figure 7 Releasing a Leg Strap From its Elastic Keeper Using the Features 4 5 Torso Straps The KED Pro is constructed with three torso straps top middle and bottom The straps are color coded for easily matc
17. e straps REMOVING EXCESS SLACK When a torso strap is released from its storage position there is a large amount of slack After fastening the buckle quickly remove most of the slack by holding the buckle at an angle to the patient with one hand while you pull the hemmed end of the strap with the other hand Figure 3 Shorten the strap only until you feel the slightest tension SNUGGING TIGHTENING To prevent twisting or jostling the patient s torso when snugging tightening the strap use the feed and pull tightening technique below 1 Grasp the portion of the strap that lays across the patient s torso and feed the strap through the buckle with one hand while pulling it through the buckle with the other hand Figure 4 2 Repeat until the strap is snug tight Male Half i Female Half Figure 1 Fastening a Buckle Figure 2 Unfastening a Buckle Figure 3 Removing Excess Slack Figure 4 Feed and Pull Tightening Technique Ferno Washington Inc 234 3396 00 January 2011 KED Pro 4 3 Lengthening Torso and Leg Straps The technique used for lengthening a strap depends on whether the strap has been buckled LENGTHENING A BUCKLED STRAP To loosen or lengthen a buckled strap feed excess strap into the buckle with one hand as you lift the buckle at an angle to the KED Pro with the other hand Figure 5 LENGTHENING A FREE STRAP To lengthen a free strap hold the male half of the buckl
18. e the pocket Figure 63 The large carrying case pocket also has room for a cervical collar Figure 64 Head Chin Straps Shoulder Strap and Take Down Straps Store the various loose straps in the Elastic Keepers small upper pocket on the carrying case Figure 65 The head straps may also be stored on the KED Pro attached to the head flaps See Head Straps page 32 Figure 63 Storing the Modular Pads Figure 64 Storing a Cervical Collar Figure 65 Storing the Head and Chin Straps Ferno Washington Inc 234 3396 00 January 2011 31 Storing the KED Pro HEAD STRAPS If the head straps are not stored in the carrying case press one end of each strap against the hook and loop fastening strips on the head area of the KED Pro and lay the straps parallel with the KED Pro slats TORSO FLAPS 1 Lay the KED Pro flat with the buckles facing upward 2 Release the three storage straps Figure 66 3 Beginning at the side with the torso straps roll the torso flap over the center of the KED Pro toward the Figure 67 Rolling the KED Pro Figure 68 Attaching the Storage Straps Figure 69 Ready for the Carrying Case 32 Figure 70 Opening the Figure 72 Closing the Carrying Case KED Pro storage straps Figure 66 and Figure 67 Continue rolling the KED Pro over the remaining torso flap Secure with the three storage straps Figure 68 and Figure 69 Open the
19. ency medical service accessories Selected items approved for use with the KED Pro are listed below Follow all instructions packed with accessories Keep the instructions with this manual Contact Ferno Customer Relations page 2 or your Ferno distributor for product information Accessory Part Number WizLoc cervical collar 081 9759 KED Pro lifting bridle BRB KED Long spine boards Ferno Najo and Millennia backboards are available in a variety of styles Call for information Scoop stretchers Ferno 65 Scoop and 65 Scoop EXL stretchers are available with a variety of restraint options Call for information 34 Attaching other equipment or items to the KED Pro can cause injury Do not attach equipment or items not specified in this manual to the KED Pro Ferno Washington Inc 234 3396 00 January 2011 KED Pro TRAINING RECORD Training Method MAINTENANCE RECORD Maintenance Performed jae Ferno Washington Inc 234 3396 00 January 2011 35
