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Remote controlled simulation mannequins are nothing new to medical training. In EMS we’ve been using them for years and each iteration comes with a host of new features. The military’s new Medi-Man dummies, however, sound like they really hit the mark when it comes to accuracy:

The dummies are remotely controlled by the instructors to simulate particular injuries. Some have gaping belly wounds or spray blood – actually a red fluid that can be chemically tweaked to reflect different injuries – from severed limbs. Others might be breathing irregularly, their pump-activated chests rising on just one side. “A trainer can change a dummy’s behavior according to trainees’ actions,” says Staff Sergeant Glenn Gonzalez, noncommissioned officer in charge of the facility.

That’s only the beginning, though. The real breakthrough may be in the intensity of the scenarios. Over at Fort Bragg, it sounds like these dummies are getting the snot beaten out of them on a daily basis while the Army’s 82nd Airborne Division trains for deployments in Iraq.

Teams of six trainees race down a path in Fort Bragg’s forest. They must treat and carry any “casualties” they encounter along the way – usually two per team. Obstacles include barbed wire, trenches and holes filled with mud. Instructors throw training grenades to keep the medics’ heads down. “I guarantee you they’re exhausted by the time they reach this point,” Gonzalez says, standing near the barbed-wire obstacle. The idea, he says, is to make sure medics can make smart decisions about treating casualties even while scared and tired. Gonzalez and his fellow instructors have trained around 1,800 medics and doctors in the past year.

So, when these things make their way into the private-sector end of medical education they will have been well tested and, hopefully, most of the durability issues will have been worked out. The only people I know who beat on training equipment more than EMS folks? Military folks.

The proof, perhaps, is in the numbers:

“There have been around 2,400 soldiers killed in Iraq due to enemy action,” says Captain Earnhardt, division spokesman. “The reason that’s 2,400 and not 10,000 is this training.”

Via War is Boring

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Oh, those Canadians are at it again with all of their inventing and politeness. Well, this has nothing to do with politeness, unless your idea of “polite” is ensuring effective chest compression rate and depth during CPR.

Two engineering students from McMaster University have invented what they believe is the solution: the CPR Glove. They have entered a prototype of their innovative device in this year’s Ontario Engineering Competition for university students being held in Ottawa from Feb. 9 to Feb. 11. They are part of a 17-member team competing from McMaster.

The black, one-size-fits-all CPR Glove features a series of sensors and chips that measure the frequency and depth of compressions being administered during CPR and outputs the data to a digital display.

To be effective, compressions must be given at the rate of 100 per minute and at a depth of four to five centimeters.

A study measuring retention of CPR training published in the Journal of the American Medical Association showed that 59 per cent of the time, compressions were applied at the rate of only 80 per minute. Thirty-seven per cent of the time, the compressions were too shallow. CPR administered at these levels is not likely to save a person in cardiac arrest.

What I find particularly interesting about this is that it seems effective in many different ways: as a training adjunct, as a real-time indicator of compression effectiveness, and as an interface device for AEDs designed for bystander-use. Think of the effectiveness of cues like “deeper” or “harder” . . . well, you get the point.

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File this one under “you must be kidding me”:

For years services have re-used single use devices like cervical collars, head-immobilizers, and tourniquets in an effort to reduce waste keep costs down. The theory was, “a few squirts or disinfectant and they’re good as new.” Historically durable stainless steel surgical devices like forceps and spreaders have been steam autoclaved or otherwise sterilized before reuse. It is prohibitively expensive for facilities to just throw away durable equipment after a single use but they are designed to be used over and over unlike fragile tracheal and endotracheal tubes which are made of plastic or other soft materials.

This is the first that I have heard of sterilizing and reusing single-use invasive medical devices like endotracheal tubes.

Reprocessed devices are soaked in sterilizing solutions, disassembled, blasted clean with a fine powder, reassembled and inspected, then packaged, sterilized and resealed. On average, they’re reused three to six times.

