Field Expedient Bleeding Simulation System

Transcript

FIELD EXPEDIENT BLEEDING SIMULATION SYSTEM TM ® FEBSS HydraSim FEBSS Impact Simulation Trainer (FIST) Information and Instructions DEDICATED TO THE “WARFIGHTER MEDICTM” TM US and Foreign Patents Pending Made in USA INTRODUCTION The HydraSim® provides the illusion of external hemorrhage at the point of injury. Those that are trained have the opportunity to see and treat bleeding wounds with hemostatic dressings, pressure dressings, and tourniquets just like they would in a real situation. When coupled with the FEBSS Impact Simulation Trainer™ (FIST) the HydraSim® provides visual bleeding simulation AND the auditory impact simulation associated with the point of wounding during a traumatic event. These simple yet powerful additions increase the realism to any medical training event. Table of Contents MultiSim® Injury Fabrication 1 Upper Extremity Wounds Charge the HydraSim® Battery Install the HydraSim® Battery 3 Loading FIST™ Charging Handles Connecting the FIST™ Charging handle Connecting outside the HydraSim® pack Connecting inside the HydraSim® pack Charging the FIST™ Operating the FIST™ Check the HydraSim® Lines Preparing the FEBSS™ Refill Tank Mixing Simulation Blood 11 Reloading FIST™ Charging Handles Lower Extremity Wounds Getting Started FEBSS Impact Simulation Trainer (FIST)™ Maintenance Guidelines 4 SKEDCO UV Sensitive Simulation Blood (UVSSB) 15 Battery Maintenance HydraSim™ Transmitter Battery Maintenance Monthly Maintenance: Flushing the HydraSi® Simulaids Blood Powder Filling the HydraSim® Using the HydraSim® Live Casualty Simulation Vomit Simulation Constructing the Line Connecting the Line to the HydraSim® Operating the HydraSim™ during Vomit Simulation Mannequin Simulation 7 Troubleshooting tips 16 Packing List 18 Deluxe Packing List 19 MultiSim TM Check the HydraSim® lines ® Unzip the HydraSim side pocket. Push on each line connector to ensure that each fitting is fully connected to its corresponding coupler body – lines may have become disconnected during shipment. Zip up the HydraSim® side pocket. MultiSim® Injury Fabrication Plug in the hot glue gun – consult the instructions for operation contained within the glue gun package. Upper Extremity Wounds Cut off an entire leg of the stocking. Cut finger holes into the closed end of the stocking. Slide an empty water bottle to the desired wound area inside the stocking. Cut two small tubing holes into the desired wound area of the stocking. Remove the nasal cannula from its wrapper. Cut off the nasal flares of the nasal cannula. Slide the two lines through the open end of the stocking, then each line through a tubing hole in the stocking. Mix enamel paint to desired color on a piece of scrap cardboard. Carefully apply hot glue to the region where the tubing exits the stocking. 1 While the glue is still hot, paint the glue with enamel paint – paint only the hot glue areas, when the glue cools – the paint will be dry. The glue will stick to the brush – do not be concerned. Continue to apply paint with the brush. GET CREATIVE - Include debris like small wood chips or rocks as simulated shrapnel to increase the realism to your fabricated wound. Once the glue has cooled, cut the excess tubing from the glued area. Lower Extremity Wounds Fabricate the lower extremity injury the same way as the upper extremity injury but do not cut the legs off the stockings. Fabricate the injury as if the user were wearing the stockings over their lower extremities. This application provides a seamless appearance of the fabricated wound. 2 Carefully remove the empty bottle from inside the nylon stocking. Cut the tubing to the desired length and install a barbed coupling insert . The fabricated injury is ready for use – use a rubber band to keep the injury sleeve from sliding down the victim’s arm. Helpful Hints: Increase realism by installing a 2 – 3 inch section of latex tubing within the blood line to allow for pressure point compression. Save time by constructing two upper extremity injuries at once. Getting Started ® Charge the HydraSim Battery Plug in the charger to a standard wall outlet – a green LED light will flash green and then go out. Plug in the HydraSim® Battery to the HydraSimTM charger – a red LED light means the battery is charging. Charge for 24 hours or until the red LED light turns green – the green LED means that the battery is fully charged. Install the HydraSim® Battery Unzip the top flap of the HydraSim® and open the battery pocket. Plug in the HydraSim® battery to the HydraSim® battery cord. Slide the HydraSim® battery into the battery pocket – the battery can be placed vertical or horizontal in the pocket. Feed the excess battery cord back through the corresponding rubber grommet within the pocket if needed and close the battery pocket flap. While the top flap is still open, check to make sure the refill port is connected to the refill line by pressing on the coupling insert – this line may have become disconnected during shipment. Close the top flap by zipping each side. ® Help ful Hints: The HydraSim battery can be used for approximately 8hrs of intermittent use. TM Remember to unplug the FEBSS TM battery when training is finished for the day – failure to do so may result in damage to the FEBSS battery. 