20. fore the KED Pro is applied AFTER the cervical collar has been applied one operator maintains manual stabilization of the patient s head and neck until the patient is properly secured within the KED Pro Figure 1 18 Applying the WizLoc Cervical Collar 5 4 Removing the KED Pro from the Carrying Case 1 Stand the carrying case on end with the open end 5 Fold the three storage straps back onto themselves facing upward to prevent them from interfering with using the chest straps Figure 21 and Figure 22 6 If the head straps are not stored on the KED Pro remove them from the pocket of the carrying case 4 Unfasten the three hook and loop storage straps Also remove at least one pad from the accessories Figure 20 and unroll the KED Pro compartment 2 Pull the finger loops to open the carrying case Lift the KED Pro out of the carrying case Figure 19 Figure 21 Storage Strap Figure 19 e we Removing the oe Finger Loop KED Pro from the Carrying Case Figure 22 Storage Strap Folded Back Onto Itself Storage Straps Figure 20 KED Pro Storage Straps 16 Ferno Washington Inc 234 3396 00 January 2011 KED Pro 5 5 Placing the KED Pro Behind the Patient 1 One operator continues to hold the patient s head and neck in neutral alignment as the KED Pro is applied 2 The second operator feels behind the lower torso and buttocks area of the patient and removes
21. g Straps 8 6 6 Adapting the KED Pro For Use asa Splint 28 4 3 Lengthening Torso and Leg Straps 9 6 7 Using the KED Pro With an 4 4 Releasing the Straps 9 Anti Shock Garment 28 4 5 Torso Straps 10 7 Storing the KED Pro 29 4 6 Leg Straps 11 7 1 Storing the KED Pro 29 4 7 Modular Pads 12 8 Maintenance 33 4 8 Lifting Handles 13 8 1 Maintenance Schedule 33 4 9 Head Straps 14 8 2 Disinfecting and Cleaning the KED Pro 33 5 Using the KED Pro 15 8 3 Inspecting the KED Pro 33 5 1 Before Placing the KED Pro in Service 15 9 Parts 34 5 2 General Guidelines for Use 15 9 1 U S A and Canada 34 5 3 Applying the Cervical Collar 16 9 2 Worldwide 34 5 4 Removing the KED Pro 9 3 Parts 34 From the Carrying Case 16 10 Accessories and Related Products 34 5 5 Placing the KED Pro Behind the Patient 17 Training Record 35 Maintenance Record 35 Ferno Washington Inc 234 3396 00 January 2011 3 Safety Information KED Pro 1 SAFETY INFORMATION 1 1 Warning Warning notices indicate a potentially hazardous situation which if not avoided could result in injury or death Untrained operators can cause injury or be injured Permit only trained personnel to apply the KED Pro Improper use of the KED Pro can cause injury Use the KED Pro only for the purpose described in this manual Improper application of the KED Pro can cause injury Apply the KED Pro only as described in this manual An unattended patient can be
22. gure 52 6 5 Adapting the KED Pro for Use With Monitoring Systems Folding two slats of each torso flap inward provides more chest exposure when needed Loosening two of the three chest straps allows defibrillation without losing immobility Figure 53 Ferno Washington Inc 234 3396 00 January 2011 Adapting the KED Pro Figure 53 Adapting for A Monitoring System 27 Adapting the KED Pro 6 6 Adapting the KED Pro For Use as a Splint The KED Pro can be used as a splint for pelvic stabilization and hip and or femur stabilization Two possible methods of adaptation are shown here HIP AND OR FEMUR STABILIZATION The KED Pro and patient are placed on a long spine board with the head portion of the KED Pro toward the patient s feet The torso portion of the is KED Pro positioned a little above the waist and centered Figure 54 The torso flaps are secured around the patient and the head flaps are wrapped around the patient s injured leg and secured with the head straps Figure 54 PELVIC STABILIZATION The KED Pro and patient are placed on a long spine board with the head portion of the KED Pro toward the patient s feet The torso portion of the KED Pro is positioned a little above the waist and centered The torso flaps are secured around the patient s pelvic area and the head flaps are wrapped around both the patient s legs and secured with the head straps Figure 55 6 7
23. h is printed on all Ferno invoices The complete terms and conditions of the limited warranty and the limitations of liability and disclaimers are also available upon request by calling Ferno at 1 800 733 3766 or 1 937 382 1451 Copyright Ferno Washington Inc All Rights Reserved Ferno Washington Inc 234 3396 00 January 2011 KED Pro TABLE OF CONTENTS Section Page Section Page Ferno Technical Support 2 5 6 Applying the Leg Straps 18 Ferno Customer Relations 2 5 7 Wrapping and Positioning the KED Pro 19 1 Safety Information 4 5 8 Fastening the Torso Straps 20 1 1 Warning 4 5 9 Securing the Patient s Head 21 1 2 Important 4 5 10 Buckling the Top Strap and 1 3 Be Aware 4 Making Final Strap Adjustments 22 1 4 Bloodborne Disease Notice 4 5 11 Using the Shoulder Strap Optional 23 1 5 Symbol Glossary 4 5 12 Extricating the Patient 2 Operator Skills and Training 5 To a Long Spine Board 24 2 1 Skills 5 5 13 Straps for a Standing Take Down Optional 25 2 2 Training 5 6 Adapting The KED Pro In Special Situations _ 26 3 About the KED Pro 6 6 1 General Guidelines 26 3 1 Description 6 6 2 Adapting the KED Pro for a Pregnant Patient 26 3 2 General Specifications 6 6 3 Adapting the KED Pro for a Pediatric Patient 27 3 3 Components 7 6 4 Adapting KED Pro for an Angulated Neck 27 4 Using the Features 8 6 5 Adapting the KED Pro for Use 4 1 Quick Release Buckles 8 With Monitoring Systems 2 4 2 Shortening Torso and Le
