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PASG / MAST in the field
We all have been trained on how to use this equipment, but has anyone used it in the field? During training I was told, "You have to know this to be licensed, but don't count on ever seeing it again." And I haven't ever seen them again. Maybe I just never had the opportunity. What's everyone else's experience with these?
Replies to This Discussion
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Permalink Reply by chele on
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I have been an EMT for only 5 years, but have never used them. In my opinion, anyone hurt badly enough to need them is hurt too badly to be loaded into them.
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Permalink Reply by Ben Waller on
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Mike,
MAST/PASG have no proven medical value, according to several prospective, randomized studies.
The most famous one was Dr. Paul Pepe's study of MAST for trauma patients in the urban setting when he was Houston FD's Medical Director. That study actually correlated WORSE patient outcomes with MAST/PASG use.
Trauma patients need for us to a) perform ONLY interventions that have proven, immediate value to patient outcomes, b) restrict patient movement the the minimum necessary to get the patient packaged for transport and moved to the transport unit and c) avoid interventions that waste time. MAST/PASG fail all three of those tests. They have no proven immediate value, they cause unnecessary patient movement, and they waste time, no matter how quickly they are applied and inflated.
The likely problem with the situation to which you referred is that MAST do provide some peripheral vascular resistance (afterload) but that afterload may actually be harmful to the patient, as it can interfere with the body's compensation mechanisms. The new standard for trauma patients is permissive hypotension - maintain enough BP to keep the patient's vital organs perfused, but avoid systolic BPs of more than 100, as these will disrupt the clotting process and potentially cause extra bleeding.
Field interventions should be limited to ABCD support. That includes keeping the patient warm. Hypothermic patients clotting mechanisms don't work very well. Hypothermic trauma patients are at a much higher risk for increased morbidity and mortality than are warm trauma patients.
In other words, blankets are more important than MAST/PASG.
I've heard paramedics state that applying/inflating MAST/PASG "popped up" a hypotensive patient's veins and the paramedic was able to make IV sticks that weren't otherwise possible. My answer is that those trauma patients need trauma surgeons and cold steel, not paramedics and IVs.
Ben
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Permalink Reply by Paul Montpetit on
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I personally have never used them.....BUT....They were used on me once.....I was the victim of a gunshot injury in 1988 and MAST were used....obviously it was successful.....LOL the bullet severed my splenic vein, bisected my large intesting and lodges behind my right adrenal....I was taken to the OR and they put everything back together and after 2 weeks in ICU I was discharged from the hospital.....God must have something in mind for me....otherwise I wouldn't be here to agitate so many people today......So please don't ever say "never" You might be surprised and not in the nice way....Stay safe all...remember to keep the faith.......Paul
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Paul,
Ever consider that you may have survived despite the MAST use instead of because of them?
Most MAST studies indicate no real value in using MAST for trauma patients and some studies show that they actually increase morbidity and mortality.
Regardless, I'm glad you're around to have the discussion.
Ben
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Permalink Reply by Brad Dietlin on
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I have used them once or twice in six years, but it wasn't on a trauma pt. I have a medic on my dept that loves using them on possible hip fx's. Yes they take a bit longer to apply but the they work very well as a splinting device.
Stay safe,
Brad
P.S.
He's an "old school" medic- 20+ years as a medic
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Permalink Reply by Salty Jake on
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Wow! are they still teaching the use of MAST? I have been in this business for close to thirty years and have used them a total of three times for trauma related calls. As an early EMT I remember questioning the State of NH protocols in regard to waiting until the patients BP was less that 90mm systolic before inflations. I found that when a patient's BP bottomed out they were more or less relying on axuillary muscles to breath (mostly belly breathing) the quality was shallow at best. Once the abdomen chamber was inflated, guess what? You better have your BVM close by! The rest of your ride to the hospital was maintenance of the airway and breathing for them. Great for splinting a bi-lat tib fib!
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Permalink Reply by Joe Stoltz on
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MAST was at one time a NYS basic EMT skill. We had to demonstrate their use by verbalizing the contraindications, applying them to a dummy and then inflating them until the pressure valves blew.
In 20 years I have never used nor seen them used. In fact about 15 years ago our medical director said that an exaggerated Trendelenburg position for the patient was faster and more effective than MAST. Over time they were dropped from the BLS protocols, and we took them off the bus a few years ago.
I think I hold the dubious distinction of being the only member left in our department who knows how to use them.
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Me too Ben....The Big Man upstairs is the only one that can answer that one...and I'm not exactly sure what happened after they put them on...wasn't in really good shape at the moment....But, regardless....something worked.....LOL thanks....Paul
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Permalink Reply by Terri on
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It is part of the state regulations we carry them. I have used them twice in my 28 year career, both times for bilateral femur fractures. They were used as stabilization, not to maintain BP. Works wonderfully in that capacity. And as for putting them on...does not take long at all. Our ER is trained in how to remove them, as are our physicians, so we have no trouble there either. If the state takes out the requirement to carry them, yes, they will probably be removed from our trucks too.
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Permalink Reply by Chris on
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We don't use them at all here. I have never seen them used. The last time I used one was in EMTP school. I believe this would also apply to the KED they test you on that dang thing but it is never used.
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Joe,
The new national standard is going away from the Trendelenburg position, too.
Apparently there can be respiratory compromise when we stack the abdominal organs on the underside of the diaphragm.
Ben
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