X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 28 Sep 1999 10:54:03 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 28 Sep 1999 10:53:24 -0400 (EDT) Received: via switchmail; Tue, 28 Sep 1999 10:53:24 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 28 Sep 1999 10:51:46 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 28 Sep 1999 10:50:47 -0400 (EDT) Received: from mx0-smtp.goodnet.com (envy.goodnet.com [207.98.129.151]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 28 Sep 1999 10:50:31 -0400 (EDT) Received: from Ptkovacs (d10-25.phoenix.goodnet.com [209.141.106.90]) by mx0-smtp.goodnet.com (8.9.3/8.9.3) with ESMTP id HAA09258; Tue, 28 Sep 1999 07:52:30 -0700 (MST) Message-Id: <199909281452.HAA09258@mx0-smtp.goodnet.com> From: "Tim Kovacs" To: "SAR-L" Cc: "WEMS News" , "MRA" Subject: W-EMED Spanish Rescuer Accident Date: Tue, 28 Sep 1999 08:06:25 -0700 X-MSMail-Priority: Normal X-Priority: 3 X-Mailer: Microsoft Internet Mail 4.70.1155 MIME-Version: 1.0 Content-Type: text/plain; charset=ISO-8859-1 Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu For those of you who asked; The Chair of the Air Rescue Commission of the IKAR (International Commistion for Alpine Rescue), currently meeting in Germany, said that they are checking into the details of this unfortunate accident now, and will email back soon. Tim Kovacs, President Mountain Rescue Association Operations Leader/ Paramedic, C.A.M.R.A./ MCSO MR tkovacs@goodnet.com www.mra.org Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 28 Sep 1999 01:21:40 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 27 Sep 1999 12:55:45 -0400 (EDT) Received: via switchmail; Mon, 27 Sep 1999 12:55:42 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 27 Sep 1999 12:53:30 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 27 Sep 1999 12:52:06 -0400 (EDT) Received: from shepherd.hurlburt.af.mil (shepherd.hurlburt.af.mil [151.166.15.65]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 27 Sep 1999 12:51:53 -0400 (EDT) Received: from shepherd.hurlburt.af.mil (root@localhost) by shepherd.hurlburt.af.mil with ESMTP id LAA11499 for ; Mon, 27 Sep 1999 11:51:28 -0500 (CDT) Received: from SMTP (virout.hurlburt.af.mil [151.166.209.70]) by shepherd.hurlburt.af.mil with SMTP id LAA11493 for ; Mon, 27 Sep 1999 11:51:27 -0500 (CDT) Received: from emh.stn.hurlburt.af.mil ([151.166.160.105]) by 151.166.209.70 (Norton AntiVirus for Internet Email Gateways 1.0) ; Mon, 27 Sep 1999 16:43:33 0000 (GMT) Received: by emh with Internet Mail Service (5.5.2448.0) id ; Mon, 27 Sep 1999 11:53:14 -0500 Message-ID: From: Allen Robert LtCol To: "'wilderness-emergency-medicine@list.pitt.edu'" Subject: RE: W-EMED osteopathic medicine Date: Mon, 27 Sep 1999 11:53:08 -0500 MIME-Version: 1.0 X-Mailer: Internet Mail Service (5.5.2448.0) Content-Type: text/plain Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P6B3E0.CNM I'm an Osteopathic Physician and emergency medicine specialist. I did my EM residency at a DoD facility, since I am active duty Air Force. I'm residency trained, board certified, and a Fellow of the American College of Emergency Physicians. Osteopathic physicians have done residencies in every medical and surgical specialty. Most prefer to go into primary care, since that is the main focus of most DO schools. However, I have friends who are neurosurgeons, neurologists, cardiologists, radiologists, etc. I've haven't found that being a DO has had any effect on my ability to obtain training, or on my practice after training (other than everybody in the hospital wants me to manipulate their backs/necks). Have a look at the med schools you 'd like to attend, see what their educational program and the philosophy of practice is. If Osteopathic Medicine is in line with your personal philosophy, then go for it! It's not easy (nothing in medicine or medical education is) but it's worth it. Good Luck, Rob Allen Robert C. Allen, DO, FACEP Lt Col, USAF MC FS Group Surgeon 720th Special Tactics Group Hurlburt Field, FL > -----Original Message----- > From: EdwardsPaulK@exchange.uams.edu [SMTP:EdwardsPaulK@exchange.uams.edu] > Sent: Thursday, September 23, 1999 2:04 AM > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED osteopathic medicine > > Just curious if anyone has any thoughts on Osteopathic medicine? I know > it > probably has no relevance to the subject of wilderness medicine but > perhaps > I could get some outside advice on continuing my education to pursue a > professional degree as an ER physician. I am a pre-med student currently > working on a MS in physiology at our state medical school. I will be > applying for osteopathic and allopathic medical schools in less than a > year. > Does anybody know the % of students that pursue a residency in the > emergency > department from an Osteopathic school? Or any relevant information > regarding > osteopathic schools? (I understand their philosophy and feel that they > are > right on track with my philosophy; but am curious how different the > education system really promotes this philosophy?) Thanks for all > comments, > Paul > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 26 Sep 1999 00:59:09 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 26 Sep 1999 00:58:34 -0400 (EDT) Received: via switchmail; Sun, 26 Sep 1999 00:58:33 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 26 Sep 1999 00:57:58 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 26 Sep 1999 00:56:47 -0400 (EDT) Received: from out5.prserv.net (out5.prserv.net [165.87.194.243]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 26 Sep 1999 00:56:39 -0400 (EDT) Received: from SKELLEHER-HOME (slip-32-100-230-233.co.us.ibm.net [32.100.230.233]) by out5.prserv.net (/) with SMTP id EAA37710 for ; Sun, 26 Sep 1999 04:58:48 GMT Message-ID: <00fd01bf07db$cdc0f370$dfdfdfdf@SKELLEHER-HOME.neonsoft.com> From: "Steve Kelleher" To: Subject: Re: W-EMED Full body Vacume splints Date: Sat, 25 Sep 1999 22:58:39 -0600 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 4.72.3155.0 X-MimeOLE: Produced By Microsoft MimeOLE V4.72.3155.0 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P29720.CNM We have been using the MDI brand full body and extremity splints for years and highly recommend them for quality of immobilization, patient comfort and for warmth. Obviously, vac. splints require more upkeep than a backboard; you need to regularly check the operation of the pumps, valves and bean bags to make sure they are in working order. We rarely have problems, however. You also need make sure folks receive ongoing training to use them properly. You should protect against punctures by using the splint with a litter, and keeping the splint off the ground when possible (the litter also adds more support). We have replaced the chicken wire in our stokes litters with lightweight plastic sheeting as a preventative against punctures. I also recommend using a c-collar with a vac. splint, even though they aren't required. More info. on this is available in the emails Dr. Conover sent to this list. Steve Kelleher EMS Director Alpine Rescue Team Evergreen, CO. -----Original Message----- From: Ed To: wilderness-emergency-medicine@list.pitt.edu Date: Saturday, September 25, 1999 11:14 AM Subject: W-EMED Full body Vacume splints >Greetings from North Alabama. Have a question for the list about the full >body vacume splints for use in rough country SAR work and Cave Rescue. > >What is available that people are actually using in the field (other than >sleeping, I mean conserving your energy at the cache, Keith :) ) and are >they a worthwhile addition vs the cost and durability ? > >What units would the list advise using or not using and why. I am trying to >work up some justification for adding one to our gear cache. > >Thanks for the help. > > >Ed Nicholas, EMT-D >Chief of Operations, >Huntsville Cave Rescue Unit, Inc >Operations Officer, >Huntsville Emergency Medical Services, Inc >High Angle - Rough Terrain (HART) Team >Huntsville, Alabama >KD4WNJ >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 14:33:29 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 14:32:55 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 14:32:55 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 14:32:02 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 14:31:29 -0400 (EDT) Received: from quint.somtel.com (Quint.somtel.com [206.139.114.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 14:31:25 -0400 (EDT) Received: from general (ddialup-na-14.somtel.com [216.227.178.34]) by quint.somtel.com (8.8.5/8.8.5) with SMTP id OAA24976 for ; Sat, 25 Sep 1999 14:33:43 -0400 Message-ID: <001d01bf0783$8b7564e0$22b2e3d8@general> From: "James Bender" To: References: <199909251640.MAA27423@post-ofc05.srv.cis.pitt.edu> Subject: Re: W-EMED Full body Vacume splints Date: Sat, 25 Sep 1999 14:26:14 -0400 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P48F50.CNM The full body vacuum splint is what we place in our stokes on every rescue, and we use it as our primary c-spine support while during EMS calls. As far as durability we have used MDI's in the woods, and "drug them", and they did not perforate; and we have hitched them to the back of snowmobiles as a quick improvised rescue sled, without the vacuum mat being damaged. Today a Ferno rep called me and stated Ferno has now designed a vacuum splint also. This splint is compartmentalized( this is so if it gets a hole, just that compartment inflates and not the whole splint. MDI is not compartmentalized) So I should have more comments on this splint after our WEMT class in January. I like MDI, but whatever you do, do not get a Heartwell, they do not hold up very well. James from Maine ----- Original Message ----- From: Keith Conover, M.D., FACEP To: Ed ; Sent: Saturday, September 25, 1999 12:42 PM Subject: Re: W-EMED Full body Vacume splints > Allegheny Mountain Rescue Group has a MDI mattress and is > generally happy with it. I'll post some MIME digests of some relevant > messages from various lists under separate cover. > > You can also search the list archives at > > www.wemsi.org > > for older messages on the topic. > > On 25 Sep 99, at 11:28, Ed wrote: > > > Greetings from North Alabama. Have a question for the list about the full > > body vacume splints for use in rough country SAR work and Cave Rescue. > > > > What is available that people are actually using in the field (other than > > sleeping, I mean conserving your energy at the cache, Keith :) ) and are > > they a worthwhile addition vs the cost and durability ? > > > > What units would the list advise using or not using and why. I am trying > > to work up some justification for adding one to our gear cache. > > > > Thanks for the help. > > > > > > Ed Nicholas, EMT-D > > Chief of Operations, > > Huntsville Cave Rescue Unit, Inc > > Operations Officer, > > Huntsville Emergency Medical Services, Inc > > High Angle - Rough Terrain (HART) Team > > Huntsville, Alabama > > KD4WNJ > > Do not reproduce without author's express permission. > > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > > as the body of a message (no subject) To: Majordomo@list.pitt.edu > > Submissions To: wilderness-emergency-medicine@list.pitt.edu > > > > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 13:26:08 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 13:25:35 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 13:25:35 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 13:24:09 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 13:23:54 -0400 (EDT) Received: from argohouston.com (mail.argolink.net [209.144.1.128]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 13:23:51 -0400 (EDT) Received: from h1z2r9 [209.176.43.33] by argohouston.com (SMTPD32-5.05) id A5A06AF80246; Sat, 25 Sep 1999 12:25:52 -0500 From: "SouthWest PaddleSports" To: Subject: RE: W-EMED FW: spinal injury Date: Sat, 25 Sep 1999 12:33:57 -0500 Message-ID: <000201bf077c$254e70a0$212bb0d1@h1z2r9> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Importance: Normal In-Reply-To: <003601bf063d$be59ef80$17148e88@suzanne> X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P44B30.CNM I did it running a few years back.....not fun, thought I had somehow gotten a hairline fx in my hip, but the recovery is much worse for a piriformis injury. Patti Carothers, RN SouthWest PaddleSports 26322 I-45 North The Woodlands, TX 77386-1022 281-292-5600 or 1-800-We Paddle http://www.paddlesports.com > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > Suzanne M. Atkinson > Sent: Thursday, September 23, 1999 10:35 PM > To: wilderness-emergency-medicine@list.pitt.edu > Subject: Re: W-EMED FW: spinal injury > > > >or excessive use of the piriformis, > > which is an external rotator of the hip > > How do you do this exactly??? Skating? X-C skiing? Dancing the > charleston? > > Suzanne > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 13:13:37 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 13:13:05 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 13:13:04 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 13:11:08 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 13:10:50 -0400 (EDT) Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 13:10:45 -0400 (EDT) Received: from micron (ehdup-g-15.rmt.net.pitt.edu [136.142.21.145]) by post-ofc04.