24. he armpits to prevent movement during extrication Finish applying the KED Pro as follows 1 Remove the top green strap from its holder and buckle it Tighten the strap to the chest using the feed and pull technique see Snugging Tightening page 8 2 Check and tighten the middle yellow strap 3 Check and tighten the bottom red strap 4 Check and tighten the leg straps The properly applied KED Pro is shown in Figure 37 22 KED Pro Figure 37 KED Pro Applied Ferno Washington Inc 234 3396 00 January 2011 KED Pro Using the KED Pro 5 11 Using the Shoulder Strap Optional Use of the shoulder strap is optional Follow your medical director s guidelines The shoulder strap is designed e to help keep the patient s shoulders back in the KED Pro Figure 38 e to straighten the upper torso Attaching e asadeceleration strap to help prevent the patient from Sh ae d sliding within the KED Pro when the ambulance niche Strap slows or stops The shoulder strap is orange with a male plastic buckle on each end The male halves attach to the white plastic female halves on the KED Pro See Components page 7 Apply the shoulder strap after the patient has been fully immobilized in the KED Pro just before the patient is moved to the long spine board 1 Center the loop side hook and loop fastener strip on the shoulder strap with the mating surface on the rear of the KED Pro under the
25. hing the left and right pieces Figure 8 When wrapping the torso flaps around the patient fasten the middle yellow strap first then the bottom red strap Do not fasten the top green strap until just before you are ready to transfer the patient to a long spine board Note The strap buckling and adjusting sequence described below is a preferred method This procedure may not be practical in all rescue situations Follow your medical director s guidelines and local medical protocols THE MIDDLE YELLOW STRAP Fasten the middle yellow strap first Figure 9 Snug the strap only until there is space for 2 or 3 fingers laid flat between the strap and the patient s torso You will tighten the straps just before transferring the patient to the long spine board The middle strap evenly secures the greatest possible area of the KED Pro providing the greatest patient stability while you finish applying the KED Pro If the rescue situation or the patient s condition requires that you remove the patient from the vehicle more quickly than anticipated the stability provided by the KED Pro with only the middle strap fastened and properly tightened may be preferable to using no supporting equipment Follow your medical director s guidelines on this issue THE BOTTOM RED STRAP The bottom strap is red in color Figure 10 Snug the strap until there is space for 2 or 3 fingers laid flat between the strap and the patient
26. ient and hold the long spine board against the patient while the Rear Operator applies the take down straps Rear Operator Pass one end of the strap through a handle or handhold near the head end of the long spine board Figure 44 Rear Operator Feed the other end of the strap through a spine board side handle near the patient s waist and through the bottom rear lifting handles of the KED Pro Figure 45 Buckle and adjust the strap Figure 46 and Figure 47 Rear Operator Repeat Steps 6 8 to attach the second take down strap on the opposite side of the patient Rear Operator Evenly tighten the take down straps When tightened properly the KED Pro should be carrying the weight of the patient Both Operators Move to the sides of the patient and grasp the long spine board Each rescuer places one hand at a spine board handhold at the level of the patient s armpit area and the other hand just below the patient s buttocks area Ferno Washington Inc 234 3396 00 January 2011 Figure 44 Pass the Take Down Strap Through the Spine Board Figure 46 Tightening the Take Down Strap Using the KED Pro Figure 45 Buckling the Take Down Strap Figure 47 Take Down Strap Applied Note Lift only the weight you can safely handle Be mindful of your back and be aware that you will be holding the full weight of the patient as the spine board tilts Use additional help before continuing to Step 12 i
