The effect of power stretchers on occupational injury rates in an urban emergency medical services system.

BACKGROUND: To examine occupational injury rates in a dual-response emergency medical services (EMS) system before and after implementation of a power-lift stretcher system. METHODS: The seasonally-adjusted occupational injury rate was estimated relative to medical call volume (per 1000 calls) and workers (per 100 FTEs) from 2009 to 2019, and stratified by severity (lost-time, healthcare only), role (EMS, FIRE) and type (patient-handling). Power-lift stretchers were adopted between 2013 and 2015. Preinjury versus postinjury rates were compared using binomial tests. Interrupted time series (ITS) analysis was used to estimate the trend and change in injuries related to patient-handling, with occupational illnesses serving as control. RESULTS: Binomial tests revealed varied results, with reductions in the injury rate per 1000 calls (-14.0%) and increases in the rate per 100 FTEs (+14.1%); rates also differed by EMS role and injury severity. ITS analysis demonstrated substantial reductions in patient-handling injuries following implementation of power-lift stretchers, both in the injury rate per 1000 calls (-50.4%) and per 100 FTEs (-46.6%), specifically among individuals deployed on the ambulance. Injury rates were slightly elevated during the winter months (+0.8 per 100 FTEs) and lower during spring (-0.5 per 100 FTEs). CONCLUSIONS: These results support the implementation of power-lift stretchers for injury prevention in EMS systems and demonstrate advantages of ITS analysis when data span long preintervention and postintervention periods.

[Design and analysis of shoulder type exoskeleton stretcher for individual soldier].

For the transportation process of rescuing wounded personnel on naval vessels, a new type of shoulder type exoskeleton stretcher for individual soldier was designed in this paper. The three-dimensional model of the shoulder type exoskeleton stretcher for individual soldier was constructed using three dimensional modeling software. Finite element analysis technique was employed to conduct statics simulation, modal analysis, and transient dynamics analysis on the designed exoskeleton stretcher. The results show that the maximum stress of the exoskeleton stretcher for walking on flat ground is 265.55 MPa, which is lower than the allowable strength of the fabrication material. Furthermore, the overall deformation of the structure is small. Modal analysis reveals that the natural frequency range of the exoskeleton stretcher under different gait conditions is 1.96 Hz to 28.70 Hz, which differs significantly from the swing frequency of 1 Hz during walking. This indicates that the designed structure can effectively avoid resonance. The transient dynamics analysis results show that the maximum deformation and stress of exoskeleton stretcher remain within the safety range, which meets the expected performance requirements. In summary, the shoulder type exoskeleton stretcher for individual soldier designed in this study can solve the problem of requiring more than 2 people to carry for the existing stretcher, especially suitable for narrow spaces of naval vessels. The research results of this paper can provide a new solution for the rescue of wounded personnel on naval vessels.

Snake optimizer LSTM-based UWB positioning method for unmanned crane.

Position determination is a critical technical challenge to be addressed in the unmanned and intelligent advancement of crane systems. Traditional positioning techniques, such as those based on magnetic grating or encoders, are limited to measuring the positions of the main carriage and trolley. However, during crane operations, accurately determining the position of the load becomes problematic when it undergoes swinging motions. To overcome this limitation, this paper proposes a novel Ultra-Wide-Band (UWB) positioning method for unmanned crane systems, leveraging the Snake Optimizer Long Short-Term Memory (SO-LSTM) framework. The objective is to achieve real-time and precise localization of the crane hook. The proposed method establishes a multi-base station and multi-tag UWB positioning system using a Time Division Multiple Access (TDMA) combined with Two-Way Ranging (TWR) scheme. This system enables the acquisition of distance measurements between the mobile tag and UWB base stations. Furthermore, the hyperparameters of the LSTM network are optimized using the Snake Optimizer algorithm to enhance the accuracy and effectiveness of UWB positioning estimation. Experimental results demonstrate that the SO-LSTM-based positioning method yields a maximum positioning error of 0.1125 meters and a root mean square error of 0.0589 meters. In comparison to conventional approaches such as the least squares method (LS) and the Kalman filter method (KF), the proposed SO-LSTM-based positioning method significantly reduces the root mean square error (RMSE) by 63.39% and 58.01%, respectively, while also decreasing the maximum positioning error (MPE) by 60.77% and 52.65%.

Comparison of different techniques for prehospital cervical spine immobilization: Biomechanical measurements with a wireless motion capture system.

