MAST TrousersBy ambogrlMarch 29, in Patient Care. Interesting thing- The concept was developed by a Dr who wrapped India rubber around patients legs to perform back surgery sitting up. Then of course the military used G-suits for dive bombers to keep them concious, and they evolved during Viet Nam. Miami FD used nys mast pants protocols hys a bit in the 60' and early 70's. I used them quite a few times, back in the day. Had unconcious unresponsive trauma patients wake up and start talking.
NYS EMS Protocols
By medic , July 22, in Patient Care. New York still has them but the protocols call for their use only for profound hypotension with pelvic instability. I may be old school but I think they still have their place in rural BLS services. And I believe they have other uses besides the written protocol.
I used to use them a fair amount but haven't in years. Mostly because the areas I now serve usually have readily available ALS. Fair question, and don't worry I have thick skin. Therefore when significant blood loss is noted or suspected the only option is to maintain what the patient still has on board. Therapeutic hypotension is one thing, exsanguination is quite another. My goals in this instance is to keep the brain, and vital organs in the chest cavity perfused.
I want every trick available. Trandelenburg, direct pressure, MAST, tourniquets, etc. One more tool in the tool box. Another mild side track. It was once common practice to apply MAST but not inflate to any trauma patient who you feared may decompensate. Then if your ongoing assessment showed a patient deteriorating you could rapidly inflate. If the garment is already on the patient this can be accomplished very rapidly.
Of course, you had to watch for negative outcomes such as PE, or increased bleeding of injuies superior to the garment. We even understood the concept of "tritating" the MAST. If it was decided to use for fx management, then only the compartments necessary would be inflated and then never ever to the point where distal perfusion was profoundly effected. All of this took place in an environment where paramedics were only seen in "the city" and there was this mythical chariot called a helicopter but even that was at least 45 minutes away if available.
MAST will probably never again be used at the level it once was, but that doesn't mean it is no longer useful at all. It was never proven to be particularly useful in the first place. The evidence is still all over the place. I'm in Western NY and we still have them on our rigs but I think they took them out of our protocos.
I will look into it. Now to answer question about using them The discussions flip flop whether or not you are causing an excellerated compartment syndrome and doing more harm than good. Secondly, you don't want to overload these patients with fluids either. Optimally you would like to have whole blood for replacement therapy but now we're going to a whole new level or care. In Michigan we dont carry them any more. They are still in the Indiana Statues for required equipment. Locally if we have a protocol for it the word mast is in 2pt font.
They were originally known as "Military", as they had some background in Fighter Jet Jockey flight suits, to prevent them from passing out when "pulling 'G's".
I have read most of the same studies you sight and can't fault the science. But in the realm of outcome based medicine, you have to look at outcomes.
We all know that is a no-no but Now for the flip side of the coin. I don't know the answer and I don't think anyone else does either. MAST obviously should not be a 1st line or stand alone treatment. I'm even OK with states removing them from the mandatory equipment lists based on their inconclusive results and infrequency of use. Thank you for the debate and exchange of information. Many of the episodes still make you think about what to do?
I watch it on Retro TV. I started watching the re runs I thought How stupid they are still showing this stuff, but except. Some things change, but alot stays the same. A visitor to New York for the Tennis "Open" was stabbed in the chest, while attempting to protect his family from a mugging. Under protocols then in use, the responding crews placed him into a MAST, inflated the 3 compartments, and proceeded to transport.
He exanguenated through the chest stab wound. Revised copies of each of the protocols affected by these changes are attached. Revised copies of each of the protocols affected by these changes are also being sent to all emergency medical services agencies statewide. Regional Emergency Medical Advisory Committees, and regional, system, and service medical directors are directed to facilitate use of the revised protocols at the local level, and are further advised to modify local protocols, policies, and procedures accordingly.
In , Cooper et al, in a retrospective study of the efficacy of MAST PASG use in pediatric trauma patients, mostly with blunt injuries, from the National Pediatric Trauma Registry who presented in hypotensive shock, found similar results. The literature cited supports the conclusion that the role of MAST PASG in the prehospital emergency medical care of adult and pediatric patients is extremely limited. The Statewide Basic Life Support Adult and Pediatric Treatment Protocols are being modified to reflect this change, and Regional Emergency Medical Advisory Committees, and regional, system, and service medical directors are advised to modify local protocols, policies, and procedures accordingly.
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Prev 1 2 3 Next Page 2 of 3. Posted July 23, Share this post Link to post Share on other sites. Not trying to pick on you; however, what is your rationale for taking this stance? However, aggressive fluid resuscitation in the field may not be helpful and may be harmful in some cases when looking at current EBM.
However, increasing the blood pressure may in fact lead to additional complications and worsen bleeding. This is especially true of internal hemorrhage. The current data is inconclusive when considering MAST, there is a scant amount of data regarding the "shock" position with the current EBM showing no conclusive benefit.
I cannot see how allowing BLS providers to access modalities that are not proven to benefit would be helpful. Posted July 25, Rob I was watching a old Squad 51 Emergency , and they put mast pants on a patient for unstable BP with hip trauma. Posted July 26, Posted July 27, Chbare, I have read most of the same studies you sight and can't fault the science. I cant remember what episode it was, but where I live they show Emergency at and At first when I started watching the re runs I thought How stupid they are still showing this stuff, but except for some of the Medical TX, alot of the episodes still apply to today.
Posted July 28, Recommendation based on other evidence. Prospective MAST study in patients. Efficacy of MAST use in children who present in hypotensive shock. A study of pneumatic antishock garments in severely hypotensive trauma patients. Definitive control of hemorrhage from severe pelvic fracture. An evaluation of the pneumatic anti-shock garment PASG in various clinical settings. Prehosp Emerg Care ;1: Use of the pneumatic anti-shock garment PASG. Commissioner, Department of Health Revised: Create an account or sign in to comment You need to be a member in order to leave a comment Create an account Sign up for a new account in our community.
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