27. ies the head straps to secure and hold the patient s head against the KED Pro and or padding 1 Wrap the head flaps around the patient s head If needed fold the head flaps back onto the KED Pro away from the patient s head as shown in Figure 35 2 Grasp a head strap with both hands and position the strap above the patient s eyebrows Secure the strap to the head flap fastening strips at a downward angle Figure 36 The angled placement minimizes the chance that the strap can slide upward on the forehead 3 Place the second strap under or on the chin area of the cervical collar and position the strap ends as horizontally as possible Secure the strap ends to the fastening strips on the head flaps Figure 36 Do not apply the strap so snugly that the patient cannot open his her mouth See Head Straps page 14 4 After the head and chin straps have been applied the operator holding the head may release his or her grasp on the patient s head Figure 36 Head Straps Applied Ferno Washington Inc 234 3396 00 January 2011 21 Using the KED Pro 5 10 Buckling the Top Strap and Making Final Strap Adjustments When the long spine board and ambulance cot are prepared and waiting it is time to buckle the top strap and make final adjustments to the other straps The purpose of the adjustments is to make sure the KED Pro is firmly in place from the lower spine to the head and is positioned high up under t
28. injured Stay with the patient at all times An unrestrained patient can fall off the spine board or cot and be injured Use restraints to secure the patient on the spine board and cot Crossing the shoulder strap over the patient s neck can choke the patient Fasten the shoulder strap only as described in this manual Attaching unapproved equipment or items to the KED Pro can cause injury Attach only equipment or items specified in this manual Improper maintenance can cause injury Maintain the KED Pro only as described in this manual Improper parts can cause injury Use only Ferno parts on the KED Pro Modifying the KED Pro can cause injury and damage Use the KED Pro only as designed by Ferno 1 2 Important Important notices emphasize important usage or maintenance information 1 3 Be Aware Boxes like the one below serve as reminders Be Aware 1 4 Bloodborne Disease Notice To reduce the risk of exposure to bloodborne diseases such as HIV 1 and hepatitis when using the KED Pro follow the disinfecting and cleaning instructions in this manual 1 5 Symbol Glossary The symbols defined below are used on the KED Pro and or in this users manual Ferno uses symbols recognized by the International Standards Organization ISO American National Standards Institute ANSI and the emergency medical services industry General Warning of Potential Injury Read the Users Manual
29. inside the KED Pro solid and unbroken Are torso and leg straps and lifting handles in good condition Is the KED Pro free of excessive wear Is restraint webbing in good condition with no cuts or frayed edges Are restraint buckles free of visible damage and do they operate properly Are the head straps free of excessive wear and is their stitching secure Are the modular pads in good condition 33 Parts Accessories KED Pro 9 PARTS 9 1 U S A and Canada In the United States and Canada to order parts contact EMSAR the only agent authorized by Ferno to manage service and repair Ferno products Telephone Toll Free 1 800 73 EMSAR Telephone 1 937 383 1052 Fax 1 937 383 1051 Internet www EMSAR com 9 2 Worldwide To order Ferno parts contact your Ferno distributor Your distributor is the only agent authorized by Ferno to manage service and repair Ferno products 9 3 Parts Part Part Number Head chin strap set of 2 FWE KEDPHC Modular filler pad set of 3 1 large 2 small FWE KEDPPS Take down strap each FWE KEDPTS Shoulder strap each FWE KEDPSS Leg strap pad set of 2 FWE KEDPLP Carrying case w integrated backpack FWE KEDPB Improper parts can cause injury Use only Ferno parts on the KED Pro Modifying the KED Pro can cause injury and damage Use the KED Pro only as designed by Ferno 10 ACCESSORIES AND RELATED PRODUCTS Ferno offers a full line of emerg
