WO1992007527A1

WO1992007527A1 - Counterpressure garment

Info

Publication number: WO1992007527A1
Application number: PCT/US1991/008142
Authority: WO
Inventors: Francis J. Mccabe
Original assignee: Mccabe Francis J
Priority date: 1990-11-01
Filing date: 1991-10-31
Publication date: 1992-05-14
Also published as: MX9101872A; CN1063610A; AU9066191A

Abstract

A counterpressure garment (10) primarily used in the treatment of a victim suffering from hypovolemic shock. The garment (10) is made of a resilient material, like elastic or a compressible material, like foam, or a combination of both, with a means for stretching or compressing the material to or near its stretch or compression limit and fastening it. This supplies the requisite counterpressure to increase blood circulation to the vital organs.

Description

TITLE: COUNTERPRESSURE GARMENT TECHNICAL FIELD

This invention relates generally to body treatment care and specifically to counterpressure garments used in emergency treatment of victims suffering from hypovolemic shock and in the presence of intractable bleeding.

BACKGROUND ART

Shock is a life threatening condition that results when the body is unable to maintain circulation to the heart, lungs and brain. It may be caused by trauma, blood loss, toxins or other circulatory diminishment. In addition to the routine shock first-aid of lying the victim prone with the lower extremities raised to move blood to the critical organs, it is also known to apply surface counterpressure to the lower extremities sufficient to overcome the pressure in the capillary and venus system to force increased circulation to the critical organs.

Circumferential pneumatic counterpressure (CPC) devices are well known inflatable garments used to apply pressure around the arms, legs and/or abdomen to control intractable bleeding and ameliorate shock. Examples of such devices are described in U.S. Pat. No. 3,933,150 issued January 20, 1976, to Kaplan et al., and U.S. Pat. No. 4,039,039 issued August 2, 1977, to Gottfried. The application of CPC device causes a dramatic rearrangement of the blood circulation within a victim's body. It causes the victim's blood pressure to rise and the volume of blood available to the heart, lungs and head to greatly increase, while the amount of blood in the extremities is decreased. The safety of pneumatic CPC devices has been questioned because the garment can be over-pressurized and cause restriction of the respiratory process, acidosis or ischemic injury (where the garment presses the skin against underlying bone) . A standard method of pressurizing a CPC is by using an air pump, which in the conditions and excitement surrounding an emergency situation, often result in the ambulance crew over-inflating the garment.

Another problem associated with CPC garments is the rapid pressure drop from the accidental puncturing of one or more bladders. A rapid depressurization could be fatal since the victim's blood pressure can decrease by as much as 60 mm HG.

Pressurized garments are also susceptible to temperature and atmospheric pressure changes, forcing the ambulance crew to adjust the garment's pressure. For example, if a skier at the top of a mountain is involved in an accident and is placed in a CPC garment, the relative pressure within the garment's bladders will decrease when the skier is brought down to ground level. Outdoor to indoor temperature changes can also raise or lower the relative pressure.

Since the pneumatic pressure fittings are sometimes metallic, a victim normally cannot be x-rayed for possible fractures or have an MRI ^* taken while in the garment. Further, the garment usually cannot be cut away in selected areas to expose portions of the victims body for treatment, as the cutting would open an air bladder and cause depressurization.

DISCLOSURE OF INVENTION The present invention involves a counterpressure garment which utilizes a resilient material, such as elastic material, or a compressible material, such as foam, or both in the legs and abdomen sections and adjustable fasteners to provide the external counterpressure necessary to transfer the blood supply back to the primary organs of a victim suffering from hypovolemic shock and possibly to slow or stop bleeding. The garment further utilizes a locatable abdomen flap containing a compressible foam block to provide appropriately direct counterpressure to the abdomen area. An advantage of this garment over the pneumatic CPC garment is that the hazards of over-pressurization and sudden depressurization are eliminated. The garment is applied in a manner that applies circumferential pressure sequentially from the ankles to the lower torso to translocate blood toward the vital organs. It does not require metallic fittings, and therefore permits x-ray and other electromagnetic imaging while the victim remains under pressure. The perineal area remains open, and portions of the garment may be cut away in other areas to expose the victim's body for treatment or hypodermic insertion without losing pressurization. .Another advantage is that it is a durable and washable garment and sufficiently inexpensive to be disposable if exposed to dangerous bacteria.

A further advantage is that its pressure is not effected by temperature and atmospheric pressure changes. This independence from temperature and atmospheric pressure also makes this garment suitable for use as a "comfort" garment under Astronauts' space suits, to keep their blood pressure stable.

The foregoing and other objects, features and advantages of this invention will be apparent from the description of the preferred embodiment and the accompanying drawings.

