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Do No Harm

By Vertical Mag

Story and photos by David Krussow | November 7, 2012

Published on: November 7, 2012
Estimated reading time 13 minutes, 43 seconds.

A recent study of physiological side effects of three common rescue devices suggests that these vital tools can sometimes have a significant negative impact on victims something rescuers should be mindful of, even in life-or-death situations.

Do No Harm

By Vertical Mag | November 7, 2012

Estimated reading time 13 minutes, 43 seconds.

A victim is short-hauled utilizing a Life Support Products (LSP) Cinch Rescue Collar. In a study led by the medical director of Travis County STAR Flight, several commonly utilized rescue devices were found to negatively impact the physiological status of a patient.
A victim is short-hauled utilizing a Life Support Products (LSP) Cinch Rescue Collar. In a study led by the medical director of Travis County STAR Flight, several commonly utilized rescue devices were found to negatively impact the physiological status of a patient.
In an aphorism that is thought to date back to Hippocrates himself, medical students around the world are taught the concept of Primum non nocere Above all, do no harm. It is a principle used to guide doctors who are in the difficult position of deciding which medical treatment to prescribe an ill patient when options are limited or poor. It also serves to remind practitioners that if a medical treatment or intervention risks more harm than potential good, they should likely refrain from such an action.
Today, an increasing number of devices are available to efficiently extricate victims from dangerous situations. Each possesses inherent strengths and limitations: some work well for cliff rescues, but are dangerous in moving- and swift-water situations. Consequently, agencies and operators must be intimately knowledgeable about the particulars of the devices they employ including the physiological impacts these apparatuses can have on those being rescued. And, as such, consideration must be given to the stresses that our equipment places on victims while in the extraction phase. In a classic question of risk versus gain, rescuers must ask themselves if they are rescuing a victim from one dangerous situation only to be creating another in the process?
To date, most decisions about which devices operators use have centered on the environment in which the victims are found (e.g., hanging from a cliff or floating in the water). Little research or consideration has been given to the effect rescue devices have on the victims themselves. This has led a few people to wonder: Do some of the techniques we regularly employ have deleterious or harmful effects on our victims that we may be unaware of?
The Science of Rescue
This was a question also posed by Dr. James Kempema, medical director of Travis County STAR Flight in Austin, Texas, when he examined the physiological effects of three rescue devices commonly used across the world for extracting victims from a variety of environments. Many of the patients that we rescue are generally healthy individuals who have gotten themselves into a difficult spot, remarked Kempema. But, what about a hiker in a remote area experiencing cardiac problems, or a victim who has sustained a prolonged exposure to cold water? What impact will the device that we select to extract this patient have on their health? Is it possible that we could be [causing] additional harm?
For the study, Kempemas research team elicited the help of 23 healthy volunteers to examine the potential physiological effects of three different devices: the Pigeon Mountain Industries (PMI) Hasty Harness, the Lifesaving Systems Corp. (LSC) Quick Strop, and the Cinch Rescue Collar from Allied Health Care Products LSP (Life Support Products) line. The study began by measuring five physiological parameters while participants were at rest: heart rate, respiratory rate, blood pressure, oxygen saturation, and end-tidal CO2 (a measurement of exhaled carbon dioxide). Participants also underwent pulmonary function testing to measure how well their lungs were able to exchange oxygen. 
After recording their resting measurements, the participants were sequentially placed in each of the three devices (with defined rest periods between tests) and suspended a few feet off the floor for four minutes. Vital signs were again recorded at one- and three-minute intervals, with the pulmonary function test administered in between. Participants were also asked to rate their comfort and pain level at each interval for each device. 
Just the Facts
Of the three devices evaluated, the PMI Hasty Harness, a rescue seat-type device, was clearly the most comfortable and had the least impact on patients physiological status.
Both the LSC Quick Strop and the LSP Cinch Rescue Collar, meanwhile, caused dramatic increases in participants heart rates and blood pressures, due to the stress and discomfort induced by the devices. Both of these cinching-type devices also rated very high on the subjective scale for pain. In fact, several participants were unable to tolerate the full four minutes suspended by these devices, and abrasions and bruises were noted after the tests in several participants.
