Mast Pants

[fireflymedic]

Here over my career I went from seeing them still being written within protocols and being used in circumstances when I think they were beneficial to not even existing on a truck or being so covered in dust and not maintained you wondered about the integrity of them. They are no longer taught in class and students are basically ignorant about them. Granted most of my work has been in primarily extremely rural areas (over 30 min transport at best as long as 2 hours at worst) though I did do some urban time for about a year for a change in pace. I never saw them on a truck during my city time. You can still find them occasionally on a rural truck depending upon the service and their director.

The biggest problem faced (at least here) wasn't so much picking the appropriate patient for them as many were and respectable results were seen (remember our transport time and general level of care when I started was one medic per shift in whole county so call it BLS). The problem was ignorant hospital personnel that did not know how to properly deflate them as they had not been trained to deal with them or ignored that giant thing on them that says "do not cut" *sigh*. I think that and the amount of time it took to apply them along with the eventual upgrading of the vast majority of the services to ALS trucks opposed to one ALS truck or a medic on call if you were lucky sealed their fate and they were dismissed. Given the right circumstances, I think they may still have a place, but the ignorance on the part of hospital staff now and fair amount of new EMS personnel make them pointless.

[Chief1C]

Now should we go into the three different types of MAST?

MAST, MAST II, MAST III

[chbare]

A note about hospital ignorance. I have been watching the permissive hypotension thread, and would like to comment about that concept and how it relates to the topic at hand. Part of the new resuscitation methodology is a concept known as damage control resuscitation. Damage control essentially consists of two parts. 1) Blood products 2) Surgery. Part of the surgical aspect involves taking the patient to OR and performing damage control surgery. In essence, open and achieve rapid hemostasis. Following hemostasis, the patient is "stabilized" over several hours, then brought back to the OR for revision type surgery.

In an ideal world, the only interaction EMS would have with the ER staff would be a friendly wave of the hand on the way to the OR. Since damage control seems to be effective and working well in the Gulf, where does MAST come into the equation. It does not really have a place. How are we to expedite delivery of a patient to OR with MAST pants applied? If anything, MAST use delays this process.

Unfortunately, we need to look at the big picture. Gone are the days of applying the MAST and giving a high five to your partner for delivering a patient with a pressure to the ER. We need to look at the big picture, specifically at how our interventions effect the patient outcome. Not simply delivering a patient with a good blood pressure to the receiving facility. If we can provide good evidence that MAST use is a good modality when considering the big picture, then it may have a use. Currently, I am not convinced.

Take care,

chbare.

[Richard B the EMT]

I think every EMS agency in service for more than 30 years has a version of the story...

An appropriate patient is placed into a MAST, which is inflated per protocols, and does as advertised. On arrival at the ER, a doctor comes to the patient, says, "lets get him/her out of this thing", pulls out scissors, and slices the device, to the sudden outrushing of air under pressure. The patient crashes. The Paramedics punch out the doctor for damaging the device, and killing their otherwise potentially viable patient.

[fireflymedic]

When I speak of ignorance I am referring to a lack of knowledge in how to deflate properly not stupidity. Ignorance in that aspect can be fixed by education on how to properly deflate. Stupidity unfortunately can't be fixed. It was not meant as an insult, it was only meant to show that there is a lack of knowledge there. One could say we all start out ignorant in EMS but that is corrected by education. The stupid ones that start off are the ones that don't pass or drop out or unfortunately pass and make it on the streets as the partner you want to kill daily....