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sat, 25 Sep 1999 13:10:40 -0400 (EDT) Message-Id: <199909251710.NAA01323@post-ofc04.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Sat, 25 Sep 1999 13:12:40 -0400 MIME-Version: 1.0 Content-type: Multipart/Digest; boundary=Digest-6A8ABF32 Subject: W-EMED even more about vacuum mattresses X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395328 0 1 P38610.CNM --Digest-6A8ABF32 X-cs: From: Self To: EMS-L@listserv.ACNS.NWU.EDU,"Craig B. Key, MD, EMT-P" Subject: Re: Spinal Immobilization Cc: "Sam Chewning, M.D." Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Sun, 11 Apr 1999 17:45:46 -0400 On 9 Apr 99, at 15:59, Craig B. Key, MD, EMT-P wrote: > > This is > > because of the large bills and longterm disability (sorry Jeff) > > caused by having massive sacral pressure necrosis requiring flaps > > for coverage. > > How often does this actually occur? I have never heard of it in my > institution, I suspect it is a rare occurrence. It seems mostly to be a problem with people who actually have spine fractures -- they spend hours and hours on unpadded boards. As far how often this occurs, let me cc: a friend who's a spine surgeon (as well as a cave rescue doctor) and see if he can give some specifics on how often the spine-injured patient gets a sacral decubitus from being on a backboard. > I think Elliot was talking about the extrication process of removing the > patient from a car for example. Often the backboard is placed on the car > seat and the patient is then extricated directly onto the board. This > prevents any unnecessary movement of the patient without spinal > immobilization. > > With a vacuum splint the patient would have to be removed completely from > the car before they could be placed in immobilization unless a KED or > similar device was used. If you use a KED, you have now blown any > advantage in time gained from using a vacuum splint as the KED is > relatively hard to apply and will at least double the time required for > extrication. True, it's easier and faster to slide someone out of a car onto an unpadded board. On the other hand, it's also easier and faster to fasten your patient to the board with a staple gun or nail gun than with straps. Do you want to do something that's easy and fast or something that doesn't hurt your patient? Though in my specialty of mountain and cave rescue EMS, it's just as easy to use a vacuum mattress as an unpadded spine board, I think that with practice the extra time and effort to use a vacuum mattress is worth the benefits in auto extrication, too. Besides, the seriously-injured patients are those who are likely to spend hours and hours immobized. --Digest-6A8ABF32 Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Sun, 11 Apr 1999 19:27:08 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Sun, 11 Apr 1999 18:55:26 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Sun, 11 Apr 1999 18:55:26 -0400 (EDT) Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 11 Apr 1999 18:55:24 -0400 (EDT) Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id RAA13572; Sun, 11 Apr 1999 17:55:15 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma013513; Sun, 11 Apr 99 17:54:49 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id RAA11033 for ; Sun, 11 Apr 1999 17:07:11 -0500 (CDT) Received: from post-ofc06.srv.cis.pitt.edu(136.142.185.43) by iris.itcs.nwu.edu via smap (V2.0) id xma010990; Sun, 11 Apr 99 17:06:55 -0500 Received: from default (ehdup-u-55.rmt.net.pitt.edu [136.142.23.165]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 11 Apr 1999 18:06:47 -0400 (EDT) Message-Id: <199904112206.SAA06479@post-ofc06.srv.cis.pitt.edu> Date: Sun, 11 Apr 1999 18:06:45 -0400 Reply-To: kconover+@pitt.edu Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Keith Conover, M.D., FACEP" To: EMS-L@listserv.ACNS.NWU.EDU, "Craig B. Key, MD, EMT-P" Cc: "Sam Chewning, M.D." Subject: Re: Spinal Immobilization In-Reply-To: <370E7827.FD888FE8@hfd.ci.houston.tx.us> MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT X-mailer: Pegasus Mail for Win32 (v3.01d) X-Listprocessor-Version: 8.0 -- ListProcessor(tm) by CREN On 9 Apr 99, at 15:59, Craig B. Key, MD, EMT-P wrote: > > This is > > because of the large bills and longterm disability (sorry Jeff) > > caused by having massive sacral pressure necrosis requiring flaps > > for coverage. > > How often does this actually occur? I have never heard of it in my > institution, I suspect it is a rare occurrence. It seems mostly to be a problem with people who actually have spine fractures -- they spend hours and hours on unpadded boards. As far how often this occurs, let me cc: a friend who's a spine surgeon (as well as a cave rescue doctor) and see if he can give some specifics on how often the spine-injured patient gets a sacral decubitus from being on a backboard. > I think Elliot was talking about the extrication process of removing the > patient from a car for example. Often the backboard is placed on the car > seat and the patient is then extricated directly onto the board. This > prevents any unnecessary movement of the patient without spinal > immobilization. > > With a vacuum splint the patient would have to be removed completely from > the car before they could be placed in immobilization unless a KED or > similar device was used. If you use a KED, you have now blown any > advantage in time gained from using a vacuum splint as the KED is > relatively hard to apply and will at least double the time required for > extrication. True, it's easier and faster to slide someone out of a car onto an unpadded board. On the other hand, it's also easier and faster to fasten your patient to the board with a staple gun or nail gun than with straps. Do you want to do something that's easy and fast or something that doesn't hurt your patient? Though in my specialty of mountain and cave rescue EMS, it's just as easy to use a vacuum mattress as an unpadded spine board, I think that with practice the extra time and effort to use a vacuum mattress is worth the benefits in auto extrication, too. Besides, the seriously-injured patients are those who are likely to spend hours and hours immobized. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover --Digest-6A8ABF32 X-cs: From: Self To: "Craig B. Key, MD, EMT-P" Subject: Re: Spinal Immobilization Cc: EMS-L@listserv.ACNS.NWU.EDU Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Sun, 18 Apr 1999 11:32:27 -0400 On 12 Apr 99, at 12:30, Craig B. Key, MD, EMT-P wrote: > > True, it's easier and faster to slide someone out of a car onto an > > unpadded board. On the other hand, it's also easier and faster to > > fasten your patient to the board with a staple gun or nail gun than with > > straps. Do you want to do something that's easy and fast or something > > that doesn't hurt your patient? > > As I understand it, the vacuum splint is not rigid until the patient is > placed on it and a vacuum is established. Correct. > That being the case, how could > you extricate someone onto a non-rigid board and not compromise the spine? See below. > > Though in my specialty of mountain and cave rescue EMS, it's just > > as easy to use a vacuum mattress as an unpadded spine board, I > > think that with practice the extra time and effort to use a vacuum > > mattress is worth the benefits in auto extrication, too. > > Wait, I thought one of the advantages of the vacuum board was that it > could be applied quicker and easier. Seems like those advantages are > becoming fewer on closer investigation. No, I'm not aware of anyone who's used one saying it's easier or quicker. For someone who's already on the ground or standing, it's probably about the same or slightly easier than a plain backboard. Certainly for boarding someone out of a car, a plain board is a lot easier. But a reasonable alternative is to slide the person out of the car using hands alone and then to do a "log-roll" type carry a couple of feet, gently put them down on the vacuum mattress, and then pump it out and apply the straps. You could also use a long board to get the person out, lay the long board down, and then do a "log-roll" many-hands lift just long enough to lift the person up and slip the vacuum mattress under. Again, do you want good or quick and easy? (I know, you want both, but . . . ) The ultimate result of shielding men from the effects of folly is to fill the world with fools. --Herbert Spencer --Digest-6A8ABF32 Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Mon, 19 Apr 1999 00:46:39 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Mon, 19 Apr 1999 00:44:00 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Mon, 19 Apr 1999 00:44:00 -0400 (EDT) Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Apr 1999 00:43:58 -0400 (EDT) Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id XAA28594; Sun, 18 Apr 1999 23:43:18 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma028550; Sun, 18 Apr 99 23:42:41 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id RAA04868 for ; Sun, 18 Apr 1999 17:44:24 -0500 (CDT) Received: from post-ofc04.srv.cis.pitt.edu(136.142.185.11) by iris.itcs.nwu.edu via smap (V2.0) id xma004866; Sun, 18 Apr 99 17:44:07 -0500 Received: from 136.142.57.10.pitt.edu (ehdup-v-35.rmt.net.pitt.edu [136.142.24.45]) by post-ofc04.