BRIEF DESCRIPTION OF DRAWINGS

Figure 1 is a perspective view of the inside of a counterpressure garment according to the invention, laid in a flat position.

Figure 2 is a perspective view of the outside of the counterpressure garment of Figure 1, laid in a flat position. Figure 3 is a perspective view of a victim laid on the counterpressure garment of Figure 1. Figure 4 is a perspective of a victim enclosed in the counterpressure garment of Figure 1.

Figure 5 is a perspective view of the inside of a counterpressure garment having separate pressure engagement means.

Figure 6 is a perspective view of the outside of a counterpressure garment having separate pressure engagement means.

MODES FOR CARRYING OUT THE INVENTION A counterpressure garment 10, depicted in a flat position in Figures 1 and 2, is adapted to be wrapped about a victim's legs and lower torso to apply external counterpressure to the lower circulatory system, as shown in Figures 3 and 4. A pair of leg sections 12a and 12b are adapted to enclose the victim's legs, while a lower torso section 14 is adapted to enclose the victim's lower torso and abdomen. Between the leg and lower torso sections, the perineal are remains exposed for hypodermic or tube insertion. A center yoke 16 provides a foundation for both the leg and torso sections, and is preferably constructed of a foam core contained inside an impermeable cover for comfort and durability.

The leg sections 12a, 12b each include a center elastic band 18a, 18b which is preferably made of a core web of elastic material, such as coarse weave spandex, sandwiched loosely between an inner and outer cover, such as a neoprene cover. The neoprene material is used to allow screening of written directions onto the material and to protect the elastic material from damage and moisture. The neoprene covers are stitched to the edges of the elastic bands and are sufficiently loose to be expandable to a width equivalent to the elastic in a fully stretched condition. The elastic bands 18 have a dumbbell shaped cut-out 20 for the knee area to free the joint for movement. The elastic bands 18 are sewn at one edge to an inner support seam 21 o polypropylene webbing and at their other edge to a similar outer support seam 22. The yoke 16 is sewn to the upper section of the inner support seams 21, as shown in Figure 2.

An outer flap 24 is sewn to the outer support seam 22. The flap 24 is contoured to a leg by having a wider upper section 24a for the thigh area, a narrow section 24b for the knee, and an intermediate width section 24c for the calf area. The thigh section 24a and the calf section 24c each have a plurality of evenly spaced horizontal velcro strips 26 sewn to their inside face, as depicted in Figure 1. A pair of molded plastic pull tabs 28, 29 are attached directly to the outer support seam 22, one tab

28 over the center of the thigh section 24a, and the other tab 29 over the calf section 24c, for ease in stretching the elastic to or near its stretch limit in those areas.

An inner flap 30 is sewn to the inner support seam 21. The flap 30 is similarly contoured to the leg by a wider thigh section 30a, a narrow knee section 30b, and an intermediate width calf section 30c. The flap 30 has a plurality of spaced horizontal velcro strips 32 on it outer face, as shown in Figure 2. The leg sections 12 are thus adapted to be tightly wrapped around the victim's legs by folding the inner flap 30 around the inside of the leg and then pulling the outer flap sections 24c, then 24a, one-at

-a-time around the leg by the pull tabs 28, 29 sufficient to stretch the elastic band 18 to provide circumferential compression as the elastic seeks to return to its relaxed state limit, then mating the velcro strips 26 to the strips

32. Since the velcro strips on both the yoke and flap sections are horizontal, the mating can be made at different overlaps to accommodate various leg thickness while still stretching the elastic bands to provide circumferential compression. The stretched elastic provides the requisite counterpressure to the leg by attempting to contract to its relaxed length, thus compressing the leg on all circumferential sides.

The lower leg sections may also be provided with a second set of flaps 25, 31 outside of the flaps 24c and 30c, for the lower calf area, as shown in Figure 2. The flaps 31 have horizontal velcro strips on their outside face, while the flaps 25 have the strips on their inside face, and are mated in the same manner as the flaps 24c and 30c to provide tighter mating over the lower calf and ankle area.

The lower torso section 14 has two elastic bands 34a, 34b sewn to a support seam 36 on one side of the yoke 16, and a single elastic band 44 sewn to a support seam 38 on the other side of the yoke. The elastic bands 34a, 34b and 44 each have a convex dumbbell shape and are also made of a elastic core sandwiched in neoprene, similar to the leg flaps. The two elastic bands 34a and 34b each have a support seam 37 supporting an end flap 39 Figure 2, which has a velcro pad 40 sewn on its inside face, as shown in Figure 1, and a hand grip edge binding 46 made by stitching the material edges around a strip of batting cord. A polypropylene pull tab 42 is attached directly to the support seam 37 associated with each of the bands 34a and 34b.

