Keeping Still
IN ADDITION TO ALL OF THE HEALTH CARE SKILLS AND MEDICAL TECHNOLOGIES AVAILABLE, SOMETIMES THE BEST MEDICINE IS JUST TO KEEP STILL AND THERE ARE EVEN THINGS TO AID WITH THAT!
In Iraq and Afghanistan, fatality rates among injured U.S. soldiers are about half that of Vietnam and one-third that of World War II. In addition to improved body armor, this large decrease in deaths among the injured may be partially attributable to new life-saving products.
Such products arose in part from a 10-year Department of Defense research program on improved first aid, according to a recent Journal of Trauma paper titled “Understanding Combat Casualty Care Statistics” by John B. Holcomb, MD, Lynn G. Stansbury, MD, Howard R. Champion, FRCS, Charles Wade, PhD and Ronald F. Bellamy, MD. Increased focus on pre-hospital tactical combat casualty care training is a likely contributing factor as well.
Most deaths occur within the first four to six minutes of being injured, so waiting for health care to come forward was the barrier, according to Rob Miller, director of business development for North American Rescue Products, Greenville, S.C. Doing something as simple as putting on a tourniquet often decreases the likelihood of death. The Army, therefore, implem Principal Technical Advisor ented a policy to outfit every soldier with a first-aid kit and training on how to use it, in order to provide treatment before the medics arrive. “The days of laying there and yelling ‘medic!’ are over,” said Miller. “The kits were developed by combat developers at the AMEDD center and school, Fort Sam Houston, and have basic critical equipment to mitigate a significant percentage of the preventable combat deaths on the battlefield.”
In addition to stopping bleeding, one of the most important steps in preparing a casualty for evacuation is immobilization. Products that facilitate this task include pelvic slings, spine boards and body sleeves. The increase in vehicle use and convoy operations is associated with an increase in deceleration accidents, where crashes, improvised explosive devices and other factors can cause the pelvis to smash into the steering wheel or other objects. This has put a premium on pelvic stabilization devices.
One such pelvic device is the SAM Sling, exclusively available to the U.S. military from North American Rescue Products (NARP). The one-size fits all SAM Sling enables the closing of the pelvic fracture, and a decrease the bleeding associated with this sometimes lethal wounding. The autostop buckle closes the sling at 150 newtowns of force, eliminating user-driven variation and requires no scissors or trimming. It closes at about a hundred of newtons of pressure. “It kind of takes the human error out of it. Because when things are this bad, people get scared and get overzealous, and try to stabilize the pelvis with something that might be too tight,” explained Miller, who previously was a senior enlisted medic in Iraq and Afghanistan, with the 3rd Ranger Battalion. The development of the sling was funded by the Office of Naval Research.
Another maker of a pelvic device is BioCybernetics International, La Verne, Calif.). Its T-POD, which stands for trauma pelvic orthotic device, provides circumferential compression around the pelvic region (ring). Royce Rumsey, vice president for product development, said the one-size-fits-all product has no asymmetrical impact on the pelvic region. “Other pelvic compression devices may induce asymmetrical impact on the pelvic region. And that further extends the risk of additional injury to the patient. Whereas if you provide compression in a symmetrical fashion around the entire region it’s a much safer means of applying that compression.”
It creates about 75 pounds of compression around the pelvic region. With this level of pressure, said Rumsey, “You’re reducing the pelvic volume, providing stabilization thus reducing the amount of blood loss that can occur in these life threatening injuries.”
The device is also radiolucent allowing the patient to go to CT scan and interventional radiology with the device in place.
STOP-MOTION SLINGS
In addition to immobilizing the pelvic region, immobilizing the entire body is often necessary as well. NARP supplies a device called a Rescue Sleeve, into which a backboard is placed. A cocoontype structure, it completely encapsulates and immobilizes the individual. “It allows you to immobilize the patient and get him out of the area of operations very quickly.” Miller said an analysis has shown that using the NARP Rescue Sleeve versus a traditional spine board reduces the time required to immobilize a patient by about four and a half to five minutes.
