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Use of a Shear Reduction Surface for Prehospital Transport: A Randomized Crossover Study.
Ann N Tescher1, Kathleen S Berns, Evan Call
1At Mayo Clinic, Rochester, Minnesota, USA, Ann N. Tescher, PhD, APRN, CNS, and Kathleen S. Berns, APRN, CNS, MS, are Advanced Practice RN Clinical Nurse Specialists. Evan Call, MS, CSM (NRM), is Lab Manager, EC Service Corp, Centerville, Utah. Also at Mayo Clinic, Patrick J. Koehler, LRT, RRT-ACCS, and Kip W. Salzwedel, RRT, LRT, are Respiratory Therapists; Heather E. McCormack, DScPT, PT, CWS, is Assistant Professor in Physical Therapy (retired); Lucas A. Myers, BS, is Senior Business Analyst; Clinton E. Hagen, MS, is Principal Data Scientist, and Jay Mandrekar, PhD, is Professor of Biostatistics and Neurology, Department of Quantitative Health Sciences. Marianne Russon, BS, is Project Manager, EC Service Corp. Acknowledgments: Mayo Clinic does not endorse specific products or services included in this article. This paper was presented as a poster at the Minnesota Affiliate National Association of Clinical Nurse Specialists Fall Conference and Annual Meeting, October 28, 2016, Minneapolis, Minnesota; at the National Pressure Ulcer Advisory Panel Research Symposium, November 9, 2016, Las Vegas, Nevada; at the Mayo Clinic Quality Conference, March 15, 2017, Rochester, Minnesota; at the Wound, Ostomy, and Continence Nurses Society's 49th Annual Conference, May 19-23, 2017, Salt Lake City, Utah; at the Wound Care From Innovations to Clinical Trials 2017 Conference, June 20-21, 2017, Manchester, England; and at the National Association of Emergency Medicine Services Physicians Scientific Assembly, January 11-13, 2018, San Diego, California. Portions of this article have been published in abstract form: J Wound Ostomy Continence Nurs 2017;44:R03; Prehosp Emerg Care 2018;22(1):137. The authors thank Scott P. Zietlow, MD, past chair (emeritus), Mayo Clinic Ambulance Board of Directors for support of this study. Kathleen Louden, ELS, senior scientific/medical editor, Mayo Clinic, substantively edited the manuscript. The Scientific Publications staff, Mayo Clinic, provided proofreading, administrative, and clerical support. The authors have disclosed no financial relationships related to this article. Submitted April 7, 2023; accepted in revised form July 26, 2023; published ahead of print August 22, 2023.
An antishear mattress overlay (ASMO) significantly reduced pressure, shear, and patient discomfort during ambulance transport compared to standard surfaces. Additional heel offloading is recommended for ambulance teams.
Area of Science:
- Biomedical Engineering
- Patient Transport Safety
Background:
- Ambulance transport involves significant pressure and shear forces on patients.
- Standard ambulance stretchers may not adequately mitigate these forces, potentially leading to discomfort and injury.
Purpose of the Study:
- To evaluate the effectiveness of an antishear mattress overlay (ASMO) against standard ambulance stretcher surfaces.
- To compare reductions in pressure, shear, and patient-reported discomfort.
Main Methods:
- Randomized crossover trial involving 30 adults across three BMI categories.
- Pressure/shear sensors applied to sacrum, ischial tuberosity, and heel.
- Testing conducted at 0°, 15°, and 30° head-of-bed elevations during simulated ambulance transport.
Main Results:
- ASMO reduced peak shear by 0.03 N (P=.02) and peak pressure by 0.16 mm Hg (P=.002) compared to standard surfaces.
- The heel experienced the highest pressure and shear.
- Patient-reported discomfort was significantly lower with the ASMO across all elevations (P=.046).
Conclusions:
- The antishear mattress overlay effectively reduces pressure, shear, and discomfort during ambulance transport.
- Specific interventions, such as heel offloading, are necessary to further enhance patient safety and comfort.
