Lisbon Fire Department Standard Operating Guidelines and Policies

– PNEUMATIC ANTI-SHOCK GARMENT

2. To define the manner in which the PASG can be used to stabilize suspected pelvic fractures and apply circumferential pressure to suspected intra-abdominal bleeding accompanied by signs of shock

2. Inflate the PASG based on protocol

3. The only absolute contraindication to inflation is pulmonary edema

4. There are relative contraindications to inflation of all three compartments

5. Inflation should be only to a level at which shock symptoms subside. Careful and frequent monitoring of the vital signs after inflation is essential

6. Do not deflate in the field unless ordered to do so by medical control

1. Assess patient for and record signs/symptoms of shock. If spinal injury is suspected, maintain spinal stabilization

2. Determine and record the patient’s blood pressure

3. Leave deflated blood pressure cuff in place on patient

5. Remove clothing from patient’s abdomen and lower extremities

6. Assess patient’s abdomen, pelvis and lower extremities for wounds or fractures. Record findings

7. Cover any open wounds with sterile dressings and bandage in place

8. Restore alignment of extremity fractures, if possible

9. Contact medical control, if required by local protocol, for permission to inflate garment. If medical control contact is not required, proceed according to local protocol

10. Open and arrange anti-shock garment

11. Apply anti-shock garment

a. Method One:

1) Lift patient’s lower extremities and buttocks, sliding the garment beneath the patient

2) If spine injury is suspected, use orthopedic stretcher, log roll or straddle slide to position patient

b. Method Two:

1) Loosely secure all three compartments

2) One rescuer puts pants over his/her arms from the foot end and grasps the patient’s ankles

3) Other rescuers pull garment onto patient like a pair of trousers

12. Verify that the superior edge of the garment is just inferior to the patient’s costal margin

13. Secure garment – legs then abdomen

15. Inflate garment until:

a. Patient’s clinical status improves satisfactorily, or

b. Velcro fasteners begin to crackle, indicating separation, or

c. Air escapes from relief valve(s)

16. Close all in-line valves

17. Leave inflation pump attached to garment during movement and transport

18. Reassess and record, immediately and at frequent intervals en route to the hospital, the patient’s:

a. Blood pressure

b. Pulse rate

c. Respiratory status

d. Level of consciousness

NOTE: Extreme circumstances may arise when the PASG may be deflated in the field, but only under authority of Medical Control. (Field deflation is not a generally accepted practice)

2. Deflate only after appropriate resuscitative and stabilization measures have been accomplished

3. Deflate only with direct physician supervision

2. Assess and record the patient’s vital signs

3. Gradually deflate the abdominal section of the garment

a. Monitor blood pressure carefully

b. For each 4 - 6 mm Hg drop in the patient’s blood pressure, stop deflation and infuse fluids until stabilized at baseline level

c. If blood pressure continues to drop despite infusion, re-inflate garment and reassess resuscitation

4. After abdominal deflation, gradually deflate each leg segment while monitoring blood pressure and resuscitating as above

5. If blood pressure cannot be stabilized during deflation, garment inflation will be maintained into the surgical setting

6. Following deflation of the garment, blood gases and electrolytes will be assessed and corrected as necessary