30. ion A Memory Aid for Fastening Order Many EMTs remember the order for fastening straps by repeating this phrase Money Buys Lots of Hot Toys Money Middle Strap Buys Bottom Strap Lots of Leg Straps Hot Head Chin Straps Toys Top Strap 20 KED Pro Figure 28 Releasing a Torso Strap Figure 30 Middle and Bottom Straps Fastened Ferno Washington Inc 234 3396 00 January 2011 KED Pro Using the KED Pro 5 9 Securing the Patient s Head Be Aware The patient s medical condition body structure and head shape determine the need for padding Follow your medical director s guidelines for the use of padding Figure 34 Padding APPLYING PADDING Placed Behind 1 One operator continues to hold the patient s head and Patient s Head neck in neutral alignment as the KED Pro is applied 2 Make sure the patient is still properly positioned against the KED Pro Adjust if necessary 3 Ifthere isa gap between the KED Pro and the patient s head the cervical collar or the patient s shoulders fill the gap with one or more of the modular pads Figure 34 or with rolled towels Always take care not to hyperextend or flex the patient s neck The pads can be folded or two pads can be joined using the attached hook and loop fastener See Modular Pads page 12 APPLYING THE HEAD FLAPS One operator will hold the head and head flaps in place while another operator appl
31. ion of the patient s head and neck until the patient is properly secured within the KED Pro After applying the KED Pro and transferring the patient to the spine board secure the patient to the spine board with restraints Stay with the patient at all times Operators performing Technical Rescue using the KED Pro for a one person lift or confined space rescue must receive professional instruction and training in Technical Rescue procedures Ferno Washington Inc 234 3396 00 January 2011 General Use Load Limit Improper application can cause injury Apply the KED Pro only as described in this manual Technical Rescue Load Limit An unattended patient can be injured Stay with the patient at all times An unrestrained patient can fall off the spine board or cot and be injured Use restraints to secure the patient on the spine board and cot Important Technical Rescue procedures require special skills and are potentially hazardous activities No rescue personnel should attempt such rescue procedures unless they have received professional instruction and training 15 Using the KED Pro KED Pro 5 3 Applying the Cervical Collar Apply the cervical collar according to local protocols and the cervical collar manufacturer s instructions In Figure 18 one operator holds the patient s head and neck in neutral alignment while the other operator applies the Ferno WizLoc cervical collar be
32. isinfect 1 Apply a solution of 2 to 5 chlorine bleach and water 2 Rinse all the pieces with warm water 3 Hang the KED Pro to dry or dry it with a towel Allow all pieces to dry completely before returning them to the carrying case Note Drying time for the KED Pro can vary from two to 36 hours depending on temperature humidity and on how long the KED Pro was exposed to water during use or during disinfecting and cleaning Moisture can be absorbed through the sewing holes wetting the battens inside the KED Pro 8 3 Inspecting the KED Pro Have your service s equipment maintenance personnel inspect the KED Pro regularly Follow the checklist at right and operate the KED Pro through all its functions as described in this manual If inspection shows damage or excessive wear remove the KED Pro from service and destroy to prevent accidental use Ferno Washington Inc 234 3396 00 January 2011 Improper maintenance can cause injury Maintain the KED Pro only as described in this manual Minimum Maintenance Intervals s Needed lt x Disinfecting thispage ef Cleaning thispag Jel Inspecting tthis pag dede Important Storing a damp or wet KED Pro in its carrying case will encourage the growth of mold Do not return the KED Pro to its carrying case until it is thoroughly dry INSPECTION CHECKLIST Are all components present Is all stitching secure Are vertical battens
