August 2007

 

EMS Equipment

by Will Chapleau

Tools For Treating Traumatic Injuries

Recent studies on intubation in the field have not painted a pretty picture of success rates and patient outcomes. Many are taking a closer look at advanced airway management and looking for basic or other advanced tools for airway management in the field. Verathon Medical offers its GlideScope video laryngoscope as an option.

While lighted stylets to offer assistance with airway intubation have been around for a while, video options were bulky and expensive until recently.

The GlideScope weighs less than 2 pounds and is constructed of high impact plastic. The company installed a high-resolution camera into the laryngoscope allowing the care provider to maintain visualization of the intubation tube as it moves through the pharynx and past the vocal cords. The images are displayed on a 3.5-inch color LCD monitor, which can be placed in view of the medic performing the intubation. The rechargeable lithium batteries allow for 90 minutes of continuous use or what the company estimates to be 20 intubations between charges.

Users that have posted reviews of the device on the company’s Web site at www.verathon.com have described crisp images and ease of use. This technology may be a way to improve success rates and be particularly useful in bloody traumatic or obstructed airways.

Splinting

Moving on to another topic, splinting can be as simple as using a board wrapped to an extremity or pillows and towels to provide stability. There are also sophisticated devices to apply traction to mid-shaft femur fractures. While many of us carry boards, pillows, and disposable cardboard and plastic splints, many providers look for fracture management systems that can provide re-usable adjuncts for managing a variety of injuries.

One company offering such a system is Reel Splint. It contains an adjustable long leg splint that articulates at the knee allowing for quick application and immobilization in multiple positions. Besides being used for fractures below the knee, it can also be used with attachments as a traction device with more adaptability than some other traction splints.

The company also has pivoting traction splints, which is not a new item, although it’s been upgraded and fitted for tactical situations. The pivoting traction splint was studied for effectiveness at managing fractures over 20 years ago. In case you haven’t seen one, at first glance it resembles a bi-polar traction splint, but it has been enhanced to provide immobilization for a number of lower extremity injuries.

The main difference between this device and other traction devices is flexibility to adapt to a patient’s contours. The ischial pad at the top of the splint is adjustable up to 35 degrees allowing it to fit against the patient’s anatomy more fully. The pad is also curved, which more closely approximates the shape of the leg, and it is replaceable. Additionally, the ankle hitch is truly a one-size-fits-all wrap and is easily adjusted to the patient’s ankle size.

REEL also makes a tactical splint option. In this version, the traction ratchet can be attached to the splint using snap ring twist “quick disconnect” sleeves. The splint breaks down into easily stored lightweight components and is easily set up in tight quarters. This REEL system was a favorite with military personnel long before it found favor in the civilian emergency medical services world.

Bleeding Control

Sager Emergency Fracture Response System, or SEFRS, also has a splint system. In contrast to the REEL system, it uses a mono-polar design and straps that can be articulated to accommodate the position of the joints.

This system also includes devices for upper extremity injury. While this kit includes all of the devices for upper and lower extremities, the company has packaged it with traction or non-traction devices separately. The Sager system for traction splinting can accommodate bilateral femur fractures using just one mono-polar splint.

Bleeding is most often associated with traumatic injuries and bleeding control is something to be dealt with. Direct pressure is still the first line and most often used method of bleeding control, along with simple gauze dressings.

In our business however, gross traumatic injuries and multiple patients create a need for rapid effective means for controlling bleeding. Dangerous situations like fire scenes, traffic situations, industrial settings and tactical situations create atmospheres that call for adjuncts that provide expedient effective means of bleeding control

Dressings

North American Rescue Products is in the business of “mission critical equipment.” They have a wide variety of equipment available for tactical emergency response. Besides haemostatic dressings (dressings that use agents to promote clotting) and tourniquets designed for combat, the company also has dressings that many of us would like to see in our everyday trauma box.

The Emergency Trauma Dressing (ETD) comes in 4- and 6-inch versions for extremity wounds and a larger abdominal dressing. It’s a durable elastic wrap with a dressing built in that is easily applied. While most wounds can be easily treated with gauze pads and roller gauze or tape, in severe trauma situations, it’s nice to have ready-made dressings that can be applied quickly to manage bleeding, allowing more time for critical injuries or multiple patients. You can get a look at these dressings at www.narescue.com/Product1.aspx?SID=1&Product_ID=22.

Another method of bleeding control is tourniquets. Bio Cybernetics International has one that they say was used to save lives at the Virginia Tech shootings. According to their marketing, the MAT tourniquet has been shown to be the quickest and most effective device available.

On its Web site at www.matourniquet.com you can view the results of military medical evaluations of this tourniquet. The device is easy to use with quickly adjustable strap and a key to turn for tightening the tourniquet.

Editor’s Note: Will Chapleau, who has 30 years of EMS experience, is the Advanced Trauma Life Support (ATLS) program manager for the American College of Surgeons. He is the former chief of the Chicago Heights (Ill.) Fire Department, has served since 1996 as the chairperson for the Prehospital Trauma Life Support (PHTLS) program of the National Association of Emergency Medical Technicians and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.

Verathon Medical’s GlideScope video laryngoscope provides caregivers visual aid in patient intubation. A camera at the end of the stylet transmits an image to an LCD screen to help guide the intubation tube through the pharynx and past vocal cords.    (Verathon Medical Photo)