Reeves EMS LLC, Frederick, Md., makes a similar device. The Reeve Sleeve and the Reeve Sleeve II are designed for patient immobilization, particularly for spinal and neck injuries. They are particularly well-suited for confined spaces, such as older buildings, buses or anywhere space and movement is limited. The military uses them on ships, for vertical and horizontal movement, said Annette Semasko, business development representative of Reeves.
The Reeves Sleeve II differs from the original version in that the former has a reinforced bottom for extra strength and durability and has 10 carry handles, versus six handles for the standard Reeves Sleeve. Both Reeves sleeves close to 24 inches by 12 inches by 5 inches and come in a carry bag with handle. The underside of both sleeves have a spine board compartment for added strength and rigidness.
Reeves EMC also makes a full line of flexible stretchers, all of which include three reinforced patient security straps to immobilize the patient. The Heavy Duty Stretcher is larger, and holds up to 750 pounds versus 350 for the Flexible Stretcher.
Another patient immobilization device is the Miller Board, manufactured by Life Support Products. Bill Gadol, who is now president of Government Marketing International, previously represented Life Support Products, now a division of Allied Healthcare Products, St. Louis, Mo. Named after its designer, Larry Miller, the Miller Board gained popularity in the U.S. Navy. “The beauty of the Miller Board is that it acts as a splint to the spine,” said Gadol. “It’s narrow where the patient is, fits a Stokes litter and it holds the patient well enough so that you can actually stand him on his head and he won’t slip, and it floats!”
The Oregon Spine Splint is another patient/spine immobilizer. It also retracts the shoulder if there is a clavicle fracture, said Bud Calkin, vice president of Skedco, Inc., Portland, Ore. “Competing products don’t have the shoulder features that this product has,” said Calkin. “With other products, the way the straps are attached, you have to release the strap before you extend the patient’s legs because they crisscross over the genitalia, and when you extend the legs they tighten up and cause extreme pain. And that can’t happen with this Oregon spine splint. You can access the complete interior torso or the front of the patient without releasing the device. So the patient is always immobilized even when you’re treating a patient for chest or abdominal injuries. And the other devices have straps or fabric that come around the torso, and when you release that, you lose the immobilization.”
STANCHING THE BLEEDING
In addition to patient immobilization, some companies interviewed for this article discussed products that stop bleeding.
NARP, for example, provides the Combat Application Tourniquet (C-A-T) which is the official tourniquet for all soldiers in U.S. Army. We operate under the pretense of save the man, salvage the limb theory and that putting a tourniquet on is the first line of defense the service member has for significant extremity bleeding during the care under fire phase of an operation, Miller said.
BioCybernetics, which supplies the TPOD, also supplies the Mechanical Advantage Tourniquet (MAT). Designed for ease of use, it also provides incremental compression in order to prevent loss of the limb. “When you put a traditional tourniquet on limb, you stand a chance of losing the limb because you’re cutting off the blood flow. The MAT has incremental compression, so you can save the soldier’s limb as well as his life,” said Rumsey.
Performance Systems, Houston, Texas, supplies the Emergency Bandage, which is informally known as the Israeli Bandage. It was invented by Bob Bar-Natan, an American immigrant to Israel, who was a medic in the Israeli army. He essentially consolidated four different functions into one product in devising the Emergency Bandage. “In the Israeli military we were always trying to use the standard bandage—the same one that was used by the American Military,” recounted Ofer Molad, president and CEO of Performance Systems. “But there was never a product that applied pressure—we would have to use a rock, another bandage or anything else to improvise as a pressure provider. So Bob thought of taking a non-adhesive pad that is applied to the wound itself, and then wrap an elastic bandage around that, and add the ‘pressure bar’ to the bandage, in order to apply constant pressure on the wound.”
A small piece of plastic enables changing directions while wrapping. And in some cases the bandage can operate like a tourniquet. After introducing it several years ago, the bandage has gained wide use in the U.S. military.
There are several models of the Emergency Bandage for different applications. One example has two pads, in order to treat both an entry wound and exit would with the same bandage. Explained Molad, “Let’s say there’s an entry wound in the back and the exit wound on the stomach. We use the same bandage, with its two pads. One you put immediately to the first wound and then once you start wrapping, you can move the other ‘sliding’ pad to the spot of the exit wound, and then you continue the wrapping. So one bandage you actually end up having two pads that can deal with two wounds.” ♦