Both the Cinch Rescue Collar and Quick Strop also affected effective lung function. Significant decreases were noted in vital capacity, forced expiratory volumes and peak flows, revealing that participants were unable to utilize the full resting capacity of their lungs due to the constriction placed around their chests. These same devices also caused significant restriction in circulation in the upper extremities.
What All This Means
In a time-critical rescue, helicopter crews may have only moments to choose the right equipment to quickly and effectively extract a patient from a life-threatening situation. Cinch-type rescue devices, whether rope-tied or commercially manufactured, have always been an excellent choice they are rapid, effective and simple to use and have been utilized in one form or another for even longer than helicopters have been involved in rescues.
Unfortunately, these devices also come with an associated cost in terms of physiological impact. Like a boa constrictor continuously tightening its grip with every breath its victim exhales, a cinch-type rescue device, such as the LSP Cinch Rescue Collar, never stops tightening its grip until the victims feet are firmly placed on solid ground.
The LSC Quick Strop, on the other hand, isnt a true cinch strap in the sense of having a continual tightening characteristic. Rather, this device is designed with both ends of the supportive strap meeting together at the connection point (i.e., the hoist hook) and employs a sliding buckle that provides the necessary tension to restrain a victim. While this device does not have the same tension applied to victims chest as the Cinch Rescue Collar, it still depends on a band wrapped around the chest and back to support the victims weight.
Lifting a body by a strap around the chest and back forces the victim into a very uncomfortable and tiring position. It quickly begins reducing the amount of air a patient is able to exchange, and can significantly reduce his or her ability to breathe. This negative effect is exaggerated in larger or obese victims. And for those victims who are already suffering from a physiological condition or impact such as low blood pressure, hypothermia, shock or a heart-related illness  the added insult of suspending them in a cinch-type device may quickly cause their condition to worsen significantly. 
It is generally assumed that the associated benefit of this type of device is worth the cost of a little discomfort, and often this is absolutely true. Few other devices are appropriate or safe for use in water environments, especially moving or swift water, and these victims are often in dire circumstances. But, as Kempemas research shows, there may be a class of victims for which a cinch-type device may be inappropriate, or even contraindicated, and consideration should be given to this often previously unrecognized predicament, especially if the hoist or short-haul transit time is expected to be long or protracted. 
Rescue crews should realize that, at a minimum, the time suspended in these types of devices should be shortened to as little as possible, ideally less than one or two minutes. Keep in mind that several otherwise healthy participants in Kempemas study were not even able to endure four minutes suspended in these devices. 
Some rescue organizations, including the United States Coast Guard, have implemented a two-ring style of extraction, in which an additional device is placed around a victims legs to create a lounge-like near-horizontal position in an effort to reduce the negative effects of hoisting.
LSC, meanwhile, is currently developing a new device that incorporates an optional, adjustable  saddle strap that passes between the victims legs to relieve some of the pressure from the patients chest and back  and secure the victim more definitively. This will also lessen the constricting effect around a patients chest. While this device should greatly diminish adverse effects, it was not available for study and evaluation by Kempema and his team.
Physicians, nurses, paramedics and emergency medical technicians worldwide are educated to evaluate the potential risk of every procedure or medication administered to sick or injured patients to ensure that no additional harm is brought upon them. As Kempemas study demonstrates, rescue devices routinely utilized by helicopter crews around the world to extract victims are not without their inherent risk or costs to the victims that these crews are risking so much to save. It is therefore imperative that air rescue crews, too, practice the ancient Greek aphorism to, Above all, do no harm.
David Krussow spent seven years as a flight nurse, crew chief and rescue swimmer with STAR Flight of Austin/Travis County. He has served 15 years in emergency service and is experienced as a helicopter rescue and firefighting instructor with Texas A&M University/Texas Engineering Extension Service and SRT Helicopters. David presently works with CalFire in Auburn, Calif.

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