Page 33 - JSOM Spring 2018

The Shrail

A Comparison of a Novel Attachable Rail System

With the Current Deployment Operating Table

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Joshua Dilday, DO *; Maxwell Sirkin, MD ; Thomas Wertin, MD ;
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Frances Bradley, CRNA ; Jason Hiles, MD 1

ABSTRACT
The current forward surgical team (FST) operating table is Methods
heavy and burdensome and hinders essential movement flex-
ibility. A novel attachable rail system, the Shrail, has been de- After institutional review board approval, a prospective study
veloped to overcome these obstacles. The Shrail turns a North was conducted at an Army FST using a two-man team to com-
Atlantic Treaty Organization litter into a functional operating pare assembly times between the English table and the Shrail.
table. A local FST compared the assembly of the FST operat- Each assembly was performed from the stored configuration
ing table with assembling the Shrail. Device weight, storage to a mission-capable configuration. Complete assembly of the
space, and assembly space were directly measured and com- English table was defined as the frame with attached clamps,
pared. The mean assembly time required for the Shrail was tray, and NATO litter. Assembly time ended with the NATO
significantly less compared with the operating table (23.36 litter being placed on the frame. Before each assembly, the
versus 151.6 seconds; p ≤ .01). The Shrail weighs less (6.80kg English table was broken down to the same configuration used
versus 73.03kg) and requires less storage space (0.019m ver- for storage and transport. Complete assembly of the Shrail
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sus 0.323m ) compared with the current FST operating table. was defined as a NATO litter on a litter stand with the Shrail
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The Shrail provides an FST with a faster, lighter surgical table attached to the litter. Assembly time ended with the NATO
assembly. For these reasons, it is better suited for the demands litter and attached Shrail being placed on the litter stands. Be-
of an FST and the implementation of prolonged field care. fore each assembly, the Shrail was broken down to the same
configuration used for storage and transport. Each device was
Keywords: Shrail; litter; operating table; prolonged field assembled as described for 20 iterations.
care; austere, military
Assembly-time analysis between the two groups was initially
performed by using Student t test. However, because of an ex-
Introduction treme data value causing nonnormality, the nonparametric Wil-
coxon–Mann–Whitney test was used to detect a difference in
Lessons learned from the history of war surgery demonstrate the underlying distribution of assembly times between groups.
the need for small, flexible, surgical teams. With its small foot-
print and ease of transport, the forward surgical team (FST)
was designed to be operationally effective in austere environ- Results
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ments. The FST has proved to be extremely beneficial in pro- The statistical analysis of the assembly times is outlined in
viding casualty care, having comparable outcomes to larger, Table 1. The mean assembly time of the Shrail was 23.36 sec-
nonmobile combat support hospitals. As the military imple- onds (standard deviation, 5.46 seconds). The mean assembly
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ments prolonged field care (PFC), more in-depth surgical re- time of the English table was 151.60 seconds (standard de-
sponsibilities will be required of the FST. viation, 90.63 seconds). The maximum assembly time for the
Shrail was 40.00 seconds. The maximum assembly time for
A novel rail system has been created to aid the transition to PFC. the English table was 528 seconds. The extreme value of 528
The rail system, the Shrail, is a frame that attaches to the North seconds compared with the mean of the English table assembly
Atlantic Treaty Organization (NATO) litter to hold and stabilize time caused nonnormality. The time required to assemble the
the same surgical equipment used on a commercial operating English table was significantly longer than the time required to
room (OR) table. In concept, the Shrail would turn the NATO assemble the Shrail (p ≤ .001).
litter into a portable operating table. The purpose of this study
was to compare the current FST operating table (i.e., the English The weight and space occupied by each device were measured
table) with the novel portable rail system (i.e., the Shrail). and compared. The English table was measured in both the
*Address correspondence to 5005 N. Piedras St, Department of Surgery, El Paso, TX 79920; or joshua.c.dilday.mil@mail.mil
1 CPT Dilday, CPT Sirkin, LTC Wertin, and LTC Hiles are affiliated with General Surgery, William Beaumont Army Medical Center, Fort Bliss,
TX. MAJ Bradley is Commander, 745th Forward Surgical Team, Fort Bliss.
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