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and packing have failed to control the hemorrhage. Junctional Finally, we demonstrated that rescue blankets, when applied
tourniquets may also be effective for the situation where inju- wet, are suitable as chest seals with good occlusive and ad-
ries occur below the level of conventional tourniquet applica- herence properties. Fixation on two sides of the dressing is
tion, but conventional tourniquets have failed to control the sufficient to provide an outlet for entrapped air and sufficient
hemorrhage. In addition, the circumstance where hypotension sealing of the chest wound. When tested in an animal model,
persists despite adequate control of external hemorrhage bi- rescue blankets were superior to plastic foils from a gauze
lateral application of junctional tourniquets may temporarily package and proved to function as a potent makeshift chest
support blood pressure for the purpose of transport. Finally, seal. This is particularly important in emergencies where no
a casualty with a junctional tourniquet in place is a signal to commercial chest seal is available [6].
providers at the receiving surgical support facility that the pa-
tient is severely injured. Care of such patients should proceed In conclusion, our investigations of these fascinating multi-
immediately to the operating room where the junctional tour- functional tools showed a considerable potential for numerous
niquet should remain in place until adequate measures have alternative applications. Rescue blankets are strong enough to
been taken to achieve proximal vascular control. As junctional function as a triangular arm-sling, figure-of-eight bandage and
tourniquets become more commonplace future research op- alternative tools for transportation in remote areas. Rescue
portunities should focus on the safety and efficacy of junc- blankets are potential makeshift pelvic binders and tourni-
tional during tactical evacuation care. quets in bleeding emergencies and can function as makeshift
chest seals for sucking chest wounds. Rescue blankets can even
substitute for sunglasses to protect against snow blindness on
Multipurpose Applicability of the Rescue Blanket glaciers. Transparency and optical properties in the military
(Multimodale Verwendung der Rettungsdecke) version of the rescue blanket will differ from the commercially
Isser M, Wallner B, Salchner H, Wiedermann FJ, available version due to the altered coating. Specific optomet-
Schachner T, Lederer W.
ric investigations of the military version of the rescue blanket
escue blankets were developed as polyethylene terephthal- are needed.
Rate foils with a thin aluminum coating by the National
Aeronautics and Space Administration (NASA) in 1964. Literature
Originally, these blankets were used by Marshall Space Flight
Center to protect exterior surfaces of spacecraft from radiated 1. Bryan W. The Space Blanket: Your Adventure Companion.
heat [1]. Nowadays, the low-weight and low-bulk foils with In: The Marshall Star. National Aeronautics and Space Ad-
their characteristic silver and gold surfaces are essential parts ministration. 2016. https://www.nasa.gov/centers/marshall
of first aid kits and backpacks. Blankets can protect from and /about/star/star160511.html
treat hypothermia by reducing heat loss from convection, 2. Isser M, Kranebitter H, Kühn E, Lederer W. High-energy
evaporation, and thermal radiation. However, it is important visible light transparency and ultraviolet ray transmission
to avoid direct skin contact with the foil as this would increase of metallized rescue sheets. Sci Rep. 2019;9(1):11208. doi:
thermal conductance. In 2015, when Tactical Alpine Medicine 10.1038/s41598-019-47418-8. PMID: 31371746

was introduced by Tyrolean Mountain Rescue, we started to 3. Kranebitter H, Wallner B, Klinger A, Isser M, Wiedermann
scientifically evaluate the multiple functions of rescue blan- FJ, Lederer W. Rescue blankets – transmission and reflectiv-
kets. In 2016, we adopted the “napkin technique“ from CMC ity of electromagnetic radiation. Coatings 2020; 10(4):375.
Ulm as the preferred mode of application. DOI: 10.3390/coatings10040375.
4. Isser M, Kranebitter H, Kofler A, Groemer G, Wiedermann
FJ, Lederer W. Rescue blankets hamper thermal imaging
Our study with optometric measurements showed that rescue
blankets are transparent to visible light and effectively block in search and rescue missions. SN Appl. Sci. 2020; 2,1486
ultraviolet light. We are aware that our conclusions on trans- DOI: 10.1007/s42452-020-03252-6.
parency are restricted to the commercially available version 5. Isser M, Kranebitter H, Fink H, Wiedermann FJ, Lederer
of the rescue blanket and do not apply to the military version W. High Tensile Strength Increases Multifunctional Use of
with altered coating. In our study transmission of ultraviolet B Survival Blankets in Wilderness Emergencies. Wilderness
rays was less than 1% for the single layer. We concluded that Environ Med. 2020;31(2):215–219. doi: 10.1016/j.wem.
rescue blankets potentially protect from solar radiation when 2019.12.012.
used for facial protection and as makeshift sun goggles [2]. 6. Schachner T, Isser M, Haselbacher M, SchröckerP, Winkler
M, Augustin F, Lederer W. Rescue blanket as a provisional
seal for penetrating chest wounds in a new ex vivo porcine
Furthermore, we demonstrated that a single-layer rescue blan-
ket could sufficiently reflect infrared radiation to render de- model. J thoracic Surg 2021; in press.
tection of a body shape impossible. It did not matter whether
the gold or silver side faced up as the transmission of near- RAMP Mass Casualty Triage
infrared radiation in the infrared–visible radiation boundary Brad Keating, MPH, NRP
region was very low [3,4]. n recent years the number of high-profile events which re-
Iquired a tactical response has increased. From the events of
In addition, we detected that blankets show impressive ten- the Pulse nightclub to more recent occurrences in Las Vegas.
sile strength, indicating that they have the potential to serve Not only are these types of “Black Swan” events more fre-
as temporary pelvic binders or even as makeshift tourniquets quent, the casualty rates are increasing in number as well.
when urgent bleeding control is needed. However, it is import- Cited time and time again in the after-action reviews of the
ant to use newly manufactured rescue blankets as flexibility incidents is a failure to triage appropriately. In the Fort Hood
diminishes with the ongoing loss of plasticizers in older sam- shooting it was found that there was approximately a 70%
ples [5]. inaccurate triage rate which led to poorer patient outcomes in

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