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 18 Apr 1999 18:43:57 -0400 (EDT) Message-Id: <199904182243.SAA00596@post-ofc04.srv.cis.pitt.edu> Date: Sun, 18 Apr 1999 18:43:28 -0400 Reply-To: kconover+@pitt.edu Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Keith Conover, M.D., FACEP" To: "Craig B. Key, MD, EMT-P" Cc: EMS-L@listserv.ACNS.NWU.EDU Subject: Re: Spinal Immobilization In-Reply-To: <37123BB7.FE63A1B@hfd.ci.houston.tx.us> MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT X-mailer: Pegasus Mail for Win32 (v3.01d) X-Listprocessor-Version: 8.0 -- ListProcessor(tm) by CREN On 12 Apr 99, at 12:30, Craig B. Key, MD, EMT-P wrote: > > True, it's easier and faster to slide someone out of a car onto an > > unpadded board. On the other hand, it's also easier and faster to > > fasten your patient to the board with a staple gun or nail gun than with > > straps. Do you want to do something that's easy and fast or something > > that doesn't hurt your patient? > > As I understand it, the vacuum splint is not rigid until the patient is > placed on it and a vacuum is established. Correct. > That being the case, how could > you extricate someone onto a non-rigid board and not compromise the spine? See below. > > Though in my specialty of mountain and cave rescue EMS, it's just > > as easy to use a vacuum mattress as an unpadded spine board, I > > think that with practice the extra time and effort to use a vacuum > > mattress is worth the benefits in auto extrication, too. > > Wait, I thought one of the advantages of the vacuum board was that it > could be applied quicker and easier. Seems like those advantages are > becoming fewer on closer investigation. No, I'm not aware of anyone who's used one saying it's easier or quicker. For someone who's already on the ground or standing, it's probably about the same or slightly easier than a plain backboard. Certainly for boarding someone out of a car, a plain board is a lot easier. But a reasonable alternative is to slide the person out of the car using hands alone and then to do a "log-roll" type carry a couple of feet, gently put them down on the vacuum mattress, and then pump it out and apply the straps. You could also use a long board to get the person out, lay the long board down, and then do a "log-roll" many-hands lift just long enough to lift the person up and slip the vacuum mattress under. Again, do you want good or quick and easy? (I know, you want both, but . . . ) The ultimate result of shielding men from the effects of folly is to fill the world with fools. --Herbert Spencer --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover --Digest-6A8ABF32 Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Tue, 13 Apr 1999 14:42:24 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Tue, 13 Apr 1999 14:38:58 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Tue, 13 Apr 1999 14:38:56 -0400 (EDT) Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 13 Apr 1999 14:38:49 -0400 (EDT) Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id NAA20171; Tue, 13 Apr 1999 13:38:41 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma020055; Tue, 13 Apr 99 13:38:14 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id NAA18999 for ; Tue, 13 Apr 1999 13:32:12 -0500 (CDT) Received: from merle.acns.nwu.edu(129.105.16.57) by iris.itcs.nwu.edu via smap (V2.0) id xma018902; Tue, 13 Apr 99 13:31:48 -0500 Received: (from mailnull@localhost) by merle.acns.nwu.edu (8.8.7/8.8.7) id NAA12071 for ; Tue, 13 Apr 1999 13:31:47 -0500 (CDT) Received: from mixed009074.nuts.nwu.edu(129.105.9.74) by merle.acns.nwu.edu via smap (V2.0) id xma011936; Tue, 13 Apr 99 13:31:36 -0500 Message-Id: <2.2.32.19990413183521.006e6ee4@merle.acns.nwu.edu> Date: Tue, 13 Apr 1999 13:35:21 -0500 Reply-To: EMS-L@listserv.ACNS.NWU.EDU Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Ed Michelson, MD" To: ems-l@listserv.ACNS.NWU.EDU Subject: Re: Spinal Immobilization: R Vomacka replies Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" X-Sender: edatnu@merle.acns.nwu.edu X-Mailer: Windows Eudora Pro Version 2.2 (32) X-Listprocessor-Version: 8.0 -- ListProcessor(tm) by CREN Date: Wed, 07 Apr 1999 18:11:11 -0400 From: Rick Vomacka Reply-To: rvomacka@usa.net X-Mailer: Mozilla 4.51 [en] (Win98; U) X-Accept-Language: en MIME-Version: 1.0 To: EMS-L@listserv.ACNS.NWU.EDU Subject: Re: Spinal Immobilization References: <001c01be812d$8d8ea5c0$0100a8c0@cx526920-a.pwy1.sdca.home.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Unless things have changed in the past year or so, I seem to recall that vacuum mattresses are also not strong enough to support an adult patient when lifted from the head and foot ends ... they must be lifted from the sides -- yes? -- Rick Vomacka, Brimfield, OH "Everyone has talent. What is rare is the courage to follow the talent to the dark place where it leads." Emergency Products & Research, Inc. Kent, OH http://www.epandr.com Ed Michelson, MD Northwestern Universwity --Digest-6A8ABF32-- Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 13:12:35 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 13:12:03 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 13:12:02 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 13:11:01 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 13:10:44 -0400 (EDT) Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 13:10:41 -0400 (EDT) Received: from micron (ehdup-g-15.rmt.net.pitt.edu [136.142.21.145]) by post-ofc04.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sat, 25 Sep 1999 13:10:32 -0400 (EDT) Message-Id: <199909251710.NAA01292@post-ofc04.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Sat, 25 Sep 1999 13:12:06 -0400 MIME-Version: 1.0 Content-type: Multipart/Digest; boundary=Digest-58F03895 Subject: W-EMED more about vacuum mattresses X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395328 0 1 P5DA50.CNM --Digest-58F03895 Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Tue, 6 Apr 1999 17:28:22 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Tue, 6 Apr 1999 17:26:47 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Tue, 6 Apr 1999 17:26:46 -0400 (EDT) Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 6 Apr 1999 17:26:45 -0400 (EDT) Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id QAA16618; Tue, 6 Apr 1999 16:26:20 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma016536; Tue, 6 Apr 99 16:26:06 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id QAA14637 for ; Tue, 6 Apr 1999 16:06:01 -0500 (CDT) Received: from ha1.rdc1.sdca.home.com(24.0.3.66) by iris.itcs.nwu.edu via smap (V2.0) id xma014576; Tue, 6 Apr 99 16:05:42 -0500 Received: from cx526920-a ([24.0.171.14]) by mail.rdc1.sdca.home.com (InterMail v4.00.03 201-229-104) with SMTP id <19990406210536.PLQN11049.mail.rdc1.sdca.home.com@cx526920-a> for ; Tue, 6 Apr 1999 14:05:36 -0700 Message-Id: <001b01be8071$3d3b2a60$0100a8c0@cx526920-a.pwy1.sdca.home.com> Date: Tue, 6 Apr 1999 14:05:45 -0700 Reply-To: EMS-L@listserv.ACNS.NWU.EDU Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Tom Scott" To: "EMS-L" Subject: RE: Spinal Immobilization In-Reply-To: <370A5CC9.A5753FF7@emory.edu> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2377.0 X-MimeOLE: Produced By Microsoft MimeOLE V4.72.3155.0 X-Listprocessor-Version: 8.0 -- ListProcessor(tm) by CREN For the last several years I've been promising myself a tattoo on my chest that said "NO BACKBOARD." The research seems to be pretty evident that the vacuum mattress is the best way to go. I guess that's why it is the standard of care in Europe. The following is a list of references I compiled 3 years ago: ------------------------------------ Chan D, Godlberg R, Tascone A, Harmon S and Chan L, "The Effect of Spinal Immobilization on Healthy Volunteers" Annals of Emergency Medicine, Vol. 23, No. 1 pp 48-51, January 1994. Study Objective: To determine the effects of standard spinal immobilization on a group of health volunteers with respect to induced pain and discomfort. Interventions: 21 healthy volunteers were placed in a standard backboard immobilization for a 30 minute period. Number and severity of immediate and delayed symptoms were determined. Measurements and Main Results: 100% of subjects developed pain within the immediate observation period. Occipital headache and sacral, lumbar, and mandibular pain were the most frequent symptoms. 55% of subjects graded their symptoms as moderate to severe. 29% of subjects developed additional symptoms over the next 48 hours. Conclusion: Standard spinal immobilization may be a cause of pain in an otherwise healthy subject. --------------------------------------------- Godlberg R, Chan D, Mason J, and Chan L, "Standard Spinal Immobilization Versus a Vacuum Mattress Splint: A Comparison of Symptoms Generated" From the Dept. of Emergency Medicine, Los Angeles County+USC Medical Center, Los Angeles, CA. Unpublished. Study Objective: To compare standard spinal immobilization techniques to a vacuum mattress splint with respect to the incidence of symptoms generated by the immobilization process. Participants: 37 healthy volunteers without history of back pain or spinal disease. Interventions: In Phase I, subjects were randomly assigned to be immobilized on either a wooden backboard or a mattress-splint for 30 minutes. The incidence and severity of any symptoms generated by the immobilization process were recorded. In Phase II, the two groups were again tested after a two week washout period, with the method of immobilization being reversed. Symptoms and severity were again recorded. Main Results: Pain symptoms were confined to four anatomic sites: occipital prominence, lumbosacral spine, scapulae and cervical spine. After adjusting for the effect of order of exposure, subjects were 3.08 times more likely to have symptoms when immobilized on a backboard than when immobilized on the VMS (p < 0.0001). They were similarly 7.88 times more likely to complain of occipital pain (p < 0.0001) and 4.27 times more likely to complain of lumbosacral pain (p < 0.0086). Severity occipital and lumbosacral pain was significantly higher during backboard immobilization (p<0.0001, p<0.0088 respectively). Conclusion: When compared to VMS, standard backboard immobilization appears to be associated with an increased incidence of symptoms in general and an increased incidence and severity of occipital and lumbosacral pain in particular. --------------------------------------------- Lovell ME and Evans JH, "A comparison of the spinal board and the vacuum stretcher, spinal stability and interface pressure" Injury, Vol. 25, No. 3 1994, pp 179-180. Abstract: The interface pressures were measured between the sacrum, mid-lumbar spine and various support surfaces. Thirty health male volunteers were recruited. The spinal board, padded spinal board and vacuum stretcher were the support surfaces evaluated. We found high and potentially ischaemic pressures between the sacrum and the spinal board interface (mean 147.3 mmHg). This was reduced in the padded board (115.5 mmHg) but dramatically reduced with the vacuum stretcher (36.7 mmHg). It was also noted that no support was given to the normal lumbar lordosis by the spinal board (padded and unpadded), but support was given the vacuum stretcher. This raises the question of how stable is an unstable spinal injury on a flat supporting surface. Hauswald M, Johnson DR, and Stockhoff C. "Superiority of a Vacuum Splint Device Over a Traditional Spine Board for Immobilization." From the Dept. Of Emergency Medicine, University of New Mexico School of Medicine. Unpublished. Thirty EMT students were immobilized on both a wooden backboard and a vacuum mattress splint for 30 minutes. 