3 Preparing the FEBSSTM Refill Tank Route the flow control hose through the FEBSSTM Field Pack hose grommet. Unscrew the hose compression fitting from the flow control handle. Place the hose compression fitting over the hose. Attach the flow control handle to the hose by pushing the hose over the barbed end of the flow control handle. Thread the hose compression fitting back onto the flow control handle and hand tighten. Mixing Simulation Blood The FEBSS HydraSimTM uses virtually any type of simulation available as long as the simulation blood has the same viscosity as water. Skedco UV Sensitive Simulation Instructions Fill the FEBSSTM Refill Tank to the Max Fill Line with cold water. 4 Shake the UV Sensitive Simulation Blood container for one minute. Pour the contents into the FULL FEBSSTM Refill Tank. Tighten the Refill Tank pump handle. TM Place the FEBSS Refill Tank TM into the FEBSS Field Pack and shake the tank ten times. UV Sensitive Simulation Blood Clean up Instructions Once all simulations are finished, wear the garment in the sunlight as long as possible – the red simulation fluid will turn to a tan color when exposed to direct sunlight and then eventually dry to a white powder. The white powder can then be brushed off of the garment. In some cases the pigment will not completely transform until the garment is almost dry. If a red/pink color still remains due to wrinkling once the garment is dry – soak the garment in water and lay it out in direct sunlight to dry again. Make sure the affected area has no wrinkles that will shade the sunlight. Repeat as needed until red/pink color had faded. Reference the enclosed Material Safety Data Sheet if needed. Simulaids Blood Powder Instructions TM Fill FEBSS cold water. Refill Tank to the Max Fill Line with Add desired amount of powder – using less of the powder will lighten the color of the simulation blood but it will be easier to wash out of the garment. Tighten the Refill Tank pump handle. TM Place the FEBSS Refill Tank into the TM FEBSS Field Pack and close the pack. Shake the tank side to side to mix the simulation blood. Helpful Hint: To help in the laundering process, add 1 cup of laundry detergent to the FEBSSTM refill tank once the simulation blood is mixed – this may cause irritation if exposed to the eyes or mouth. 5 Filling the HydraSimTM WARNING: DO NOT LEAVE THE HydraSim® UNATTENDED WHILE FILLING. Too much pressure within the HydraSim® may cause the bladder to rupture – Do not overfill. Unzip the FEBSS Field Pack and pressurize the Refill Tank. Connect the flow control handle to the color coded black coupler body within the HyraSim® simulated drink tube line. Once connected, squeeze the yellow flow control lever and lock it into place by pushing it forward – simulated blood will flow into the HydraSim® as long as the Refill Tank is pressurized and connected to the HydraSim® Fill Line. The HydraSim® will expand with fluid and become firm to the touch when it is full. Filling should take less than two minutes. Once the HydraSim® is full and firm to the touch disconnect the Refill Tank. Hold the HydraSim® upright and connect an injury coupling insert to the color coded black coupler body to bleed all of the air out of the system. Squeezing the HydraSim® while upright will aid in this process. Removing the air from the HydraSim® allows the system to operate in all positions. Failure to remove the air will result in poor performance during simulations. 6 Shake the HydraSim® to ensure that all of the air has been bled from the system. If you continue to hear noticeable fluid movement inside the HydraSim® repeat the previous step. Simulation Using the HydraSim® The FEBSS HydraSim® is worn just like a common hydration pack. The simulated drink tube is routed underneath the clothing and capa of being used with live simulated casualties AND connected to a series of predetermined injuries. The HydraSim® has the capability mannequin simulation casualties. Each line is color coded: Arterial = Tan Venous = Foliage Green FIST Air In = OD Green FIST Air Out = Coyote Brown Blood Fill = Black Helpful Hint: Arterial and venous blood lines operate independently of one another. However, both arterial lines will turn on and off at the same time. Both venous lines will turn on and off at the same time. Some leakage may occur if both venous or both arterial lines are connected at the same time - this is normal. To activate each bleeding injury, press the “on” button on the corresponding color coded remote transmitter. Each Arterial and Venous coupler body has a fluid adjustment valve that can be dialed up or down according to how much blood is required for each simulated injury. To deactivate each bleeding injury press the “off” button on the corresponding color coded remote transmitter. Connect each simulated injury line and adjust fluid volume to desired amount. 