33. lifting handle Figure 38 Press the hook and loop surfaces together 2 Bring the strap forward over both shoulders of the patient Figure 39 and attach each strap end to the Figure 39 buckle on its side of the KED Pro Figure 40 Do Bringing the NOT cross the straps at the patient s chest because this Shoulder can choke the patient Strap 3 Tighten the shoulder strap to a snug fit Figure 40 Do Over the not overtighten Shoulders Crossing the shoulder strap over the patient s neck can choke the patient Fasten the shoulder strap only as described in this manual Figure 40 Buckling the Shoulder Strap Ferno Washington Inc 234 3396 00 January 2011 23 Using the KED Pro KED Pro 5 12 Extricating the Patient To a Long Spine Board Two generally accepted methods for extricating a patient from a vehicle are described below Alternative techniques have been developed and are in use Follow your medical director s guidelines when choosing a technique e Feet First Two operators pivot and lift the patient while working Se j SEF Figure 41 from the same side of the vehicle The operators pivot the patient so his her back is toward the midline inside of the vehicle Pivoting the Patient e Head First Two operators pivot and lift the patient while a third operator handles the long spine board The operators pivot the patient so his her back is toward the door of the vehicle with the head emerging firs
34. n order to control the weight of the patient 12 13 14 Both Operators and Additional Helpers if present In a coordinated movement both operators take one step in the direction of the patient s head as they lift and pivot the long spine board horizontally to bring the patient to a level carrying height If a third operator is present move the ambulance cot near the patient Both Operators and Additional Helpers if present Lay the patient on the ground or nearby ambulance cot Secure the patient to the cot with additional restraints 25 Adapting the KED Pro KED Pro 6 ADAPTING THE KED PRO IN SPECIAL SITUATIONS 6 1 General Guidelines When necessary the KED Pro can be adapted for use in special situations and circumstances Some possible adaptations are presented in this section Follow your medical director s guidelines for adapting the KED Pro Attaching unapproved equipment or items to the KED Pro can cause injury Attach only equipment or items specified in this manual 6 2 Adapting the KED Pro fora Pregnant Patient When applying the KED Pro to a pregnant patient fold two slats inward on each torso flap to leave the abdomen exposed Strap configuration will depend on the patient s abdomen and breast size Generally straps can be positioned to lay beneath the breasts but above the abdomen Figure 48 Two possible configurations are described in this subsection
35. njuries Technical rescue requires additional equipment and specialized training See Operator Skills and Training page 5 The KED Pro is for professional use by a minimum of two trained operators Additional help may be preferred or needed FEATURES e Color coded sewn in securing straps e Wraparound head flaps e Wraparound torso flaps e Shoulder strap e Take down strap 2 e Head chin strap 2 e Leg straps 2 with removable padding e Modular filler pads 1 large 2 small e Integrated carrying handles e Carrying case with integrated backpack e X ray translucent except metal buckles e Rated for vertical and confined space rescue specialized training required Improper use of the KED Pro can cause injury Use the KED Pro only for the purpose described in this manual 3 2 General Specifications Length Opened flat 830 mm 33 in Rolled in case 840 mm 33 in Width Opened flat 820 mm 32 in Rolled in case 245 mm 10 in Thickness Opened flat 35 mm less than 1 5 in Rolled in case 200 mm 8 in Weight 4 5 kg 10 lbs Load Limit 250 kg 550 Ib Technical Rescue Load Limit 150 kg 330 b Note Weight includes all straps padding and carrying case General specifications are rounded to the nearest whole number Metric conversions are calculated before rounding the Imperial measurements For more information contact Ferno Customer Relations page 2 or your Ferno distributor Ferno reserves the righ
36. onnect the bridle to all three carry handles and adjust to ensure equal load on all three carry handles Figure 14 B e Ensure the leg straps and chest straps are tight and secure before moving the patient Important Technical Rescue procedures require special skills and are potentially hazardous activities No rescue personnel should attempt such rescue procedures unless they have received professional instruction and training am Technical Rescue 150 kg The KED Pro is rated for a one person lift for vertical and confined space rescue Specialized training is required 330 Ib Ferno Washington Inc 234 3396 00 January 2011 Using the Features Lifting Handle 3 Figure 14 Attaching a KED Pro Lifting Bridle To the KED Pro Lifting Handles 13 Using the Features 4 9 Head Straps Two universal head straps are provided to secure the head flaps in place They can also be used to secure the KED Pro when it is being used as a splint Follow your medical director s guidelines and local medical protocols for the use and placement of the head straps APPLYING THE UPPER STRAP 1 Grasp the center pad of one head strap with both hands Figure 15 A and turn the center pad fully inside out exposing the rubber Figure 15 B 2 Center the pad just above the patient s eyebrows with the rubber against the skin Position the strap ends at a downward angle and secure them to the fastening strips on the hea