30 other students working in teams of 4 with one acting as a patient were timed as they immobilized the "patient" on each device as quickly as possible. The board was slowly lifted up to 90 degrees laterally, until the subject first felt any body part slip. The angle of tilt was recorded. Results: The vacuum splint was more comfortable than the wooden spine board: 6.6 +/- 1.5 vs. 3.3+/-1.8 (p<0.001). It was also slightly faster to apply: 132 +/- 24 seconds vs. 155 +/- 22 seconds (p<0.001). The angle at which slippage was first noted was greater for the vacuum splint than the spine board: 29.2 +/- 7.0 degrees vs. 19.8+/-4.3 degrees (p<0.05). Conclusion: Wooden spine boards have few advantages except that they are cheaper and easier to clean than vacuum splints. Vacuum splints are much more comfortable, quicker to apply and allow less slippage on lateral tilting. ----------------------------------------------------- Delbridge TR, Auble TE, Garrison HG and Menengazzi JJ, "Discomfort in Health Volunteers Immobilized on Wooden Backboards and Vacuum Mattress Splints" Prehospital and Disaster Medicine, Volume 8 Suppl 2 (Abstracts of Scientific Papers 9th Annual Conference and Scientific Assembly of NASEMSP). Jul-Sep 1993. Conclusion: The results suggest that vacuum mattress splints cause less discomfort than do wooden backboards; the effect is more pronounced as the duration of spinal immobilization increases. Prospective studies are necessary to evaluate the clinical significance of this effect and the cost-effectiveness of similar alternative immobilization devices. -------------------------------------- This is the research that I believe supports a transition from backboards to the vacuum mattress for spinal immobilization. They may cost more, but would you want you mother, father or spouse strapped to a backboard for an hour or more? Tom Scott mailto:Tom.Scott@pobox.com EMS and Managed Care Consultant Scott Consulting Poway, San Diego County, California +1 (619) 748-9064 http://members.home.net/tomscott/ > -----Original Message----- > From: owner-EMS-L@listserv.ACNS.NWU.EDU > [mailto:owner-EMS-L@listserv.ACNS.NWU.EDU]On Behalf Of Jeffrey P. > Salomone, MD > Sent: Tuesday, April 06, 1999 12:13 PM > To: EMS-L@listserv.ACNS.NWU.EDU > Subject: Re: Spinal Immobilization > > > How do you define "best"? And, furthermore, what DATA do you > have to back up > your claim of superiority? > > Jeff Salomone, MD, NREMT-P > Emory University > > Allen Sims wrote: > > > Best method of Spinal Immobilization - Vacuum Mattresses. > Nothing else even > > comes close. They are expensive, but if you want the best... > > > > Method we have adopted: > > Nylon webbing. You can buy it in bulk, and the end result is > about $5.00 a > > set. A 1000 ft roll makes 25 40 foot sections. One section > works for one > > patient. It's usually a two person job to apply, as it's > symmetrical from > > head to toe, but can be done by just one. To apply, mark the > center of the > > webbing. Place this over the patients neck (not too tight - for obvious > > reasons). Then loop to the first handhold just above the patients > > shoulders. Loop under the patients arm and through the initial > run that was > > over the patients neck, and then back to the next hole in the backboard. > > This creates a type of harness that keeps the patients shoulders very > > steady. Keeping this critical area stable is the biggest failure of all > > other types of immobilization I've tried. Then proceed loop > through your > > partners webbing at the patients center all the way down to the > feet, then > > tie securely at the end. At each handhold, you create a type > of half-hitch > > (at least that's what I call it - I'm not any type of boy scout knot > > expert). This keeps some tension, and a failsafe if the bottom > tie comes > > loose. If you want to be extra cautious, you can use some > blankets to pad > > void area, and the patient just doesn't move. If you need to lift the > > patient vertically, you can go from just above the patients > hips, between > > his legs (be careful - for obvious reasons) and then back above > the hips. > > It takes less than one minute for an experienced crew to apply. > It can be > > removed in the same amount of time in the ER. If it gets cut off by > > hospital staff, it's only a few dollars lost. It can be > washed, it's easy > > to label, it works with any backboard that has handholds, and it's very > > effective. > > > > Allen Sims > > Cypress Creek EMS > > http://www.ccems.com > > > > -----Original Message----- > > From: Stephen Reid > > To: EMS-L@Listserv.acns.nwu.edu > > Date: Friday, April 02, 1999 10:53 AM > > Subject: Spinal Immobilization > > > > >Hey folks: > > > > > >I know this is an old and drawn out topic, but unfortunately I > have been > > >tasked with the impossible mission. I need to know if there are any > > >documented studies on the use of straps (whether spider or single) > > >versus the use of tape when immobilizing a spinal patient. > > > > > >I appreciate that this topic has been beat to death, but I have as of > > >yet been able to find anything on paper....HELP! > > > > > >Thanks > > > > > > > > >-- > > >STEPHEN B REID > > >Paramedic II, EMD, Crewchief > > > > > >PO Box 1422 > > >Middleton, Nova Scotia > > >B0S 1P0 > > > > > >'EMS is an artform only few recognize but everyone appreciates' > > > > > > > > > > > > --Digest-58F03895 Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Wed, 7 Apr 1999 17:22:43 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Wed, 7 Apr 1999 17:19:22 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Wed, 7 Apr 1999 17:19:22 -0400 (EDT) Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 7 Apr 1999 17:19:20 -0400 (EDT) Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id QAA18477; Wed, 7 Apr 1999 16:18:55 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma018373; Wed, 7 Apr 99 16:18:39 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id OAA07172 for ; Wed, 7 Apr 1999 14:34:09 -0500 (CDT) Received: from ha1.rdc1.sdca.home.com(24.0.3.66) by iris.itcs.nwu.edu via smap (V2.0) id xma007153; Wed, 7 Apr 99 14:33:53 -0500 Received: from cx526920-a ([24.0.171.14]) by mail.rdc1.sdca.home.com (InterMail v4.00.03 201-229-104) with SMTP id <19990407193348.CBXP11049.mail.rdc1.sdca.home.com@cx526920-a> for ; Wed, 7 Apr 1999 12:33:48 -0700 Message-Id: <001c01be812d$8d8ea5c0$0100a8c0@cx526920-a.pwy1.sdca.home.com> Date: Wed, 7 Apr 1999 12:33:45 -0700 Reply-To: EMS-L@listserv.ACNS.NWU.EDU Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Tom Scott" To: Subject: RE: Spinal Immobilization In-Reply-To: <370BA206.6FAF42C9@hfd.ci.houston.tx.us> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2377.0 X-MimeOLE: Produced By Microsoft MimeOLE V4.72.3155.0 X-Listprocessor-Version: 8.0 -- ListProcessor(tm) by CREN Craig Key wrote > Unfortunately, the literature you posted and most of the literature out > there about vacuum splints does not demonstrate that it is any better > than a backboard at immobilization of the spinal column. All it > demonstrates is that it is more comfortable. I agree that intuitively > the vacuum splint makes more sense and probably is "best" but there is > no real evidence to support this. Here are some more references. They seem to demonstrate that the vacuum mattress is at least as efficacious as the spine board in terms of immobilization. But more importantly, vacuum mattresses don't violate the first rule of medicine: Do No Harm (which I believe is one of your mantras Craig, at least when it comes to RSI in the field). Not only are spine boards "uncomfortable" they actually result in tissue damage. EMS patients come to us with a lot of pain to begin with. Why should we add to that pain when there is an alternative that achieves the same clinical objectives: immobilization, in a pain free manner? Vacuum mattresses cost more, are harder to clean, are more easily damaged. But they should still be implemented because it is the Right Thing To Do for the patient. Tom Scott mailto:Tom.Scott@pobox.com EMS and Managed Care Consultant Scott Consulting Poway, San Diego County, California +1 (619) 748-9064 http://members.home.net/tomscott/ ----------------------------------------------- J Emerg Med 1996 Sep-Oct;14(5):553-9 The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization. Hamilton RS, Pons PT University of California San Diego Medical Center/Mercy Hospital, CA 92103, USA. r_hamilton@ucsd.edu We performed a prospective crossover study to determine the cervical spine immobilization and comfort level of healthy subjects on a full-body vacuum splint in comparison with a standard backboard, with and without cervical spine collars. Twenty-six healthy volunteers were immobilized on a backboard (BB) and a full-body vacuum splint (VS), both with and without a cervical collar (CC). Pre- and post-immobilization cervical spine range-of-motion measurements were made using an electronic digital inclinometer and a standard handheld goniometer. Subjects were also asked to subjectively grade their immobilization and discomfort both overall and in seven specific body regions. No statistically significant difference was found between the VS+CC and the BB+CC for flexion and rotation, although the VS+CC combination provided significantly superior immobilization to the BB+CC for extension and lateral bending. The VS alone, in all cases except extension, provided superior immobilization to the BB alone. A statistically significant difference in subjective perception of immobilization was noted, with the BB being less effective than the other three alternatives and the VS+CC providing the best immobilization. A significant difference in overall comfort and occipital region comfort, favoring the vacuum splint, was found. In conclusion, the vacuum splint is an effective and more comfortable alternative to the background for cervical spine immobilization. ----------------------------------------------- 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 study was a prospective, nonblinded comparative study conducted at a statewide emergency medical services (EMS) training facility and included a convenience sample of emergency medical technician (EMT) and paramedic students. 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. Vacuum splints offer a significant improvement in comfort over a traditional backboard for the patient with possible spinal injury. They can be applied in reasonable time frames and provide a similar degree of immobilization when compared to a standard rigid backboard. ------------------------------ Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR: Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med July 1995;26:31-36. Study objectives: Although spine boards are one of the main EMS means of immobilization and transportation, few studies have addressed the discomfort and potential harmful consequences of using this common EMS tool. We compared the levels of pain and tissue-interface (contact) pressures in volunteers immobilized on spine boards with and without interposed air mattresses. Design: Prospective crossover study. Setting: Emergency department of Methodist Hospital of Indiana, Indianapolis, Indiana. Participants: Twenty healthy volunteers who had not taken any analgesic drugs in the preceding 24 hours, were not experiencing any pain at the time of the study, and did not have history of chronic back pain. Interventions: To simulate prehospital transport conditions, we immobilized volunteers with hard cervical collars and single-buckle chest straps on wooden spine boards with or without commercially available medical air mattresses. The crossover order was randomized. After 80 minutes, immobilization measures were discontinued and the subjects were allowed to get off the boards for a recovery period of 60 minutes. Subjects were then studied for a second 80-minute period with the opposite intervention. At baseline and at 20-minute intervals, the level of pain was rated with a 100-mm visual analog scale. Tissue-interface