BACKGROUND: Various rescue techniques are used for the prehospital transport of trauma patients. This study compares different techniques in terms of immobilization of the cervical spine and the rescue time. METHODS: A wireless motion capture system (Xsens Technologies, Enschede, The Netherlands) was used to record motion in three-dimensional space and the rescue time in a standardized environment. Immobilization was performed by applying different techniques through different teams of trained paramedics and physicians. All tests were performed on the set course, starting with the test person lying on the floor and ending with the test person lying on an ambulance cot ready to be loaded into an ambulance. Six different settings for rescue techniques were examined: rescue sheet with/without rigid cervical collar (P1S1, P1S0), vacuum mattress and scoop stretcher with/without rigid cervical collar (P2S1, P2S0), and long spinal board with/without rigid cervical collar (P3S1, P3S0). Four time intervals were defined: the time interval in which the rigid cervical collar is applied (T0), the time interval in which the test person is positioned on rescue sheet, vacuum mattress and scoop stretcher, or long spinal board (T1), the time interval in which the test person is carried to the ambulance cot (T2), and the time interval in which the ambulance cot is rolled to the ambulance (T3). An ANOVA was performed to compare the different techniques. RESULTS: During the simulated extrication procedures, a rigid cervical collar provided biomechanical stability at all angles with hardly any loss of time (mean angle ranges during T1: axial rotation P1S0 vs P1S1 p<0.0001, P2S0 vs P2S1 p<0.0001, P3S0 vs P3S1 p<0.0001; lateral bending P1S0 vs P1S1 p = 0.0263, P2S0 vs P2S1 p<0.0001, P3S0 vs P3S1 p<0.0001; flexion/extension P1S0 vs P1S1 p = 0.0023, P2S0 vs P2S1 p<0.0001). Of the three techniques examined, the scoop stretcher and vacuum mattress were best for reducing lateral bending in the frontal plane (mean angle ranges during T1: P2S1 vs P3S1 p = 0.0333; P2S0 vs P3S0 p = 0.0123) as well as flexion and extension in the sagittal plane (mean angle ranges during T2: P1S1 vs P2S1 p<0.0001; P1S0 vs P2S0 p<0.0001). On the other hand, the rescue sheet was clearly superior in terms of time (total duration P1S0 vs P2S0 p<0.001, P1S1 vs P2S1 p<0.001, P1S0 vs P3S0 p<0.001, P1S1 vs P3S1 p<0.001) but was always associated with significantly larger angular ranges of the cervical spine during the procedure. Therefore, the choice of technique depends on various factors such as the rescue time, the available personnel, as well as the severity of the suspected instability.

Carrying life and death: the daily routine of hospital stretcher bearers in the context of COVID-19. / Carregando vidas e mortes: o cotidiano de trabalho de maqueiros hospitalares no contexto da COVID-19.

This article aims to analyze the daily work of stretcher bearers in a Federal Teaching and Research Hospital in the context of COVID-19, exploring the subjective aspects related to working in constant contact with death and the invisibility to which these workers are subjected. The proposed discussion stems from a more comprehensive qualitative investigation. The main methodological resource of the empirical research was the direct observation in the daily work that allowed one to capture nuances of the work in a dialectical analysis with the workers. The data obtained were analyzed from the perspective of Social Psychology of Work. Transience and invisibility were identified as important categories of analysis of this daily work, where the process of becoming a stretcher-bearer was marked by aspects of precariousness of work and vulnerability of the worker. Working in contact with death was also understood as a factor of invisibility, where the creation of bonds and humor appeared as a collective strategy to face the harshness of work. This article concluded by examining the importance of looking at the subjective aspects of the work carried out by stretcher bearers, as well as the expansion of research on the subject.

Este artigo analisa o cotidiano de trabalho de maqueiros em um Hospital Federal de Ensino e Pesquisa no contexto da COVID-19, explorando os aspectos subjetivos referentes ao trabalhar em constante contato com a morte e à invisibilidade a que esses trabalhadores estão submetidos. Adotamos o referencial da Psicologia Social do Trabalho, como técnica de pesquisa foram feitas observação direta no cotidiano de trabalho e rodas de conversa com os maqueiros, o que permitiu capturar nuances do trabalho numa análise dialética junto aos trabalhadores. A transitoriedade e invisibilidade foram identificadas enquanto importantes categorias de análise desse cotidiano trabalho, onde o processo de tornar-se maqueiro era marcado por aspectos de precarização do trabalho e vulnerabilização do trabalhador. O trabalho em contato com a morte também foi compreendido como um fator de invisibilidade, onde a criação de vínculos e humor emergem como estratégias coletiva de enfrentamento da dureza inerente ao trabalho. Conclui-se a importância de olhar para os aspectos subjetivos do trabalho realizado pelos maqueiros, assim como a ampliação de pesquisas sobre a saúde desses trabalhadores.