The single band 44 terminates against an outer support seam 48 Figure 2, to which is also sewn a fastener flap 50 and a zipper flap 52 Figure 1. The fastener flap 50 has a plurality of spaced horizontal velcro strips 51 covering its outside face, as shown in Figure 2. The zipper flap 52 supports one non-metallic zipper track. The matching non- metallic zipper track is attached to a removable abdomen compress 54, which comprises a compressible foam block 56 enclosed in a neoprene cover. The foam block 56 has a slight pear-shape to correspond roughly with the soft abdomen area between the rib cage. The abdomen compress is normally kept zipped to the garment, and is used whenever direct inward pressure on the abdomen is desired, such as to control suspected intra-abdominal hemorrhage. If direct abdomen pressure is not needed, the compress can be removed by the zipper. An excess of fabric can be used in the abdomen compress to permit sizing adjustments.

The zipper flap 52 is located inside from the fastener flap 50, such that the abdomen compress 54 can be placed over the victim's abdomen before the lower torso section 14 is fastened around the victim. The lower torso section 14 is wrapped around the victim by folding flap 50 inward, then pulling the bands 34a and 34b by their pull tabs 42 one-at-a-time around the torso to stretch the elastic, and then mating the velcro pads 40 to the horizontal velcro strips 51, at the overlap necessary to hold the elastic in a stretched condition. To achieve greater counterpressure about the abdomen, a removable stiffener plate or plates can be situated in the lower torso section.

Although not depTLcted in the drawings, it will be understood by those of ordinary skill that a gross size adjustment could be included to accommodate an exceptionally large or obese person by increasing the width of the elastic bands several inches in the leg and torso sections, and placing zipper tracks the same several inches apart on the elastic bands. The elastic material would then be folded to bring the zipper tracks together and zipped to produce an effective width for the normal adult body size, as depicted in the drawings. The zippers could then be opened before placing an extraordinarily large person in the garment to provide increased width.

In use, the counterpressure garment is laid flat as in Figure 1, and the victim is placed face up on the garment with the tip of the garment below the lowest rib, as shown in Figure 3. Appropriate graphic markings and instructions, such as SPINE, LINE, LEFT LEG and RIGHT LEG may be screened onto the neoprene surface to assist in placing the victim. The rescue personnel then kneel by the victim and enclose the legs by pulling the leg flaps to stretch the elastic and mating the velcro strips, as shown in Fig. 4. To translocate blood toward the vital organs, the calf flap 24c is mated first, then the lower calf flap 25, then the thigh flap 24a. If abdominal pressure is desired, the abdominal compress is placed over the soft abdomen area, and the lower torso flaps are pulled to stretch the elastic and fastened by the velcro strips. If portions of the garment must be cut away to expose area of the victim's body for treatment or insertion, the appropriate area can be marked, the flaps opened and the area cut out with a scissors, then refastened. Since there are no air bladders, cutting away material will not destroy counterpressure by the elastic in the covered areas. As the garment and zipper are all non-metallic, the patient can be x-rayed for fractures or have an MRI taken while in the garment.

The garment 10 may be primarily of a compressible material, such as foam. Preferably, a cloth or fabric is used to cover the foam on both inside and outside faces, making a "sandwich". The adjustable length fastening means may be the "Velcro" mating strips or pull-straps and buckles although any fastening means can be used to secure the garment, including zippers, buttons, snaps and the like.

The selection of the elastic or compressible material is made so that when applying the fastening means, a range of pressure placed upon the material does not significantly effect the counterpressure applied to the victim. For example, if a 35 lb. application to the pull-straps is needed for the required counterpressure, a 30 to 40 lb. application will not bring the counterpressure applied to the victim out of the beneficial range. (The beneficial range is the range where the victim benefits from the application of the counterpressure garment, i.e. the counterpressure is not so insignificant such that the application of the garment does not increase the blood supply to the victim's vital organs, and is not so great as to cause further injury to the victim.) Thus, the inherent properties of the material eliminate the strength of the attendant as a variable in determining the counterpressure applied to the victim.

The number of "Velcro" mating strips or pull-straps is proportional to the counterpressure applied to the victim. A greater number of "Velcro" mating strips or pull-straps decreases the effort needed to achieve an equivalent counterpressure. For example, if two (2) pull-straps are used and the needed counterpressure requires a 30-40 lb. application to set each pull-strap, then by increasing the number of pull-straps to four (4) would decrease the pressure needed to set the pull-straps to 15-20 lbs. each. In another embodiment of the present invention (Figs. 5 and 6) , the fastening means Ilia, 111b is used solely to hold the garment about the victim. A separate variable pressure engagement means is used to set the needed counterpressure. A zipper 114 in each leg section is the preferred type of fastener to be utilized as the variable pressure engagement means, but any fastener which can compress the material and hold it in place can be used. A zipper allows a more gradual increase in counterpressure that either the "Velcro" strips or the pull-straps. This method provides a gradient for controlling the counterpressure, and also helps in eliminating the strength of the attendant who applies the garment, as a variable in setting the counterpressure.