pressures were measured at the occiput, sacrum, and left heel. Results: Mean pain on the visual analog scale was 9.7 mm at the end of the mattress period and 37.5 mm at the end of the no-mattress period (P =.0001). Although there were no significant differences in pain between the two groups at time 0, volunteers reported significantly more pain during the no-mattress period at 20 (P =.003), 40 (P =.0001), and 60 minutes (P =.0001). All 20 subjects reported that immobilization on the spine board with the mattress was "much better" (five-point scale) than that without the mattress. Interface pressure levels were significantly less in the mattress period than in the no-mattress period measured at occiput (P =.0001), sacrum (P =.0001), and heel (P =.0001). Conclusion: In a simulated immobilization experiment, healthy volunteers reported significantly less pain during immobilization on a spine board with an interposed air mattress than during that on a spine board without a mattress. Tissue-interface pressures were significantly higher on spine boards without air mattresses. This and previous studies suggest that immobilization on rigid spine boards is painful and may produce tissue-interface pressure high enough to result in the development of pressure necrosis ("bedsores"). Emergency care providers should consider the use of interposed air mattresses to reduce the pain and potential tissue injury associated with immobilization on rigid spine boards. --Digest-58F03895 X-cs: From: Self To: "Jeffrey P. Salomone, MD" How do you define "best"? And, furthermore, what DATA do you have to back > up your claim of superiority? There are excellent studies that show that after 45' on a backboard, people get severe pain, and after 90 minutes, start to get skin breakdown. [references posted on this list in the past and available again if you want them] However, there are many of us who have _slept_comfortably_ in a vacuum mattress for up to 4-5 hours during SAR exercises (after that it gets a bit uncomfortable). This by itself is enough to make me agree. And test it yourself -- there are no controlled studies of the degree of immobilization in a vacuum mattress, but properly applied and with a bit of duct tape (used preferentially in SAR) or a strap across the top of the head, you can actually feel that you move _less_ in a vacuum mattress than in a CID and collar on a hard board. Yes, I'm an unrepentant fan of vacuum mattresses! --Digest-58F03895 X-cs: From: Self To: "Jeffrey P. Salomone, MD" How do you define "best"? And, furthermore, what DATA do you have to back > up your claim of superiority? There are excellent studies that show that after 45' on a backboard, people get severe pain, and after 90 minutes, start to get skin breakdown. [references posted on this list in the past and available again if you want them] However, there are many of us who have _slept_comfortably_ in a vacuum mattress for up to 4-5 hours during SAR exercises (after that it gets a bit uncomfortable). This by itself is enough to make me agree. And test it yourself -- there are no controlled studies of the degree of immobilization in a vacuum mattress, but properly applied and with a bit of duct tape (used preferentially in SAR) or a strap across the top of the head, you can actually feel that you move _less_ in a vacuum mattress than in a CID and collar on a hard board. And yes, Craig, there are no studies -- but then there is no evidence that holding someone "tighter" is better, either -- the degree of immobilization needed for potential spine injuries is really pretty undefined, except for that one study that Vince Mosesso did with cadavers. Yes, I'm an unrepentant fan of vacuum mattresses! --Digest-58F03895 X-cs: From: Self To: "Jeffrey P. Salomone, MD" How do you define "best"? And, furthermore, what DATA do you have to back > up your claim of superiority? There are excellent studies that show that after 45' on a backboard, people get severe pain, and after 90 minutes, start to get skin breakdown. [references posted on this list in the past and available again if you want them] However, there are many of us who have _slept_comfortably_ in a vacuum mattress for up to 4-5 hours during SAR exercises (after that it gets a bit uncomfortable). This by itself is enough to make me agree. And test it yourself -- there are no controlled studies of the degree of immobilization in a vacuum mattress, but properly applied and with a bit of duct tape (used preferentially in SAR) or a strap across the top of the head, you can actually feel that you move _less_ in a vacuum mattress than in a CID and collar on a hard board. And yes, Craig, there are no studies -- but then there is no evidence that holding someone "tighter" is better, either -- the degree of immobilization needed for potential spine injuries is really pretty undefined, except for that one study that Vince Mosesso did with cadavers. This is a situation where we have to use a mixture of controlled studies and anecdotal evidence to make a decision, as in many other areas of EMS. Yes, I'm an unrepentant fan of vacuum mattresses! --Digest-58F03895 X-cs: From: Self To: EMS-L@listserv.ACNS.NWU.EDU Subject: Re: Spinal Immobilization Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Fri, 9 Apr 1999 13:19:26 -0400 Interesting discussion. Tom did indeed post a quantity of evidence, and despite Jeff's criticisms, I've read through the articles themselves and found them at least moderately persuasive, with fairly good methodology. For what it's worth, here's the detailed logical chain I've used to decide that vacuum mattresses are superior to backboards. (I'll note that my interest in wilderness EMS and the problems of very long- term evacuations prompted me to look at this quite closely.) 1. Backboards cause severe pain if you're on them more than an hour (the references Tom posted establish this without a doubt). 2. Backboards cause tissue damage if you're on them for more than a few hours. Again, fairly good evidence from Tom - but also, the American Society for Surgery of the Spine (hope I got the name right) has in the past few years been trying to persuade emergency physicians and trauma surgeons to get people, especially those with even unstable spinal injuries, off backboards ASAP. This is because of the large bills and longterm disability (sorry Jeff) caused by having massive sacral pressure necrosis requiring flaps for coverage. 3. The degree of spinal immobilization that's required for adequate protection is unknown, therefore a reasonable approach is to see if a vacuum splint is as good or better than our current baseline -- backboard, c-collar, CID. Tom quoted some data on this, and in making my own decision, I performed some not only unpublished but even unrecorded studies -- put a bunch of people (about 5) on a backboard with c-collar and CID, and had them try to wiggle. Put the same people in a vacuum mattress and had them try to wiggle. Wiggled a lot on the board, almost not at all in the vacuum mattress. Not documented, but easy to perform yourself at home! As a standard part of testing SAR immobilization, we also tilt the litter up on its foot end and bounce the litter up and down to see if the patient moves. Answer -- a lot less with the vacuum mattress. We also do this head-down and the answer is the same. Anecdotal, but quite persuasive to me. and Elliot said: > What also is missing in these studies is a critical look at how > the patient gets from wherever on to the various devices used for > immobilization. I have not had any good experience getting > patients on to the "vacuum mattress". If there is a technique > that moves the patient less than a well exec Well, I dunno about you, but the technique for slipping a vacuum mattress under someone is the same as slipping a backboard under someone. Yes, it's a bit bigger and you have to lift someone a few inches higher, but the principle's exactly the same. Yes, I'm an unrepentant fan of vacuum mattresses! (P.S. having been able to catch a nap for a couple of hours in one while being the patient in a SAR exercise is quite persuasive if you've ever been on a backboard before!) --Digest-58F03895 Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Fri, 9 Apr 1999 13:41:52 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Fri, 9 Apr 1999 13:39:34 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Fri, 9 Apr 1999 13:39:31 -0400 (EDT) Received: from listserv.acns.nwu.edu (iris.itcs.nwu.edu [129.105.213.30]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 9 Apr 1999 13:39:24 -0400 (EDT) Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id MAA11977; Fri, 9 Apr 1999 12:38:44 -0500 (CDT) Received: from localhost(127.0.0.1) by iris.itcs.nwu.edu via smap (V2.0) id xma011786; Fri, 9 Apr 99 12:38:04 -0500 Received: (from mailnull@localhost) by listserv.acns.nwu.edu (8.8.7/8.8.7) id MAA09732 for ; Fri, 9 Apr 1999 12:20:20 -0500 (CDT) Received: from post-ofc06.srv.cis.pitt.edu(136.142.185.43) by iris.itcs.nwu.edu via smap (V2.0) id xma009718; Fri, 9 Apr 99 12:20:14 -0500 Received: from 136.142.57.10.pitt.edu (ehdup-t-5.rmt.net.pitt.edu [136.142.23.15]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 9 Apr 1999 13:20:03 -0400 (EDT) Message-Id: <199904091720.NAA02238@post-ofc06.srv.cis.pitt.edu> Date: Fri, 9 Apr 1999 13:20:02 -0400 Reply-To: kconover+@pitt.edu Sender: owner-EMS-L@listserv.ACNS.NWU.EDU From: "Keith Conover, M.D., FACEP" To: EMS-L@listserv.ACNS.NWU.EDU Subject: Re: Spinal Immobilization In-Reply-To: <370A5CC9.A5753FF7@emory.edu> MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT X-mailer: Pegasus Mail for Win32 (v3.01d) X-Listprocessor-Version: 8.0 -- ListProcessor(tm) by CREN Interesting discussion. Tom did indeed post a quantity of evidence, and despite Jeff's criticisms, I've read through the articles themselves and found them at least moderately persuasive, with fairly good methodology. For what it's worth, here's the detailed logical chain I've used to decide that vacuum mattresses are superior to backboards. (I'll note that my interest in wilderness EMS and the problems of very long- term evacuations prompted me to look at this quite closely.) 1. Backboards cause severe pain if you're on them more than an hour (the references Tom posted establish this without a doubt). 2. Backboards cause tissue damage if you're on them for more than a few hours. Again, fairly good evidence from Tom - but also, the American Society for Surgery of the Spine (hope I got the name right) has in the past few years been trying to persuade emergency physicians and trauma surgeons to get people, especially those with even unstable spinal injuries, off backboards ASAP. This is because of the large bills and longterm disability (sorry Jeff) caused by having massive sacral pressure necrosis requiring flaps for coverage. 