Page 106 - Journal of Special Operations Medicine - Winter 2014

the prevention of costly and debilitating limb morbid- long” (or over time) because they perform as advertised;
ity. We believe the SAM is a great splint for many rea- until or unless they are supplanted by a superior device.
sons, but concluding, out of hand, absent any clinical We see no evidence supporting a broad postulation per-
support/evidence, that the SAM is equivalent to the RS taining to military care in its totality. The authors cite
is absurd. The RS has been extensively evaluated and no clinical and/or scientific evidence in doing so. The
clinically proved to be the most reliable and robust ar- fact is, the RS has, and continues, documenting scores
ticulation device for these critical and important areas of clinical cases, while garnering hundreds of testimo-
of lower extremity care. nials of efficacy in a variety of operational care situa-
tions. Patients continue to benefit significantly from the
The authors fail to appreciate the findings of a significant RS in military and civilian emergency medical services
patient study in the Annals of Emergency Medicine. This (EMS) scenarios. Original US Army studies underscore
2
2-year referenced field study was conducted at the Uni- the broad scope of use that the authors seem to ignore
versity of California, San Francisco School of Medicine. or dismiss — that the RS is well suited (and remains so)
The study presented 53 “real” patient cases, only 11 of in most described BAS, DTS, and MEDIVAC type of op-
which involved traction. Of significance is that 42 other erations and was, therefore, recommended for purchase.
cases involved many other types of injuries, including We believe, as US Military and other studies demon-
4
difficult joint dislocations and angulated fractures. The strate, the UNIVERSAL RS continues to have many
first prototype RS splint performed exceedingly well in important roles in military and civilian lower extremity
this patient field study. (Subsequent commercial models care scenarios.
have proved to be even better performers.) We know of
no credible information or studies regarding angulated Other statements from the article by Studer et al. caught
lower extremity care, using malleable aluminum sheet– our attention. As the presented chart of advantages and
padded splints, specifically as they would compare with disadvantages reveals, KTD accurately depicts their
RS performance. A.J. Heightman, editor of the Journal product as a traction “device” while underscoring that
of Emergency Medical Services, authored an article in other “splinting materials may be required.” We surmise
which he discussed his views on the RS specific to severe the same for other similar “pole devices” as the CT-6
joint and fracture immobilization. He concluded the RS and STS. Obvious and pertinent questions arise: What
3
is the “perfect splint for the task,” stating “I have dis- other splinting materials would be needed to be brought
covered an articulating splint that’s perfect for the im- forward to completely stabilize the limb? How much do
mobilization of severely dislocated and fractured bone they weigh? How bulky are they, and what would they
and joints” [RS], “the [RS] can be adjusted or molded cost? Would any such scenarios even be practical within
to almost any fracture or dislocation angle,“ and “The the narrow scope of “dismounted operations”? Addi-
[RS] provides ease of movement and support straps al- tionally, we have seen no evidence of pelvic problems
low for wound treatment and visualization.” He further cited for traction with the RS.
states that the SAM and adjustable Air and Vacuum
splints may not be useful because “conventional splints Three unique design features of the RS were not no-
may not adequately immobilize or support the injury, ticed or discussed as improvements over the more an-
above and below the joint [emphasis added], being even tiquated HARE style traction “splint”: (1) the highly
more difficult, “when the knee is rotated.” Shouldn’t the contoured ISCHIAL pad, (2) the pivoting ischial fit, and
question arise as to when and where is it appropriate to (3) the minimal 5-degree position of function knee flex-
use proven care modalities for military care situations; ion. The flexion feature completely addresses peroneal
especially when these injuries represent not just the 2% nerve issues (a superficial nerve located at the area of the
of traction applications but, importantly, the other 98% proximal fibula), as well as improving popliteal artery
of lower extremity traumatic injuries? We believe the RS function. In regard to the peroneal nerve, it is telling that
has demonstrated that it positively addresses an entire the majority of EMS providers cannot identify the nerve
distinct and separate area of clinical evaluation. or its location. Because it is important in traction appli-
cations, the nerve is even more consequential in the man-
The authors take a broad leap of faith by suggesting the agement of all angulated type fractures and dislocations,
RS should be removed from “military service” entirely; which can greatly affect morbidity and return to duty
the authors state, the RS has “persisted too long, due issues. In terms of training and ease of use, the DMSB
to its length of service.” Basing such comments on a results underscore that the RS requires “little instruction
study in which there is such a high rate of failure when time” and “ease of application as the patient lays.” 1
attempting to apply the splint and “generalized poor
performance and overall low confidence (of the partici- Military medicine is certainly complex in many areas
pants) with traction splinting” is not sound. We believe and involves many unique care challenges. It stands
products such as the RS “persist” (sustainable) “too to reason that specific products are more suitable for

96 Journal of Special Operations Medicine Volume 14, Edition 4/Winter 2014