37. p of the flaps should be just below the patient s armpits Figure 29 3 Depending on the size of the patient use the lift handles to adjust and raise the KED Pro to position the top edges of the torso flaps firmly into the armpit area You can also use the lift handles to keep the KED Pro in place until the straps can be buckled Note With a small patient it is important to align the head flaps so they are correctly positioned with the patients head Note Properly applied leg straps will also help hold the KED Pro in position 4 Before fastening the straps fold the torso flaps back if needed see below Verify that the patient is snugly against the KED Pro as fully as his her body structure and condition allow Figure 30 FOLDING THE TORSO FLAPS To adapt the KED Pro for the patient s size or medical needs or to allow medical equipment to be applied fold one or two slats of the torso flaps inward toward the patient Make sure the buckles and restraints remain available for use Follow your medical director s guidelines See Adapting the KED Pro in Special Situations pages 26 28 for some circumstances that may require folding back the torso flaps Important It is important to pull the KED Pro up firmly under the armpits to make sure the patient s weight is suspended This will reduce the possibility of the patient slipping downward later while being lifted Be Aware Positioning the patient a
38. point on the KED Pro as close as possible to the body midline Figure 27 Repeat Steps 1 6 with the other leg strap o Ifyou are using the same side configuration do not cross the straps at the groin Buckle them on their sides of origin Figure 28 o If you are using the criss cross configuration cross the straps at the groin and buckle the straps opposite their sides of origin Snug both straps using the feed and pull method see Snugging Tightening page 8 Leave space for two or three fingers laid flat between the strap and the patient s leg You will tighten the leg straps just before transferring the patient to the long spine board KED Pro Be Aware Do not use the criss cross configuration when there is a suspected groin injury Use the same side configuration or do not use the leg straps Follow your medical director s guidelines for the use of leg straps Figure 26 Placinga Leg Strap Under the Patient s Leg F Figure 27 Leg Straps Aligned With the Body Midline Figure 28 Leg Straps Applied Ferno Washington Inc 234 3396 00 January 2011 KED Pro 5 7 Wrapping and Positioning the KED Pro 1 One operator continues to hold the patient s head and neck in neutral alignment as the KED Pro is applied 2 Wrap both torso flaps around the patient s torso lifting the patient s arms only as much as needed to slide the flaps beneath them The to
39. s fully as possible against the KED Pro minimizes the need for padding between the patient s head and the KED Pro However be aware that some patients may not be able to sit fully back into the KED Pro Ferno Washington Inc 234 3396 00 January 2011 Figure 29 Snug the KED Pro Under the Patient s Armpits Figure 30 Assist the Patient Into the KED Pro Using the KED Pro Using the KED Pro 5 8 Fastening the Torso Straps After the KED Pro is wrapped and properly positioned under the armpits fasten the middle strap and then the bottom strap Do not fasten the top green strap at this time To fasten the torso straps 1 One operator continues to hold the patient s head and neck in neutral alignment as the KED Pro is applied 2 Remove the middle yellow strap from its elastic keeper by grasping the male half of the buckle and pulling the strap Figure 28 Fasten the middle strap buckle Figure 29 4 Remove the bottom red strap from its elastic keeper and fasten the buckle Figure 30 5 Use the feed and pull technique to snug both straps leaving space for two or three fingers laid flat between the strap and the patient s chest 6 You will fasten the top strap and tighten all straps just before transferring the patient to a long spine board and the ambulance cot 7 Iftime permits arrange the loose ends of the straps so they will not snag on objects during the extricat