Pockets 117 can also be sewn into the exterior of the lower torso section to secure the stiffener plates 116 (See Fig. 6) .

Abdomen flaps on the lower torso section allow the counterpressure garment to be adjusted to a particular victim. Leg flaps serve the same purpose. Other sizing adjustments can be made by properly situating the contoured stiffener plate over the victim's stomach. An excess of fabric is designed into the abdomen flap which permits this sizing adjustment. This allows the counterpressure to be applied to the appropriate point of the victim's abdomen. Also, additional fasteners can be placed in the material to aid in sizing each section to the victim. For example, if an additional zipper is used as a sizing means, it can be left open or unzipped when the victim is a large person, and closed or zipped when the victim is smaller. Further, the fastening means can be used to adjust the size for the individual victim, by using wide mating strips of "Velcro".

Any section can be used independently from another section by not engaging the pressure engagement means or by providing a detachable interconnecting means between each lower section and the upper section. If a detachable interconnecting means is desired, the greatest flexibility is achieved by using zippers 115, as shown in Figs. 5 and 6. "Velcro" mating strips would also be suitable as a detachable interconnecting means.

The structural strength of foam allows the foam counterpressure garment to be used as a splint. For example, if a broken bone, sprain, or torn ligaments are present, the counterpressure garment can be used to restrict movement and provide the necessary support of the affected area.

There are many variations in which one skilled in the art can adapt the preferred embodiment to suit their particular needs. One variation would be to manufacture a suit which utilizes compressible material (e.g., foam) and resilient material (e.g., elastic) in one suit. This combination foam/elastic counterpressure garment may have advantages over a counterpressure suit made of only one of the aforementioned materials. Other variations include adding one or more inflatable bladders to each section, or substituting buttons or snaps as the primary fastener.

Claims

1. In a counterpressure garment for medical use by application to a patient, said garment having a pair of leg sections adapted to enclose the legs of a patient and a lower torso section adapted to enclose the lower torso and abdomen of a patient, the improvement characterized in that resilient material is provided in said leg and lower torso sections to provide, when stretched, counterpressure to the circulatory system of said patient; and fastening means engaging the leg sections and lower torso sections for securing each section around a portion of the patient with the material under tension.

2. The counterpressure garment of Claim 1 wherein the material is elastic and when placed under tension, stretches.

3. The counterpressure garment of Claim 2 wherein the fastening means comprises material made to grip on contact and mate with other material by the application of pressure to cause engagement of the two materials and mating and having sufficient dimensions to allow said material to be mated at varying overlaps sufficient to stretch the elastic material around parts of patients of different sizes.

4. The counterpressure garment of Claim 1, further comprising a flap containing a compressible block in hinged attachment to the lower torso section, said hinged attachment adapted to allow the block to be placed over a patient's abdomen before the lower torso section is positioned to enclose the patient.

5. The counterpressure garment of Claim 2, further comprising a flap containing a compressible block in hinged attachment to the lower torso section, said hinged attachment adapted to allow the block to be placed over the patient's abdomen before the lower torso section is positioned to enclose the patient.

6. In a counterpressure garment for medical use by application to a patient, said garment having a pair of leg sections adapted to enclose the legs of a patient and a lower torso section adapted to enclose the lower torso and abdomen of a patient, the improvement characterized that at least partially compressible material is provided in said leg and lower torso sections to provide, when compressed, counterpressure to the circulatory system of said patient; and fastening means engaging the leg sections and lower torso sections for securing each section around a portion of the patient with the material compressed.

7. The counterpressure garment of Claim 6 wherein the fastening means comprises material made to grip on contact and mate with other material by the application of pressure to cause engagement of the two materials and mating and having sufficient dimensions to allow said material to be mated at varying overlaps sufficient to stretch the material around parts of patients of different sizes.

8. The counterpressure garment of Claim 6 wherein the compressible material is a foam.

9. The counterpressure garment of Claim 1, 2 or 6 wherein a hand grip is attached to each flap to assist in engaging the fastening means.

10. The counterpressure garment of Claim 1, 2 or 6 having a means for detachably connecting the leg sections to the lower torso section.

11. The counterpressure garment of Claim 1 with variable pressure means for varying the pressure applied by the garment to the patient after the garment has been fastened about the patient.

12. The counterpressure garment of Claim 11 wherein the variable pressure means is a zipper.