Optical nanofiber stretcher.

Piezoelectric stretching of optical fiber is a technique that enables the creation of optical delays of a few picoseconds; this is useful in a variety of applications in interferometry or optical cavities. Most commercial fiber stretchers involve lengths of fiber of a few tens of meters. Using a 120-mm-long optical micro-nanofiber, we can create a compact optical delay line that achieves tunable delays of up to 19 ps at telecommunication wavelengths. The high elasticity of silica and the micron-scale diameter allow this significant optical delay to be achieved with low tensile force while keeping the overall length short. We successfully report both static and dynamic operation of this novel, to the best of our knowledge, device. It could find application in interferometry and laser cavity stabilization, where short optical paths and strong resistance to the environment would be required.

The effect of foot-stretcher position and stroke rate on ergometer rowing kinematics.

Rowing ergometers are popular tools for general fitness and competitive crew teams. The effect of the equipment set up on the rowing stroke has received limited attention. This study aimed to determine the effects of altering the foot-stretcher position on rowing kinematics across different stroke rates. Eleven college-level rowers took part in this study. A rowing ergometer was modified to allow the height and angle of the foot-stretcher to be adjusted. Seven foot-stretcher positions were tested, each at rates of 22, 26, and 32 strokes per minute. Sagittal plane kinematic waveforms were compared between conditions for all major joints using statistical parametric mapping, and temporal variables were assessed (p < 0.05). Stroke rate was found to affect kinematic patterns for all joints. The effect of the foot-stretcher position was limited to the ankle and hip. Similarly, the timing of events during the rowing stroke was affected by the stroke rate, but not foot position. These results indicate that while some limited changes to the stroke technique can be caused by altering the foot-stretcher position, the changes were largely compensated for by the rowers and are generally smaller than differences between stroke rates.

Reply to Gurney, T.; Ronca, F. Comment on "Hack et al. Effect of Guarana (Paullinia cupana) on Cognitive Performance: A Systematic Review and Meta-Analysis. Nutrients 2023, 15, 434".

We thank Dr. Gurney for his interest and comment [...].

Cryptic diversity in Zoraptera: Latinozoros barberi (Gurney, 1938) is a complex of at least three species (Zoraptera: Spiralizoridae).

The order Zoraptera contains relatively few species, but current molecular phylogenetic studies suggest an unexpectedly high level of cryptic diversity in the order with many overlooked species based on morphology alone. Latinozoros Kukalova-Peck & Peck, 1993 represents the only genus of monotypic Latinozorinae (Zoraptera: Spiralizoridae) with only one species described, L. barberi (Gurney, 1938), until now. Although this species has been repeatedly reported from a number of locations in South and Central America, it is likely a complex of unrecognized species. Here, we present a molecular phylogenetic reconstruction revealing three genetically distinct lineages in Latinozoros, and we also present detailed morphological comparisons that prove the species status of Latinozoros cacaoensis sp. nov. from French Guiana and L. gimmeli sp. nov. from the Dominican Republic, Trinidad and Panama. The results indicate that the species previously referred to L. barberi is actually a species complex that includes L. barberi, the new species described here, and perhaps other species.

Cell Stretcher Assay to Analyze Mechanoresponses to Cyclic Stretching.

In their natural environment, most cells and tissues are continuously exposed to cyclic mechanical strain. Sensing these stimuli by mechanosensory proteins and subsequent conversion into a variety of biological responses (referred to as mechanotransduction) are key processes for tissue homeostasis, survival, and differentiation. Perturbations of underlying signaling pathways lead to severe diseases in vivo (Urciuoli E, Peruzzi B, Int J Mol Sci 21(24). https://doi.org/10.3390/ijms21249426, (2020)). In addition, cellular mechanoresponses to cyclic stretching of an isolated single cell differ from those of a cell monolayer, network, or even three-dimensional tissue. Since these processes depend on various physical and biological parameters, the development of a precise, well-characterized, and highly reproducible but also easily tunable stretcher assay is indispensable. Here, we describe the fabrication of defined elastic substrates and their application in cyclic stretching of cultured cells in a custom-made cell stretcher device. We focus on the detailed description of the system and provide a possibility for mechanoresponse characterization, using the analysis of actin stress fiber orientation as exemplary mechanoresponse to cyclic stretching of adherent cells.

