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We use both. We have adult size and child size versions from
the MDI company.
Our experience is that the vacuum mattress is better tolerated
by patients and preferred by our clinical transport teams. Pressure sores are a
very real hazard with rigid boards and there is literature on that. The problem
is exacerbated by the additional time taken in referral hospitals to remove a
spine board after the patient's transportation. This can be many
hours....
We actually use vacuum mattresses in non-spinal patients too -
as an adjunct to restraint. Children seem to prefer to be 'snuggled' in this
secure manner.
One issue I haven't heard mentioned in this discussion is
how the safety and efficacy of the patient restraint system is maintained while
a vacuum mattress is in use. Wherever possible we try to meet the aviation and
road transport regulations applicable to healthy occupants of vehicles (as an
example, there is a requirement to restrain against a forward force of 9G for
air and 22G for road). The G loading of the patient is transmitted to
the vehicle (generally via the stretcher and a 4 or 5 point strap
harness). Spinal boards and vacuum mattresses are generally not designed to
act as intermediaries in transmitting this load and the strap
securing system should therefore bypass them. It is my observation that a
full patient restrain harness is more easily used in combination with a spinal
board than a vacuum mattress. In practice the patient is fixed to the
vacuum mattress and the vacuum mattress is then fixed to the stretcher. The
handles on vacuum mattresses are not designed to transmit the G-loaded patient
forces.
Otherwise, the vacuum mattress gets my 'vote'. Perhaps the
vacuum mattress manufacturers could work on an improved design which permits
patient restraint straps to pass over or through them?
Dr Andrew Berry Andrew.Berry@nets.org.au
State Director NETS (NSW newborn & paediatric Emergency Transport Service) www.nets.org.au Hotline +61 1300 36 2500
Warmline +61 1300 36 2499 Facsimile +61 1300 36 2498 Personal +61 (0)2 9633 8770
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>>> Macgyver@FlightMedicMail.com 5/01/2003 3:29:17 >>> Dear list, A thought to consider. Recent discussions on another list (in the UK) have been very firm against the use of traditional spineboards and log-rolling as opposed to scooping onto a vacuum mattress. Long boards only used as an extrication tool. Many of the comments, a good number from ER docs, relate to there being no proof of safety in the proceedures we use in North America. And highlite the tissue necrosis that can occur, not to mention the effect on semi-conscious patients who then struggle a LOT against the straps in an atttempt to relieve the pain of the pressure points and straps during the 2+ hours from board application to removal in the hospital. One of the studies quoted was: Am J Emerg Med 1996 Jul;14(4):369-72; "Comparison of a vacuum splint device to a rigid backboard for spinal immobilization." Johnson DR, Hauswald M, Stockhoff C.;New Mexico EMS Academy, University of New Mexico School of Medicine, Albuquerque 87106, USA. In this study, comparison of a vacuum splint device to a rigid backboard was made with respect to comfort, speed of application, and degree of immobilization. The vacuum splint was judged to be significantly more comfortable on a 10-point scale than the rigid backboard after subjects had been lying on each device for 30 minutes (P < .001). It was also faster to apply: 131.6 +/- 24.3 seconds versus 154.6 +/- 22.2 seconds (P < .001). Various measures of immobilization were similar for the two devices. The vacuum splint provided better Immobilization of the torso and less slippage on a gradual lateral tilt. The rigid backboard with head blocks was slightly better at immobilizing the head. So my questions are, what does everyone do? Especially those with extended transport (ground or air) times? Is there in fact research that shows what we do is safe and does not move the spine? And that placement on a board does not cause motion of unstable fragments from their 'position found' in such a way as to cause damage? Can vomiting be well managed with a non-intubated somewhat obtunded (ETOH etc) patient with the typical suction and board roll to the side without spine movement? How much movement (and in what planes and at what level) is too much? Is the only reason we (generally) tend to use the rigid/unpadded backboard over here one of the economics of equipment supply? and, should we be critically analysing our practice in this area and changing it based on the results? Fly Safe. Ken L-W GN/CCEMT-P/WMT Duct tape is like the force, it has a light side and a dark side, and it holds the universe together. _______________________________________________ Flightmed mailing list To unsubscribe or change your email address, go to http://www.pairlist.net/mailman/listinfo/flightmed |