Modernizing Pelvic Binding Devices for Prehospital Medicine

For many years pelvic binding has been the standard of care in prehospital trauma. Even with the overwhelming supporting data for prehospital pelvic binders, EMS and Military prehospital systems have been slow to adopt routine use. Peer-reviewed literature highlights the benefit of improved patient outcomes using prehospital pelvic binding devices. In 2017 the military recommended routine prehospital pelvic binding due to common battlefield MOIs. Retrospective analysis of battlefield deaths and common battlefield injuries was the driver for the Joint Trauma System recommendation for routine prehospital pelvic binder application. A staggering 26% of service members who died in OEF/OIF died WITH a pelvic fracture. The numbers are too big to ignore.

The origin of CRO was to identify capability gaps in medicine for the austere prehospital medic in operational environments and build tools to address those needs. The name "CRO" comes from Cro-Magnon, or the evolution of medicine, like the natural evolution of man, hence "Cro-Magnon. Of course, once the logo came back from the graphic designer, "CRO" seemed to work fine, and we even liked it better. It was not until years later that we learned what a Combat Rescue Officer was. However, we accepted it because it threw the scent of the company's Navy/Marine Corps origin. The company is now service and background agnostic, instead broadly serving excellence in medicine as a whole.

In early 2017 our founder set up a moulage patient with a directional blast injury in the breach during the Raven exercise with MARSOC. The medic did an excellent job treating the patient until a Tactical Compression Wrap failed to appropriately bind the pelvis, ripping off the body and adding little to no support. The only true benefit of the Tactical Compression Wrap was the size. Items, especially items of routine use, needed to be small, low cube items without sacrificing the capability of carrying a purpose-built tool. At that moment (pictured below), the idea and original tagline of the company were born: "When space is an issue and advanced capabilities are a must, CRO Medical Gear has the kit you need!" Ha, a lot has changed since those early days, except for the mission of making smaller, purpose-built tools for critical care, like the CRO Pelvic Binder.

 



It all started with the TPOD. The TPOD has primarily driven the standard of pelvic binding in the hospital environment. It was never designed or suitable for the prehospital environment. While ambulances and some airframes have the luxury of space, moving into the field environment, weight and cubes become increasingly important to which items make it into the aid bag. There are other drawbacks too. This device uses an intricate lace system that can add complexity to the application, especially for medics that have not taken the time to master the proper procedure for placing the device. The TPOD must be physically cut with shears to size appropriately for the patient. This lace design is not preferred for binding in the prehospital environment, especially in military trauma scenarios.


Enter SAM:
At CRO, we have a high degree of respect for SAM's work and total contribution to our field. That is not to say old ideas cannot be improved. The development of TrueLock technology from SAM allowed for a pelvic sling using a unilateral strap tightening system, preferred over lacing systems seen in the TPOD and Pelvic Binder brand products. Prehospital systems widely adopted the TrueLock technology, including SAR, flight, and military.
The fundamental technology is based on achieving appropriate binding pressure. Thanks to SAM's innovation in this area, we know that 150 Newtons (33lbs) of circumferential force, when properly placed across the greater trochanters, is suitable to "close the book" on open-book pelvic fractures, which also carry a 50% mortality rate.

The "Pelvic Binder" is just a cheaper TPOD:
Around 2015 the Pelvic Binder brand of binders started showing up in DoD medical assemblages. The primary driver of most logisticians is the reduced price, mainly coming from cheaper construction and materials. A cheaper cost of production is acceptable in most cases, especially considering that a bedsheet is "suitable" for binding, but still, the lacing system and large size of the binder have the same complexities as the TPOD. Now, the question of cost over optimal function needs to be addressed, but try explaining that to the supply officer!

When digging into the literature on pelvic binding, we know of many documented cases of under reduction. However, we could not identify a single case of over-reduction of open-book pelvic fracture. This makes us ask whether "just enough" or "just the minimum" is the appropriate methodology?

These principles of pelvic binding led us on a four-year journey to discover the most compact, fastest, and most medically sound way to routinely bind the pelvis to ensure end-users will have a pelvic binder in their first line kit, where it belongs. Ultimately the best piece of medical equipment is the one you will have with you when you need it. Nearly all of our customers working in the field have to consider weight and cubes as a primary product adoption driver. Often, the ground medic is limited to what he can carry on the body. Our original design used a windlass to achieve circumferential tightening force. We quickly identified the BOA precision dial system as a superior mechanical advantage. This system, used on snowboard boots and in other extreme temperature situations, is designed not to fail. BOA is based in Denver, CO, and has a team of expert engineers and developers working in a world-class testing facility to maximize the effectiveness of their hardware in all extreme environments. BOA tests all applications and puts partner companies through a rigorous review and approval process to ensure quality control implementation of their hardware. A perfect teammate for creating a precision medical device.

It was not easy to convince BOA of the need for this technology in the military prehospital environment. However, once this project's scope was presented, it was clear that this is a large market with a great need. Ultimately, the use of their hardware will result in countless improved outcomes for patients with high-velocity injuries like blasts and GSWs.

One of the most critical features of the binder is the elastic sheath that allows the binder to flex up to 8 inches without compromising the internal windless strap that provides circumferential pressure. This feature reduces the overall size of the binder while still allowing it to fit 95% of the population.

The binder packs flat in an aid bag and is easily employed in the field. Once hand tightening is achieved, you ratchet the dial as tightly as possible. The hardware eliminates human factors, and you know you have reached at least 33lbs of circumferential pressure because the audible "clicks" slow and become more infrequent. Working with BOA, we selected the M4 dial, which the strongest human hand can tighten to 80 lbs. In comparison, the average human hand can tighten between 40-50 lbs., ensuring that the average user can quickly achieve binding pressure, especially when working in low-light or no-light environments. If over-reduction is not an issue, pressure over 150 Newtons is acceptable and even preferred in most cases.


Our goal is to eliminate all factors that can lead to omission or error by the medic operating in the field, and we are proud to bring you the latest in Pelvic Binding - a four-year journey that was well worth it.

If you want to learn more about our Pelvic Binder, check it out here or send an inquiry to support@cromedical.com.

Let us know your thoughts and comments on this great device, and look for new medical device launches in the coming year.

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