Today, the AP reports on federal legislation that will address the increasing use of “reprocessed medical devices” and the medical and ethical complications that arise such as those suffered by Sean Van Duyn after an Orlando hospital placed a reprocessed single-use only tube in his tracheal stoma. There is also the issue of informed consent as Van Duyn’s parents, for example, were never told that the devices labelled “single use only” were in fact used on other patients, up to six other patients.

Federal regulators say reprocessing is safe, but original device manufacturers say they can’t guarantee recycled products will work correctly — and that they are wrongly blamed for malfunctions and patient harm caused by reprocessing.

A federal law taking effect Tuesday, requiring reprocessors to put their company name on recycled devices as well as the packaging, could help determine who’s at fault when problems occur. For devices too small to mark, detachable stickers could be transferred to the patient’s chart.

“That’s like a ‘Sue Me!’ sticker,” and may not be used much, said Josephine Torrente, a lawyer and biomedical engineer who consults for device manufacturers.

The practice, that reportedly saves hospitals 50% over purchasing new equipment, has become so prevalent that there is even a professiona organization that represents the reprocessing companies, the Association of Medical Device Reprocessors. Their position is that the, “products are totally safe because each item is inspected before being shipped.”
The argument has, however, extended past the bounds of ethical medical practice and solid patient advocacy and has become one of copyright.

Johnson & Johnson subsidiary Ethicon Endo-Surgery is suing the biggest reprocessor, Ascent Healthcare Solutions, for trademark infringement over reprocessing its single-use devices.

“It is impossible to reuse them,” said Robert O’Holla, J&J’s head of regulatory affairs for medical devices, because they are not designed to be taken apart for cleaning. Yet J&J gets complaints from customers about problems with devices showing excessive wear or bleach on them — signs of reprocessing.

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Researchers at the Georgia Institute of Technology’s GTRI have developed an ultrasonic device that promises to make difficult veinipunctures and other peocedures that require vascular access much easier. The unit, designed specifically for use by paramedics and EMTs in the field uses the Doppler Effect to assist in determinig the key location, depth, and angles required to access hard to find veins in patients with severe bruising, burns, or a history of vein-destroying diabetes.

“Although the use of Doppler technology isn’t new, the novel aspect of our vein finder is the system’s design, which makes it both portable and economical,” says Peter Rogers, a professor in Georgia Tech’s School of Mechanical Engineering.

The patent-pending vein finder is composed of two parts: A reusable unit houses the electronics and signal processing components, while a disposable coupler box holds a reflector and needle guide. The needle guide is positioned parallel to the sound beam being transmitted by a transducer in the device’s reusable section.

Dehydration and cardiac arrest also present challenges which are compounded by the need for immediate vascular access with large-bore catheters. The time saved by using the acoustic vein finder could save numerous lives (and Quality Improvement statistics). Researchers promise that it will be small and inexpensive:

Once the system is successfully adapted for humans, data processing and electronics will be miniaturized in a prototype for field-testing. The researchers envision the final product will be about the size of a fat fountain pen.

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We often refer to the abdomen as “the big gray box” in the prehospital setting because, before the advent of portable ultrasound units like those by SonoSite that are sturdy and inexpensive enough for prehospital use, the only way to differentiate between a “surgical abdomen” that required immediate intervention by a trauma surgeon and an uninjured one were vague diagnostic signs and symptoms like “tender” and “rigid.” The value of early bedside ultrasound exams such as FAST (focused abdominal sonography for trauma) have been proven time and again in emergency departments but until the last few years the value of training EMTs and paramedics to perform the exams in the field was questionable.

There are a few interesting and very promising studies from Europe that deal the with feasability and diagnostic value of out-of-hospital ultrasonography for the evaluation of traumatic and atraumatic abdominal injuries. The initial results make a rather striking case for expanding research if not implementation of a FAST exam (or similar) protocol for use in ambulance and air-medical operations.

Pre-hospital ultrasound when applied by an proficient examiner using a goal-directed, time sensitive protocol is feasible, does not delay patient management and provides diagnostic and therapeutic benefit. Further studies are warranted to identify the exact indications and role of pre-hospital sonography.

More after the jump. Continue Reading »

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