Herbie, if you remember, a penetrating abdominal injury is an automatic contraindication for MAST. Isn't a GSW to the abdo considered a 'penetrating abdominal injury'?
I admit it has probably been at least 15 years since I have used the MAST suit on a patient- we no longer even carry them. I do recall that in our system, penetrating abdominal injury was a RELATIVE contrainidication for MAST, meaning we could apply them, inflate all but the abdominal compartment (needed a DR's orders), but impaled objects and eviscerations were absolute contraindications. Pregnancy meant that with an MD's orders, you could also apply the suit and only inflate the legs.
Below is the part of the scenario that I was initially stuck on, and made a couple assumptions based on my interpretation of the situation. This simple phrase to me meant that there were 2 BLS rigs, and I would be able to jump on board with only one of the 2 patients to provide ALS care, so this was essentially about triaging. I may have misinterpreted these parameters, and if so, mea culpa. Your in an ALS response car and are met at the scene by 2 x BLS in an ambulance. You can only take one patient.
I assumed that this meant there were 2 BLS rigs, and you- as the ALS provider- would be only able to provide ALS care to one of the patients, while the other would be transported BLS. I was trying to come up with BLS interventions and prioritizing the patients based on what I could do for them. As I mentioned, as an ALS provider, there would be little prehospitally I could do for the GSW to the abdomen. If the patient with the potential for a tamponade or pneumo crashed, I could provide help for that person beyond the scope of an EMTB . I was thinking in desperation mode- try everything you can based on a difficult situation- which is really what much of our jobs often entails. Obviously, transport times also play a key role in the decision making process for triaging, treatment, and transport.
Brings back memories- some horrible, like power washing the remnants of a GI bleed or bloody trauma from the suit. When I first started in EMS, MAST pants were part of the protocol on nearly every cardiac arrest- traumatic or medical. We became quite proficient at quickly applying them- and even learned that by putting your arms through the suit's legs(which were already closed by the velcro) and grabbing the patients legs, we could simply slip them on the patient and all that was left was to apply the abdominal portion and inflate. The hardest part of the process became getting the suit out of the case- and keeping the ER staff from cutting them when they arrived at the ED, of course. LOL
Like the studies now indicate, their value for autotransfusion may have been neglible, but I found they were quite effective for splinting things like pelvic fractures. The patient was more comfortable, it made patient movement easier, and the often bumpy transport was much more comfortable for them.
Who knows-maybe MAST will someday make a come back since things in EMS old is sometimes new again: Think sodium bicarb.
I sincerely hope that rotating tourniquets have gone the way of the dinosaur, however.
Thanks for keeping an old fart like me on my toes, Lone Star.