40. t Note 4 triangular bandage wrapped around the patients knees and ankles can help hold the patients legs together during the extrication Be Aware Make sure to maintain the patient s body angle and a straight midline as you pivot the patient Operators Grasp the KED Pro handholds 2 Operators Pivot tilt and lift the patient to place the patient Figure 42 head first or feet first Figure 41 out the vehicle door Lifting the 3 Operators Lift the patient enough to provide a slight gap Patient between the patient and the vehicle seat for the long spine board Figure 42 4 Assistant if present Slide the appropriate end of the long spine board between the patient and the seat as far into the vehicle as possible 5 Operators Place the patient on the long spine board Figure 43 Operators and Assistant if present Lift the spine board and patient out of the vehicle and place them on the ambulance cot 7 One Operator Immediately loosen or unbuckle the top green torso strap to allow the patient more chest expansion Note Keeping the remaining straps tightened provides stability for the patient during the starts stops and turns of the ambulance ride to the hospital 8 Check the leg straps and snug tight Properly applied leg straps will loosen when the patient is placed supine on the long spine board Figure 43 9 Apply a head immobilizer Placing the 10 Secure the patient on the long spine board with the spine Patient On boar
41. t s condition For complete instructions see Applying the Leg Straps page 18 Same Side Configuration Figure 11 To reduce pressure on the groin area pass the straps under the patient s legs and buckle the left strap to the left side of the KED Pro and buckle the right strap to the right side of the KED Pro Criss Cross Configuration Pass the straps under the patient s legs then buckle the left strap to the right side of the KED Pro and buckle the right strap to the left side of the KED Pro ALIGN THE STRAPS WITH THE BODY MIDLINE Whether using the same side or criss cross config uration you must position the straps as close as possible to the body midline When buckled straps are correctly positioned they run straight down from their anchoring points on back of the KED Pro Figure 12 before passing beneath the buttocks Note Positioning the straps correctly for the same side configuration requires a more focused effort because the tendency during this application is to place the straps away from the midline Important To prevent pressure on the groin when using the same side configuration take care to correctly align the leg straps parallel with the body midline USING LEG STRAPS DURING TECHNICAL RESCUE In Technical Rescue situations such as a vertical lift or confined space rescue place the leg pads on the leg straps This will help set the groin area and will minimize
42. t to change specifications without notice General Use Load Limit Inspect the KED Pro if the load limit has been exceeded See Inspecting the KED Pro page 33 Technical Rescue The KED Pro is rated for a one person lift for vertical and confined Space rescue Specialized training is required Ferno Washington Inc 234 3396 00 January 2011 KED Pro About the KED Pro 3 3 Components Note The outside view of the KED Pro is shown below with straps in storage configuration Head Chin Strap 2 Modular Filler Pad 3 Color Coded a Lifting Securing Strap 3 Handle 3 Wraparound Head Flaps Shoulder Strap Buckle 2 Leg Strap 2 Storage Strap 3 a gt Shoulder Strap 1 Take Down Strap 2 Ferno Washington Inc 234 3396 00 January 2011 Using the Features KED Pro 4 USING THE FEATURES 4 1 Quick Release Buckles The torso and leg strap buckles are snap lock and quick release blue colored metal buckles Shoulder strap buckles are white plastic To fasten connect the male and female halves of the buckle Figure 1 A distinctive click signals that the buckle is properly fastened To unfasten a buckle press the release tabs on the female half Figure 2 and separate the halves 4 2 Shortening Torso and Leg Straps Buckled torso and leg straps are shortened in two stages first removing excess slack and then snugging tightening th
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