From stretcher bearer to practitioner: A brief narrative review of the history of the Anglo-American paramedic system.

BACKGROUND: This narrative review presents a brief chronological history of the Anglo-American paramedic system, combining decades of stories from across ambulance services in western, English-speaking developed countries METHODS: Databases, including Embase, MEDLINE, Web of Science, CINAHL and Google Scholar were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forwards and backwards searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Included studies were summarised using narrative synthesis structured around the exploration of the history of the Anglo-American paramedic system. RESULTS: The research team structured the narrative in chronological order and used metaphorical models based on philosophical underpinnings to describe in detail each era of paramedicine. The narrative explores several key milestones including, industrial orientation, scope of practice, innovation, education and training, regulation as well as significant clinical and technological advancements in the delivery of traditional and non-traditional paramedic care to patients. CONCLUSIONS: Paramedicine, like other allied health professions, has successfully navigated the pathway toward professionalisation in a considerably short period of time. From its noble beginnings as stretcher bearers in times of war, the profession has looked outwards to emulate the success of our healthcare colleagues in establishing its own unique body of knowledge supported by strong clinical governance, national registration, professional regulatory boards, self-regulation, and a move towards higher education supported by the development of entry-to-practice degrees. Whilst the profession has achieved many great milestones, their application across multiple jurisdictions within the Anglo-American paramedic system remains inconsistent, and more research is needed to explore why this is.

Developmentally interdependent stretcher-compressor relationship between the embryonic brain and the surrounding scalp in the preosteogenic head.

BACKGROUND: How developing brains mechanically interact with the surrounding embryonic scalp layers (ie, epidermal and mesenchymal) in the preosteogenic head remains unknown. Between embryonic day (E) 11 and E13 in mice, before ossification starts in the skull vault, the angle between the pons and the medulla decreases, raising the possibility that when the elastic scalp is directly pushed outward by the growing brain and thus stretched, it recoils inward in response, thereby confining and folding the brain. RESULTS: Stress-release tests showed that the E11-13 scalp recoiled and that the in vivo prestretch prerequisite for this recoil was physically dependent on the brain (pressurization at 77-93 Pa) and on actomyosin and elastin within the scalp. In scalp-removed heads, brainstem folding was reduced, and the spreading of ink from the lateral ventricle to the spinal cord that occurred in scalp-intact embryos (with >5 µL injection) was lost, suggesting roles of the embryonic scalp in brain morphogenesis and cerebrospinal fluid homeostasis. Under nonstretched conditions, scalp cell proliferation declined, while the restretching of the shrunken scalp rescued scalp cell proliferation. CONCLUSIONS: In the embryonic mouse head before ossification, a stretcher-compressor relationship elastically develops between the brain and the scalp, underlying their mechanically interdependent development.

Reducing intraoperative time with laryngeal mask airway and stretcher in pediatric adenotonsillectomy.

OBJECTIVES: Adenotonsillectomy (T&A) is one of the most common surgical procedures performed in the United States. Several studies have defined the safety of laryngeal mask airway (LMA) during this surgery, and conflicting evidence exists describing the role it plays in reducing intraoperative times. Our objective is to describe the role LMA and operating on a stretcher have on reducing intraoperative time during pediatric T&A. METHODS: This is a retrospective review between October 2017 and January 2020. We included patients between the ages of 4-18 years old undergoing T&A. We excluded medically complex patients with chromosomal, craniofacial, and metabolic abnormalities, patients with cerebral palsy, and those who were tracheostomy dependent. Patient demographics included surgical indication, age, sex, obesity, use of preoperative midazolam, type of airway used, use of traditional operating room (OR) bed versus transport stretcher, surgeon type, and intraoperative times. Data was analyzed with univariate t-test and multivariate linear regression. RESULTS: One hundred seventy-nine patients were included with an average age of 7.2 years. LMA and stretcher were used on 46.4% and 40.2% of patients, respectively. On multivariate linear regression LMA reduced emergence time by 4.4 min (p ≤ 0.001, 95% CI -6.7 to -2.1) and transport stretcher reduced induction time by 2.5 min (p = 0.04, 95% CI -4.9 to -0.1). Use of LMA and stretcher did not have a statistically significant difference on actual procedure time. CONCLUSION: Our study further supports the role LMA has in reducing intraoperative times in addition to describing a novel method of reducing intraoperative time by operating on a transport stretcher for healthy children undergoing T&A. LEVEL OF EVIDENCE: 3.