3. The degree of spinal immobilization that's required for adequate protection is unknown, therefore a reasonable approach is to see if a vacuum splint is as good or better than our current baseline -- backboard, c-collar, CID. Tom quoted some data on this, and in making my own decision, I performed some not only unpublished but even unrecorded studies -- put a bunch of people (about 5) on a backboard with c-collar and CID, and had them try to wiggle. Put the same people in a vacuum mattress and had them try to wiggle. Wiggled a lot on the board, almost not at all in the vacuum mattress. Not documented, but easy to perform yourself at home! As a standard part of testing SAR immobilization, we also tilt the litter up on its foot end and bounce the litter up and down to see if the patient moves. Answer -- a lot less with the vacuum mattress. We also do this head-down and the answer is the same. Anecdotal, but quite persuasive to me. and Elliot said: > What also is missing in these studies is a critical look at how > the patient gets from wherever on to the various devices used for > immobilization. I have not had any good experience getting > patients on to the "vacuum mattress". If there is a technique > that moves the patient less than a well exec Well, I dunno about you, but the technique for slipping a vacuum mattress under someone is the same as slipping a backboard under someone. Yes, it's a bit bigger and you have to lift someone a few inches higher, but the principle's exactly the same. Yes, I'm an unrepentant fan of vacuum mattresses! (P.S. having been able to catch a nap for a couple of hours in one while being the patient in a SAR exercise is quite persuasive if you've ever been on a backboard before!) Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. --Digest-58F03895-- Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 12:44:48 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 12:44:15 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 12:44:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 12:42:30 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 12:42:21 -0400 (EDT) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 12:42:18 -0400 (EDT) Received: from micron (ehdup-v-3.rmt.net.pitt.edu [136.142.24.13]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sat, 25 Sep 1999 12:41:55 -0400 (EDT) Message-Id: <199909251641.MAA27673@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Sat, 25 Sep 1999 12:43:58 -0400 MIME-Version: 1.0 Content-type: Multipart/Digest; boundary=Digest-5CB185F3 Subject: W-EMED even more vacuum mattress messages X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395328 0 1 P166F0.CNM --Digest-5CB185F3 X-cs: From: Self To: "joe ivy" Subject: Re: vacuum mattresses.. Cc: NCRC@ontosystems.com (NCRC Discussion List) Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/enriched; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Wed, 15 Jul 1998 10:27:34 -0400 Times New RomanOn 14 Jul 98, at 21:17, joe ivy wrote: Keith,Saw your post on the NCRC Dlist and had some quick questions. Where does one find one of these vacuum mattresses and how much does one cost? About $400-500 > Are they reusable or one time only? Reusable. Plus easily fixed with duct tape. > How do these things work? bunch of bean-bag-chair-type styronoodles in a big heavy plastic bag. When you suck out all the air, they get hard. > How durable are they? pretty solid, at least the models I've seen. > Will they work in a SKED? Yes, but they fill it up a bit more than with just a patient. Thought others might want to know too so I'm forwarding this to the NCRC list, too. --Digest-5CB185F3 X-cs: From: Self To: "joe ivy" Subject: Re: vacuum mattresses.. Cc: NCRC@ontosystems.com (NCRC Discussion List) Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Wed, 15 Jul 1998 17:54:44 -0400 On 15 Jul 98, at 13:53, joe ivy wrote: > Keith, > > Thanks for the quick reply+ACE- Just a couple more questions occurred to > me upon reading your reply. Where does one buy these mattresses? There are several suppliers, both moutain rescue outfitters like CMC and Weinel, and EMS suppliers. I'd recommend checking your local EMS supplier first. These are used by many ambulance companies. For that matter, check your local EMS agency and ask to borrow their catalogs. > Was the > price you quoted retail or wholesale? Just a rough guide. > How compact are they when packed > i.e will it fit inside a SKED pack? They're light but big, they usually come in their own stuffsack -- but the ideal I think is a Ferno with a vacuum mattress prepacked in it, ideal for most cave rescue. > Does the mattress completely surround > the patient and if so, does it also work as padding/insulation/vapor > barrier for in-cave transport? It is under and around but not over. It indeed is padding, insulation, and lower vapor barrier, as well as flotation. Adding a small warm cover and a tarp is all you need to add. ? One more quick question+ACE- How do you suck the air out of the mattress? They come with a lightweight hand- or foot- operated pump. And to be truthful, I haven't played around with the different models to know which is best. Maybe someone else on the list has experience with the various brands? --Digest-5CB185F3 Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Tue, 21 Jul 1998 09:27:27 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Tue, 21 Jul 1998 09:27:20 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Tue, 21 Jul 1998 09:27:18 -0400 (EDT) Received: from ontosystems.com (mail.ontosystems.com [166.82.129.17]) by post-ofc03.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Tue, 21 Jul 1998 09:27:14 -0400 (EDT) Message-ID: <5C00B82D01880100@ontosystems.com> X-SMF-Message-ID: 5C00B82D01880100 X-SMF-Hop-Count: 1 Date: Tue, 21 Jul 1998 09:27:34 -0400 Sender: NCRC Discussion List From: NCRC Discussion List To: NCRC Discussion List Subject: RE: Vacuum mattresses Mime-Version: 1.0 Content-Type: text/plain; charset="ISO-8859-1" Content-Transfer-Encoding: 7BIT Precedence: Bulk X-Mailer: InterChange (Hydra) SMTP v3.12 RC6 ******************************************************************** * NOTICE! * * The following information cannot be published without the * * expressed consent of the author. * ******************************************************************** On 21 Jul 1998 at 09:27, Peter Ludwig (peter.ludwig@bfi-bbrz.or.at) wrote: Tim and others wrote: > The MRA did some field testing of the Hartwell and MDI at the annual > conference in Provo in June 1997. Vacuum matreeses are pretty popular here in central Europe almost for decades (I know them for 20 years IMHO). Every single ambulance car has one or more in it. So we can get them easily at any time. BUT: The usual mattress is much to thick and too bulky for cave rescue, we may get only very small patients into it AND a normal stretcher. So we bought a thinner one for our cave rescue cache. As patients are always also put into a stretcher this is no drawback. But I like more the Swiss system with 2 component foam in a plastic foil bag. Advantages: Only two plastic bottels to carry (one about a liter, the other half of it). The compound produces mild heat when reacting. The 'mattress' is not affected by puncturing the foil. When necessary you may bend the patient at his/her hips without moving other body parts (you have to damage the foam there). If the patient is larger/smaller you can adapt foam volume. Drawbacks: One way road: When the compound has reacted you cannot change anything (they key is, as usual, experience). Training cost is higher (but you get plenty of foam for the price of one vacuum mattress). greetings from Austria, Peter --Digest-5CB185F3 Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Tue, 28 Jul 1998 02:26:09 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Tue, 28 Jul 1998 02:26:07 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Tue, 28 Jul 1998 02:26:07 -0400 (EDT) Received: from ontosystems.com (mail.ontosystems.com [166.82.129.17]) by post-ofc03.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Tue, 28 Jul 1998 02:26:04 -0400 (EDT) Message-ID: <0FBBB82D01880100@ontosystems.com> X-SMF-Message-ID: 0FBBB82D01880100 X-SMF-Hop-Count: 1 Date: Tue, 28 Jul 1998 02:08:36 -0400 Sender: NCRC Discussion List From: NCRC Discussion List To: NCRC Discussion List Subject: two component foam mattress Mime-Version: 1.0 Content-Type: text/plain; charset="ISO-8859-1" Content-Transfer-Encoding: 7BIT Precedence: Bulk X-Mailer: InterChange (Hydra) SMTP v3.12 RC6 ******************************************************************** * NOTICE! * * The following information cannot be published without the * * expressed consent of the author. * ******************************************************************** On 28 Jul 1998 at 02:08, Peter Ludwig (peter.ludwig@bfi-bbrz.or.at) wrote: Keith Konover wrote: > Hi, Peter. Who sells this two-component foam system? Nobody. It is so easy to do it by yourself. The Swiss cave rescue uses almost exclusively the so called 'Schwarzer Trage' (Schwarzer stretcher), this is a two piece, mummy shaped, pretty 'deep' stretcher. It is also adjustable for the victim's size. And the Swiss make a plastic bag of about the same shape out of relatively sturdy plastic (lets say at least twice the thickness than a heavy duty garbage bag). If you have some experience doing so, you may easily weld your own bag with a soldering iron (and a special tip for it) in a few minutes. These two component foams where very popular about twenty years ago for insolating many things in your house, nowadays tubes are more common, but the two component type is still available. I will look for recommended brands. I think you need an accelarator to get the thing working in 10 minutes at alpine cave temperature. The Swiss carry the componets in two Nalgene bottles, the larger one has enough space left to mix the two components in it (shake it). The you fill it into the plastic bag and distribute it (experience helps, as always). You put the bag into the stretcher and then the victim. You have some minutes time to 'adjust' the foam distribution, this is the time when the foam has its final volume but is still soft, so there is no danger that the victim gets jammed in. While reacting the foam produces a mild warmth, wich is usually comfortable. In the Schwarzer stretcher the victim is covered around the sides the whole 'thickness' of the body. As the stretcher is adjustable in the length, but not in the other dimensions, the actual foam volume may vary (not possible with a vacuum mattress), pieces of hardened foam may be cut or broken away. There were several US cavers at the cave rescue day in La Chaux de Fonds last year, maybe some of them have videoed it. Also Dr. Noel Sloan has a good slide show about the Schwarzer stretcher and the foam mattress (has he disappeared completly from cave rescue?). I'm looking for a website about these things, maybe the Swiss have one greetings from Austria, Peter --Digest-5CB185F3 Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Tue, 28 Jul 1998 03:13:45 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Tue, 28 Jul 1998 03:13:44 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Tue, 28 Jul 1998 03:13:44 -0400 (EDT) Received: from ontosystems.com (mail.ontosystems.com [166.82.129.17]) by post-ofc03.