Sunday, May 11, 2014

EMS Evolution: Relaxation of Spine (Back) Boarding Rules Ahead?

Not sure if anyone has noticed or not, but the National Athletic Trainers' Association has a new blog directed to professionals and students in the field.  Content is generated via professionals from around the country, and a couple of days ago one was brought to my attention.
You can read it here.

While the post doesn't delve into specifics, it does state that several protocol changes are occurring in the area of spine boarding...most notably the prospective omission of the use of spine boards with suspected cervical injuries.  EMS appears poised to begin transporting certain cases (I am unsure at this point as to which ones) with a cervical collar only.   As Dr. Swartz points out, this should really spur ATC's to meet with their local EMS provider(s) to discuss their current protocols and how it might affect your overall management.    I'll certainly be looking forward to the upcoming position statement...

In the meantime, consider my curiosity piqued.  Two questions linger for me:
Are backboards even effective?
Are cervical collars even effective?
So, I did a bit of searching and this is what I found.

This article challenges conventional wisdom (perhaps a better term is conventional practice) regarding the blanket use of cervical collars.  In fact, validation for challenging the efficacy of cervical collars was studied a decade ago.  Which ultimately lead me to this article, which was a real eye opener.  There are a number of valid points the article raises, and one of them is the topic of patient comfort.  Having seen a full body vacuum splint used when I was in France a few years ago, I can honestly say it makes a lot of sense to potentially use one of those as compared to a traditional spine board.  It seemed far more comfortable compared to it's stiff counterpart.

So after becoming  more convinced evidence is lacking, I stumbled upon  Neurosurgery PreHospital Cervical Spinal Immobilization After Trauma, which states virtually the exact opposite of what other studies are saying. 

Needless to say, it will be very interesting to see how this situation develops, both regionally and nationally.  While I fully realize I'm not answering any definitive questions here, I am trying to illustrate the difficulty clinicians face when attempting to best care for their patient.  That headache, neck and/or back pain may be exacerbated by the very tools we use to "safely" care for them.   

Thursday, May 1, 2014

PowerPlay Cold & Compression Product Review

Earlier this month, I was contacted to complete a product review for PowerPlay Portable Cold & Compression systems.  I replied that I would be more than happy to do so.  Before we begin, I offer  that I am not receiving reimbursement of any kind, and offer my objective and unbiased view of the product. 

I was shipped the PowerPlay Standard Kit, which included the Cold and Compression Ankle Wrap and the  Knee Wrap.  The entire contents of the system, which was shipped in a convenient and small bag (14" x 10.5"), weighed less than 10 pounds.  My initial thoughts were that this is a fantastic, lightweight, portable system which would travel easily.  As an ATC who travels, this would certainly be very easy to toss into my checked baggage.  The product was clearly designed with efficiency and portability in mind.  That said, it would work very easily in a standard sports medicine clinic as well.

The directions for each "unit" came with easy to read instructions, which included both written and diagram instructions.  The instructions were quite simple and straightforward, covering everything from contraindications to battery life, true to electrical modality form.  Set up only took 3 minutes, but I was fiddling around with it.  By the third time I used it, I could set it up in under a minute and a half.  Ease of use is a tremendous bonus with this product. 

For the compression unit itself, these items were included:
1. PowerPlay Pump

2. Cloth Sleeve (this serves as a protective area for exposed skin)
3. Gel Pack (one each for ankle and knee)
4. Compression Wrap (one each for ankle and knee)

Prior to applying,  the gel packs must be frozen for a minimum of one hour, remove from the freezer and then attach them to the inside of the Compression Wraps.  This is done via velcro attachments, which fit quite snugly inside.   You simply had to fit the patient, then attach the hose to one of the three ports on the PowerPlay Pump, which you then turned on.  I love the fact that there were three different ports, as you can treat multiple regions/body parts at once. The pump is small, but very efficient and easy to use.  It only has four buttons, a Power On/Off, and one each for the port of choice. 

Once attached, you press the port of attachment, and choose a level of compression both appropriate and comfortable for the athlete.  I did notice a discrepancy here, as the instructions indicate you can choose between 30 mmHg and 70 mmHg of pressure, however the pump only displays 50-70 mmhg, in 5 mm increments.  Not a huge deal, but a discrepancy nonetheless.  Once you set the pressure, the unit will automatically turn on and provide intermittent compression for a 20 minute time period, automatically shutting off at the conclusion.  Again, the design is so convenient and easy to use, I could see myself utilizing this product on a very regular basis. 

During it's first trial run, I kept getting a "HI" message on the LED screen, which upon further inspection revealed cord compression (the athlete's leg was compressing the cord, impeding airflow).  Simply moving the chord was not difficult, as each compression wrap has a 5 foot long air hose, which I thought was well thought out.  Not everyone likes to have a compression unit buzzing on their chest during treatment! If you needed a longer one, an additional 5 foot extension was located in the bag as well.

The compression was uniform and quite comfortable, as opposed to say, plastic wrap around an ice bag on a joint, which can be effective but also uncomfortable.  It was also surprisingly cold (in a good way), which surprised me.  Sometimes feedback from athletes is that it's not cold enough when compared to ice, but with this product, it was definitely not an issue. The gel packs themselves were designed well, and I was particularly fond of the knee wrap, which left a horizontal opening in back, allowing for a comfortable treatment of the knee not only in extension, but stages of flexion as well.

The unit is powered by an internal NiMH battery, which according to the manufacturer will run the system for 4-6 hours prior to needing a charge.  A wall charger is included in the package.  Of interesting note, it is recommended that the battery be charged every 60 days while NOT in use, and will last for roughly 500 recharges in between replacements.   Translation:  this should last you a long time.

In terms of price, it is very comparable to similar systems.  It is more expensive than traditional CryoCuff systems, but much less expensive than a Game Ready, both of which require water and ice. While cold therapy has had it's knocks over the past few years, I do still believe that it has a place in treatment, and can plainly see the advantages to using this.  In my opinion, this is a sound product and investment in the care of your patients and athletes.