The Effect of Introduction of Motorized Stretchers on Hospital-Based Patient Transporter Injuries and Resultant Workers' Compensation Costs.

Manual stretchers cause more injuries than hydraulic stretchers in workers who transport patients. OBJECTIVE: To evaluate the impact of introducing motorized stretchers on transporter injuries and resultant workers' compensation costs. METHODS: The number of transporters who sustained injuries related to stretcher manipulation, and associated workers' compensation costs, before and after the introduction of motorized stretchers, was determined. The Wilcoxon Rank Sum test was used to examine costs and lost and restricted workdays. RESULTS: The number of injuries and restricted work days decreased after motorized stretchers were introduced. Transporters incurred less lost work days (median 24.5 vs 7 days, P = 0.050). CONCLUSIONS: Motorized stretchers were associated with decreased injuries and lost work days.

Effect of Ambulance Stretcher Bed Height Adjustment on CPR Quality and Rescuer Fatigue in a Laboratory Environment.

Background: The quality of cardiopulmonary resuscitation (CPR) is closely related to the survival rate of a patient, and it is crucial to maintain the quality of CPR during the ambulance journey to the receiving hospital. The purpose of this study was to investigate the effects of different stretcher bed heights on operator CPR quality. Methods: In this randomized crossover trial, 16 male emergency medical technicians-paramedics (EMT-Ps) performed continuous chest compressions on a hemimorphic mannequin for 5 minutes, alternating between the current height of the stretcher bed on the ambulance (38 ± 1 cm) (S-38) and the height of the participant's midpoint of the patella (S-knee), where the stretcher bed surface is. Results: According to the analysis of the quality of CPR exercises with two different stretcher bed heights at 5 minutes of continuous chest compression, the mean chest compression depth (CCD) of the S-38 position (53.81 ± 1.91 cm) was significantly lower than that of the S-knee (55.12 ± 2.03 cm; p < 0.001). The mean chest compression rate (CCR) of the S-38 position (111.44 ± 3.44 beats/min) was significantly higher than that of the S-knee (109.63 ± 4.46 beats/min; p = 0.027). The mean of total chest compressions (TCC) of the S-38 position (557.44 ± 16.81 times) was significantly higher than that of the S-knee (548.24 ± 19.40 times; p = 0.029). The rating of perceived exertion (RPE) of the S-38 position was significantly higher than that of the S-knee (12.75 ± 1.91 %; p = 0.015). Only the chest compression rebound rate (CCRR) (S-38: 97.56 ± 4.63 % vs. S-knee: 98.31 ± 1.89 %, p = 0.401) and the chest compression fraction (CCF) (S-38: 98.44 ± 0.81 % vs. S-knee: 98.44 ± 0.96 %, p = 1.000) did not reach a significant difference. Conclusion: When a resuscitator is performing chest compressions in a standing position in an ambulance, the excessive downward leaning of the resuscitator's upper body affects CPR quality and increases fatigue. This study has verified that setting the stretcher bed of the ambulance at the knee height of the EMTs provides better CPR quality and lower fatigue.

Shoulder strap fixation of LUCAS-2 to facilitate continuous CPR during non-supine (stair) stretcher transport of OHCAs patients.

Early recognition and rapid initiation of high-quality cardiopulmonary resuscitation (CPR) are key to maximising chances of achieving successful return of spontaneous circulation in patients with out-of-hospital cardiac arrests (OHCAs), as well as improving patient outcomes both inside and outside hospital. Mechanical chest compression devices such as the LUCAS-2 have been developed to assist rescuers in providing consistent, high-quality compressions, even during transportation. However, providing uninterrupted and effective compressions with LUCAS-2 during transportation down stairwells and in tight spaces in a non-supine position is relatively impossible. In this study, we proposed adaptations to the LUCAS-2 to allow its use during transportation down stairwells and examined its effectiveness in providing high-quality CPR to simulated OHCA patients. 20 volunteer emergency medical technicians were randomised into 10 pairs, each undergoing 2 simulation runs per experimental arm (LUCAS-2 versus control) with a loaded Resusci Anne First Aid full body manikin weighing 60 kg. Quality of CPR compressions performed was measured using the CPRmeter placed on the sternum of the manikin. The respective times taken for each phase of the simulation protocol were recorded. Fisher's exact tests were used to analyse categorical variables and median test to analyse continuous variables. The LUCAS-2 group required a longer time (~ 35 s) to prepare the patient prior to transport (p < 0.0001) and arrive at the ambulance (p < 0.0001) compared to the control group. The CPR quality in terms of depth and rate for the overall resuscitation period did not differ significantly between the LUCAS-2 group and control group, though there was a reduction in both parameters when evaluating the device's automated compressions during transport. Nevertheless, the application of the LUCAS-2 device yielded a significantly higher chest compression fraction of 0.76 (p < 0.0001). Our novel adaptations to the LUCAS-2 device allow for uninterrupted compressions in patients being transported down stairwells, thus yielding better chest compression fractions for the overall resuscitation period. Whether potentially improved post-OHCA survival rates may be achieved requires confirmation in a real-world scenario study.