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Tue, 28 Jul 1998 03:13:42 -0400 (EDT) Message-ID: X-SMF-Message-ID: A9BCB82D01880100 X-SMF-Hop-Count: 1 Date: Tue, 28 Jul 1998 03:03:42 -0400 Sender: NCRC Discussion List From: NCRC Discussion List To: NCRC Discussion List Subject: RE: Vacuum mattresses Mime-Version: 1.0 Content-Type: text/plain; charset="ISO-8859-1" Content-Transfer-Encoding: 7BIT Precedence: Bulk X-Mailer: InterChange (Hydra) SMTP v3.12 RC6 ******************************************************************** * NOTICE! * * The following information cannot be published without the * * expressed consent of the author. * ******************************************************************** On 28 Jul 1998 at 03:03, Bill Frantz (frantz@netcom.com) wrote: On 27 Jul 1998 at 18:59, Keith Conover, M.D., FACEP (kconover+@pitt.edu) wrote: > >Hi, Peter. Who sells this two-component foam system? I'd like to >see if they have a distributor in the U.S., or would be willing to sell >some for evaluation here. Two component foam plastic is available retail from TAP Plastics, with several stores in the San Francisco Bay area. It is used for filling 55 gallon drums to turn them into buoys for boating and harbor use. You may be able to find it locally in a boating supply store. ------------------------------------------------------------------------- Bill Frantz | If hate must be my prison | Periwinkle -- Consulting (408)356-8506 | lock, then love must be | 16345 Englewood Ave. frantz@netcom.com | the key. - Phil Ochs | Los Gatos, CA 95032, USA --Digest-5CB185F3 X-cs: From: Self To: Art Fortini Subject: Re: Vacuum body splints Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Wed, 23 Sep 1998 14:33:13 -0400 Hi, Art. Your concenrs seem reasonable. To me, a log roll _onto_ a vacuum splint makes no sense for the reasons you point out. Solution is simple: place the mattress in the litter. Log roll the patient, LIFT the patient to a standing position, put the litter under, and then gently lower the patient onto the middle of the stretcher/vacuum mattress combination. An even nicer solution is to to a clothing/webbing lift with people straddling the patient (often the best you can do in a cave), and then slide the litter/vacuum mattress under people's legs, gently lowering the patient onto the mattress. May I use your email message for teaching purposes with our group? It's an excellent summary of how not to use a vacuum splint! And you might want to post this reply wherever it might do the most good. Thanks. Take care. On 22 Sep 98, at 20:24, Art Fortini wrote: > Keith, > > I posted a question to thelister a month or so ago regarding full body > vacuum splints and never quite got an answer to my question.  Since I see > your name on the Cavers' Digest every now and then (i.e., you're a caver > like me), you have a little more credibility than most.  The MD after your > name helps too. > > Anyway, the question is how well is the spine protected while getting a > person INTO a vacuum splint?  I was the simulated victim once, and the > amount of motion required to get me in was pathetic.  Logrolling someone > onto a limp noodle just doesn't work very well. > > Specifically, the main problems were these: > > 1. The device is very thick.  While trying to logroll me onto it, at one > point during the "downward" part of the roll, all of my weight was > supported on the edge of the device.  It was similar to lying on a (well > paded) log which was parallel to, but offset from, my spine.  This can't > be good if someone has a real injury. > > 2. Because of the thickness, it was impossible to get it centered > relative to me while I was > lying on my side.  After they got me supine again (with the > aforementioned lump next to my spine), they had to slide me sideways to > get me centered.  They tried sliding me up & down like what you would do > for a person on a longboard, but that didn't work.  So then they tried > dragging me sideways relative to the device, and that didn't work much > better. (But they did manage to put a nice "S" curve in my back.)  > Eventually, they just manhandled me (I only weight 130 lbs) into > position.  Not very good for the spine, but they did get me centered! > > 3. Because the device had poor rigidity, the downstroke of the logroll > resulted in a significant amount of twisting of my spine.  I think the > fact that I was offset from the centerline exacerbated the problem. > > 4. After the logroll debacle, they tried just lifting me with 4 guys and > having a 5th person slide the device under me.  This was probably the > smoother of the two options, but the amount of motion my back experienced > was, IMHO, completely unacceptable. > > While I agree that it was by far the most comfortable, and possibly most > effective, spinal immobilization device I had ever been affixed to, the > amount of manhandling required to get me in offset any possible benefit. > Quite honestly, if I got injured and saw someone coming up to me with one > of those things, I would run away from them with my last dying breath.  > (Yes, I have a pretty strong opinion after having been a simulated > victim.) > > >From what I've seen on the lister, most people seem to like them.  > Myself included if I ignore the above concerns.  Since you seem to be a > supporter, please help me out.  How do YOU get people into one of these > things without bending them over a log or pushing/pulling them sideways?  > Has anyone ever done a retrospective study on the efficacy of these > devices? > > FYI, I've been an (ambulance based) EMT for almost 15 years and with SAR > for the last 7.  I am well aware that nothing currently in use is > perfect.  Wooden backboards, scoops, miller boards, KEDs, etc, all have > limitations.  In the wilderness, things get even more out of control > because the ground is NEVER flat.  At least in the urban setting, they > land on flat ground once in a while.  But if people had such a hard time > making the vacuuim splint work under ideal conditions, I have to be > skeptical. > > I've seen studies about the amount of motion caused by the logroll > maneuver.  Ditto for the use of a scoop stretcher.  Ditto for logrolling > them once they are secured and vomit.  Nothing currently in use solves all > the world's problems, and I don't expect the vacuum device to so either.  > As I see it, the key is CAUSE as little motion as possible during > application of the device, and ALLOW as little motion as possible once > they are secured.  While I believe the vacuum splint excells on the latter > point, I feel it is exceedingly poor one the former. > > So those are my ramblings.  Please try to make a convert out of  me.  > Thanks a bunch! > > - Art Fortini >   >   >   >   >   > > --Digest-5CB185F3-- Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 12:42:46 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 12:42:12 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 12:42:11 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 12:41:09 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 12:40:51 -0400 (EDT) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 12:40:45 -0400 (EDT) Received: from micron (ehdup-v-3.rmt.net.pitt.edu [136.142.24.13]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 12:40:39 -0400 (EDT) Message-Id: <199909251640.MAA27423@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: Ed , wilderness-emergency-medicine@list.pitt.edu Date: Sat, 25 Sep 1999 12:42:11 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Full body Vacume splints In-reply-to: <71CC974D48FCD111825300A0C990B705047D10@host-208-170-96-33.tlsinc.com> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P79660.CNM Allegheny Mountain Rescue Group has a MDI mattress and is generally happy with it. I'll post some MIME digests of some relevant messages from various lists under separate cover. You can also search the list archives at www.wemsi.org for older messages on the topic. On 25 Sep 99, at 11:28, Ed wrote: > Greetings from North Alabama. Have a question for the list about the full > body vacume splints for use in rough country SAR work and Cave Rescue. > > What is available that people are actually using in the field (other than > sleeping, I mean conserving your energy at the cache, Keith :) ) and are > they a worthwhile addition vs the cost and durability ? > > What units would the list advise using or not using and why. I am trying > to work up some justification for adding one to our gear cache. > > Thanks for the help. > > > Ed Nicholas, EMT-D > Chief of Operations, > Huntsville Cave Rescue Unit, Inc > Operations Officer, > Huntsville Emergency Medical Services, Inc > High Angle - Rough Terrain (HART) Team > Huntsville, Alabama > KD4WNJ > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 12:42:21 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 12:41:48 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 12:41:48 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 12:41:01 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 12:40:43 -0400 (EDT) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 12:40:39 -0400 (EDT) Received: from micron (ehdup-v-3.rmt.net.pitt.edu [136.142.24.13]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sat, 25 Sep 1999 12:40:37 -0400 (EDT) Message-Id: <199909251640.MAA27414@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Sat, 25 Sep 1999 12:40:13 -0400 MIME-Version: 1.0 Content-type: Multipart/Digest; boundary=Digest-2AE61646 Subject: W-EMED more vacuum mattress messages X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395328 0 1 P09510.CNM --Digest-2AE61646 X-cs: From: Self To: sar-l@listserv.islandnet.com,asrc-field@virginia.edu Subject: MDI vacuum mattress and V-Vac suction device Cc: mra@altadena.net,NCRC@ontosystems.com (NCRC Discussion List),Allegheny Mtn. Rescue Maillist Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/enriched; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Mon, 21 Sep 1998 20:25:18 -0400 Just got a MDI vacuum mattress for Allegheny Mountain Rescue Group from Moore Medical (1-800-234-1464 x5431, Manufacturer's PN 81-A5000, Moore Medical PN 53719, Full Mattress Set: mattress, pump, adapter, case, $360.) Didn't like the light but BIG pump that comes with it. Got a lightweight V-Vac handheld hand-powered suction device (from Kim Rosser at Parr Emergency Product Sales, P.O. Box 7, Galloway, OH 43119, 412-926-3644, as I remember it was about $40). Turns out that if you cut the little adapter off the end of the MDI pump's hose, it fits perfectly into the suction end of the V-Vac (almost as if maybe it was designed that way -- maybe it was). There is a little hole in the rim of the adapter, and I put a piece of small accessory cord through this, tied a stopper knot, and attached the other end to the frame of the V-vac so it can't (well, less likely to) get lost. Takes about 90-100 "pumps" with the V-vac to evacuate the splint. Not bad. So it's lighter, smaller, and also gives you airway suction. What a deal! I'll be ordering some extras of these tips from MDI if I can - those of you who have MDI mattresses (e.g., Blue Ridge Mountain Rescue Group -- saw three of them in your locker a couple of weeks ago) might want to look into this. Medical Devices International is reachable at (800) 323-9035 Take care, all. --Digest-2AE61646 X-cs: From: Self To: sar-l@listserv.islandnet.com,NCRC Discussion List Subject: Re: MDI vacuum mattress and V-Vac suction device Cc: mra@altadena.net,Allegheny Mtn. Rescue Maillist Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Tue, 22 Sep 1998 21:55:08 -0400 On 21 Sep 98, at 20:53, Buddy Lane wrote: > Also note that MDI sells a smaller metal pump, which we use at CHCRS. > > Please be advised that the plastic pump that Keith writes about, will > NOT work in cold conditions!! We found this out the hard way; several > years ago. > > I would advise all, to check your pump for cold weather use, no matter > what the type. In addition keep the O-ring coated with silicone > grease. > > Buddy Lane, Captain > Chattanooga Hamilton County Rescue Service > Cave / Cliff Unit Hi, Buddy. What's the problem in cold? It may be that redesign of the V-Vac over the years has fixed this. Airway suction that doesn't work in the cold can be a problem, too. I've seen a small, handheld suction pump device similar to the V-vac in size and design but much heavier -- not usable for airway suction, it looks as though it's designed for vacuum splints. Blue Ridge Mountain Rescue Group in Charlottesville, VA, has one. Is that the small MDI pump you're talking