[Rescue of injured horses, cattle and pigs from manure and cesspools by the large animal rescue service Switzerland and Liechtenstein (GTRD CH/FL)®]. / Bergung von verunfallten Pferden, Rindern und Schweinen aus Mist- und Jauchegruben durch den Grosstier­rettungsdienst Schweiz und Liechtenstein (GTRD CH/FL)®.

INTRODUCTION: One of the varied tasks of the Large Animal Rescue Service Switzerland and Liechtenstein (GTRD CH/FL)® is the recovery of animals from manure and cesspools. The aim of the present retrospective study was the evaluation of the rescue protocols of the GTRD CH/FL from such operations and the documentation of a rescue procedure. In the past 25 years, a total of 176 animals have been rescued from manure and cesspools. These included 113 cattle, 51 horses and 12 pigs. All animals could be safely rescued with the animal rescue and transport net (TBTN) or the large animal vertical rescue set (GTVBS). The TBTN is used when the opening of the cesspool is large enough to recover the animal in a horizontal position. The GTVBS is particularly suitable for narrow openings, as the recovery in a -vertical position does not require any constructional modification or the enlargement of the cesspool opening. Both rescue harnesses are characterized by reliable handling and allow gentle recovery.

INTRODUCTION: L'une des multiples tâches du Service de sauvetage des grands animaux de Suisse et du Liechtenstein (GTRD CH/FL)® est de sortir des animaux de fosses à fumier ou à lisier. Le but de la présente étude rétrospective était l'évaluation des protocoles de sauvetage du GTRD CH/FL sur la base de ces opérations et la documentation d'un processus de sauvetage. Au cours des 25 dernières années, 176 animaux au total ont été tirés de fosses à fumier ou à lisier. Il s'agissait de 113 bovins, 51 chevaux et 12 porcs. Tous les animaux ont pu être secourus en toute sécurité grâce au filet de sauvetage et de transport des animaux (TBTN) ou à l'équipement de sauvetage vertical pour grands animaux (GTVBS). Le TBTN est utilisé lorsque l'ouverture de la fosse à lisier est suffisamment grande pour récupérer l'animal en position horizontale. Le GTVBS est particulièrement adapté aux ouvertures étroites, car la récupération en position verticale permet de ne pas devoir ou modifier modifiées par d'autres mesures structurelles les ouvertures des fosses. Les deux harnais de sauvetage se caractérisent par une manipulation fiable et permettent une récupération en douceur.

Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study.

BACKGROUND: Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board. METHODS: Medical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis. RESULTS: Under ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6-273.2 s) and 83.4 s (95 % CI 77.5-89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0-400.6 s) and 112.6 s (95 % CI 102.6-122.6 s), respectively (p < 0.01). CONCLUSIONS: Spinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress. We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.

Synthesisation of design features for multifunctional stretcher concepts.

A stretcher is a lightweight and portable apparatus used to facilitate the movement of patients who require medical care. While its design and functions have been known to man for over 600 years, there is still much room for improvement with regard to comfortability, mobility and ergonomics aspects. This study aims to synthesise design features from patents, journals and products for the conceptualisation of multifunctional stretchers. Based on the conceptual synthesis of this study, if a stretcher is redesigned to be foldable, then less storage space would be required, thus allowing the paramedic or medical person to store more stretchers and attend to multiple patients at a time. In comparison to a regular stretcher, a foldable stretcher would not only be smaller and more portable but would also help medical personnel reach the patient in a timelier manner. A reduction in response time for emergency medical services might increase the survival rate among patients who are in critical conditions. In the aspect of multifunctionality, the medical person may also be able to respond to different types of medical transportation needs. Multifunctional stretchers can increase the versatility of emergency medical service teams in adapting to different situations at a reduced cost.