about? Thanks. --Digest-2AE61646-- Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 25 Sep 1999 12:42:15 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 25 Sep 1999 12:41:42 -0400 (EDT) Received: via switchmail; Sat, 25 Sep 1999 12:41:42 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 25 Sep 1999 12:40:55 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 25 Sep 1999 12:40:37 -0400 (EDT) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 25 Sep 1999 12:40:33 -0400 (EDT) Received: from micron (ehdup-v-3.rmt.net.pitt.edu [136.142.24.13]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sat, 25 Sep 1999 12:39:57 -0400 (EDT) Message-Id: <199909251639.MAA27263@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Sat, 25 Sep 1999 12:38:35 -0400 MIME-Version: 1.0 Content-type: Multipart/Digest; boundary=Digest-750E9A4E Subject: W-EMED vacuum mattress messages X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395328 0 1 P7AD50.CNM --Digest-750E9A4E Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Thu, 27 Aug 1998 18:34:37 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Thu, 27 Aug 1998 18:34:35 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Thu, 27 Aug 1998 18:34:35 -0400 (EDT) Received: from ns.altadena.net (ns.altadena.net [206.126.144.2]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Thu, 27 Aug 1998 18:34:33 -0400 (EDT) Received: (from majordom@localhost) by ns.altadena.net (8.9.1/8.8.6) id PAA01950 for mra-outgoing; Thu, 27 Aug 1998 15:28:20 -0700 (PDT) X-Authentication-Warning: ns.altadena.net: majordom set sender to owner-mra@altadena.net using -f Received: from merlin.sedona.net (root@merlin.sedona.net [204.245.58.252]) by ns.altadena.net (8.9.1/8.8.6) with ESMTP id PAA01924 for ; Thu, 27 Aug 1998 15:28:16 -0700 (PDT) Received: from [204.245.58.60] (client51.sedona.net [204.245.58.60]) by merlin.sedona.net (8.9.1/8.8.5) with SMTP id PAA28556; Thu, 27 Aug 1998 15:27:55 -0700 (MST) Message-Id: <199808272227.PAA28556@merlin.sedona.net> Subject: Re: vacuum splints Date: Thu, 27 Aug 98 14:47:23 -0000 x-mailer: Claris Emailer 1.1 From: Ropes That Rescue To: , "MRA" , "Jim Koile" Mime-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Sender: owner-mra@altadena.net Precedence: bulk We use the Hartwell Medical full bdy air splint from Bound Tree EMS. It is very rugged and I like the air orifice at ether end. Sincerely yours---in safety, Reed Thorne Ropes That Rescue Ltd. eMail: ropes@sedona.net Web Site: http://www.sedona.net/ropes " T h e A R T o f C l e a n R i g g i n g " --Digest-750E9A4E Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Fri, 28 Aug 1998 01:05:01 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Fri, 28 Aug 1998 01:05:00 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Fri, 28 Aug 1998 01:04:59 -0400 (EDT) Received: from ns.altadena.net (ns.altadena.net [206.126.144.2]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 28 Aug 1998 01:04:56 -0400 (EDT) Received: (from majordom@localhost) by ns.altadena.net (8.9.1/8.8.6) id VAA13346 for mra-outgoing; Thu, 27 Aug 1998 21:58:57 -0700 (PDT) X-Authentication-Warning: ns.altadena.net: majordom set sender to owner-mra@altadena.net using -f Received: from rkymtnhi.com (rkymtnhi.com [204.131.46.200]) by ns.altadena.net (8.9.1/8.8.6) with ESMTP id VAA13342 for ; Thu, 27 Aug 1998 21:58:53 -0700 (PDT) Received: from Frank.rkymtnhi.com (204.131.46.122) by rkymtnhi.com with SMTP (Eudora Internet Mail Server 1.1.2); Thu, 27 Aug 1998 22:58:15 -0600 Message-ID: <35E63774.1A07@rkymtnhi.com> Date: Thu, 27 Aug 1998 22:52:04 -0600 From: "Frank J. Nieto" X-Mailer: Mozilla 3.01C-KIT (Win95; I) MIME-Version: 1.0 To: mra lister Subject: Vacuum Mattress Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-mra@altadena.net Precedence: bulk Re:Vacuum mattress. We have been using the Vac Mattress (Bean Bag as we call it) for approximately 3 years,, we have found it to be very effective for back country evacuation of trauma patients. It provides a rigid support for the patients spine and allows for the hollows of the body that a typical backboard doesnt. It is much more comfortable for the patient for extended extrications. We used it for our MRA certification in 1995 and the patient said afterwards that it was the most comfortable that she had ever been for a certification. Some Drawbacks: 1. you need a backup. 2. When it springs a leak it is useless as a spinal immobilization device. 3. it can be repaired, but hartwell guards the kits like gold.. it took several weeks to get a kit and then it would only cover 2 holes. 4. It does have some flex to it,, so i reccomend using it in conjunction with a backboard under it for rigidity. 5. We have had our splint in repair with Hartwell for about 5 weeks , not a good turnaround time, hence the need for a spare. 6. They cost about $500.00 as opposed to $150.00 for a bb. Conclusion: The Hartwell Vacuum Splint is a very useful tool, but you must make some changes in your regular SOP's and training. as well as make sure you protect it both in the field and in storage on your truck so as not to rub holes into the splint. Frank Nieto, NREMT-P Grand County SAR, Field Director --Digest-750E9A4E Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Fri, 28 Aug 1998 08:56:24 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Fri, 28 Aug 1998 08:56:22 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Fri, 28 Aug 1998 08:56:22 -0400 (EDT) Received: from ns.altadena.net (ns.altadena.net [206.126.144.2]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 28 Aug 1998 08:56:20 -0400 (EDT) Received: (from majordom@localhost) by ns.altadena.net (8.9.1/8.8.6) id FAA26422 for mra-outgoing; Fri, 28 Aug 1998 05:47:03 -0700 (PDT) X-Authentication-Warning: ns.altadena.net: majordom set sender to owner-mra@altadena.net using -f Received: from shadow.dimensional.com (root@shadow.pagan.net [206.124.26.20]) by ns.altadena.net (8.9.1/8.8.6) with ESMTP id FAA26418 for ; Fri, 28 Aug 1998 05:46:59 -0700 (PDT) Received: from oemcomputer (p08.pm3c04.pm.dimcom.net [206.124.5.201]) by shadow.dimensional.com (8.9.1/8.9.1) with SMTP id GAA04399 for ; Fri, 28 Aug 1998 06:46:57 -0600 (MDT) From: "Jeff Sparhawk" To: "mra lister" Subject: RE: Vacuum Mattress Date: Fri, 28 Aug 1998 06:46:04 -0600 Message-ID: <000101bdd281$d2099760$a5057cce@oemcomputer> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Importance: Normal X-MimeOLE: Produced By Microsoft MimeOLE V4.72.3155.0 In-Reply-To: <35E63774.1A07@rkymtnhi.com> Sender: owner-mra@altadena.net Precedence: bulk My foggy memory seems to be telling me that a good old bike tube patch kit works well on punctured bean bags. Also, from fairly extensive testing over the last 10ish years RMRG has chosen to go with the Germa bags. I think you have to go to Sweden to get them, but they are far superior to any of the other bags around. Significant factors are outside dimensions of bag, number of beans, size of beans, reliability of valve and reliability / ease of use of the pump. --Jeff Sparhawk Some Drawbacks: 1. you need a backup. 2. When it springs a leak it is useless as a spinal immobilization device. 3. it can be repaired, but hartwell guards the kits like gold.. it took several weeks to get a kit and then it would only cover 2 holes. 4. It does have some flex to it,, so i reccomend using it in conjunction with a backboard under it for rigidity. 5. We have had our splint in repair with Hartwell for about 5 weeks , not a good turnaround time, hence the need for a spare. 6. They cost about $500.00 as opposed to $150.00 for a bb. --Digest-750E9A4E Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Fri, 28 Aug 1998 11:31:12 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@pop.pitt.edu; Fri, 28 Aug 1998 11:31:09 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Fri, 28 Aug 1998 11:31:09 -0400 (EDT) Received: from ns.altadena.net (ns.altadena.net [206.126.144.2]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 28 Aug 1998 11:31:07 -0400 (EDT) Received: (from majordom@localhost) by ns.altadena.net (8.9.1/8.8.6) id IAA00572 for mra-outgoing; Fri, 28 Aug 1998 08:22:36 -0700 (PDT) X-Authentication-Warning: ns.altadena.net: majordom set sender to owner-mra@altadena.net using -f Received: from preytor.ecentral.COM (root@preytor.ecentral.com [206.64.70.3]) by ns.altadena.net (8.9.1/8.8.6) with ESMTP id IAA00568 for ; Fri, 28 Aug 1998 08:22:32 -0700 (PDT) Received: from Default (ppp64.ecentral.com [206.64.70.64]) by preytor.ecentral.COM (8.8.7/8.6.9) with SMTP id JAA14840 for ; Fri, 28 Aug 1998 09:19:59 -0600 Date: Fri, 28 Aug 1998 09:19:59 -0600 Message-Id: <199808281519.JAA14840@preytor.ecentral.COM> X-Sender: hmpaul@pop.ecentral.com X-Mailer: Windows Eudora Pro Version 2.1.2 Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: mra@altadena.net From: "Howard M. Paul" Subject: Re: Vacuum Mattress Sender: owner-mra@altadena.net Precedence: bulk At 10:52 PM 8/27/98 -0600, you wrote: >We used it for our MRA certification in 1995 and the patient said >afterwards that it was the most comfortable that she had ever been for a >certification. > >Some Drawbacks: > >1. you need a backup. >2. When it springs a leak it is useless as a spinal immobilization >device. >3. it can be repaired, but hartwell guards the kits like gold.. it took >several weeks to get a kit and then it would only cover 2 holes. >4. It does have some flex to it,, so i reccomend using it in >conjunction with a backboard under it for rigidity. >5. We have had our splint in repair with Hartwell for about 5 weeks , >not a good turnaround time, hence the need for a spare. >6. They cost about $500.00 as opposed to $150.00 for a bb. > >Conclusion: > >The Hartwell Vacuum Splint is a very useful tool, but you must make some >changes in your regular SOP's and training. as well as make sure you >protect it both in the field and in storage on your truck so as not to >rub holes into the splint. > >My foggy memory seems to be telling me that a good old bike tube patch kit >works well on punctured bean bags. Also, from fairly extensive testing over >the last 10ish years RMRG has chosen to go with the Germa bags. I think you >have to go to Sweden to get them, but they are far superior to any of the >other bags around. Significant factors are outside dimensions of bag, >number of beans, size of beans, reliability of valve and reliability / ease >of use of the pump. Jeff and Frank: Having evaluated both the Hartwell brand and MDI/Germa brand bean bags before buying, I agree with Jeff that the MDI/Germa are superior to the Hartwell. Hartwell copied the Germa brand bag using lower quality material -- I assume to come up with a less expensive product. I was unimpressed with the projected durability of the material *for SAR & mountain rescue.* It ought to be perfectly adequate for ambulance-based EMS. It is my opinion as well Jeff, that the red bags -- the MDI/Germa -- have a much tougher fabric. I know of only one air leak in all our bags in three years. Jeff, you're right about patches. The Germa patch kit is very much like a vulcanized rubber patch kit for bike tubes. Now for brand history. The Germa bag was not manufactured here in the states when it was first introduced her. The company president was a Swede who lived in Loveland, Colo. He could not find a US fabricator that could meet his quality control standards. The import duty drove the price skyward. Hence, he sold the US manufacturing and sales rights to MDI -- so the MDI bag *is* the Germa brand bag (I've seen both). Howard _______________________________ Howard M. Paul Photography for Communication and Commerce