7 Live Casualty Simulation During live casualty simulation, it is recommended that the live simulated casualty operate the HydraSim®. This allows the casualty to control the amount of pressure applied to their simulated wounds during the training exercise. If dressings and tourniquets are too loose during application, the casualty has the ability to keep their simulated wounds bleeding. This forces the caregiver to continue to treat visible wounds. If dressings and tourniquets have enough pressure on the wounds during applicaton, the casualty has the ability to stop the wounds from bleeding. The live simulated casualty can conceal the HydraSim® remote transmitters in a pocket or underneath gloved hands. At the point of injury – activate bleeding wounds Once treated correctly – deactivate bleeding wounds Helpful Hint: Waterproofing the remote transmitter with a plastic bag will extend the life of the transmitter. *Courtesy of Dan Olesnicky, MD, ABEM, ABIM, International School of Tactical Medicine When a tourniquet is applied to the extremity of a live simulated casualty, the casualty needs the ability to deactivate the bleeding wound(s) once the tourniquet begins to tighten. When used correctly, tourniquets cause a substantial amount of pain – when the tourniquet begins to tighten and possibly hurt, the casualty must remotely deactivate the bleeding providing the illusion that the treatment worked while preventing an actual tourniquet like effect. THE USE OF TORNIQUETS ON LIVE SIMULATED CASUALTIES SHOULD BE CLOSELY MONITORED IN ORDER TO PREVENT INJURY. 8 Vomit Simulation Vomit Simulation The HydraSim® offers a unique vomit simulation configuration constructed with simple and expendable materials. The HydraSim® connects to a modified balloon placed in the palm of the live simulated casualty. The casualty makes a fist blocking the fluid flow causing pressure to build up in the balloon. Once the balloon is pressurized, the casualty moves his or her gloved hand to their mouth and opens their hand. This releases the pressure built up in the balloon and simulates projectile vomiting. You’ll need: 1 set of nasal cannulla 2 rubber bands 1 long sleeved shirt or coat 1 pair SKEDCO Simulation Gloves 1 balloon – 12” size (preferably black in color) Constructing the Line Cut the entire nasal cannulla portion off of the line and slide the cut end of the line into the open end of the balloon. Use 1 Rubber band to secure the balloon to the line making a water tight seal. Using a pair of scissors, cut a 1” slit into closed end of the balloon. Measure the line by tracing it up the simulated casualty’s arm toward the simulated drink tube of the HydraSim®. Cut the line at the appropriate length and slide a coupling insert into the line. 9 Connecting the Line to the HydraSim® Ensure that the HydraSim® is filled with the desired fluid and connected to its power source. Place the second rubber band around the casualty’s wrist to keep the line from sliding up the casualty’s arm. While wearing both simulation gloves, slide the open end of the balloon through the hole in one of the casualty’s gloves and expose the cut portion of the balloon in the casualty’s palm. Route the line from the casualty’s palm, underneath the casualty’s long sleeved shirt or coat and up the arm to the HydraSim® simulated drink tube. Operating the HydraSim® during Vomit Simulation The live simulated casualty should make a fist and then remotely activate the venous line of the HydraSim®. This will cause the balloon to expand and pressurize. When the balloon is nearly full, the live simulated casualty should move their gloved hand near their mouth and open their hand. The balloon will rapidly empty and simulate projectile vomiting. Remotely deactivate the HydraSim® once vomit simulation is finished. 10 Connect the coupling insert of the vomit line to ® a venous coupler body of the HydraSim and ensure that the fluid adjustment valve is wide open. Conceal all of the HydraSim® lines. Helpful Hint: Increase the realism of the vomit simulation by using vomit sound effects provided by the live simulated casualty. FISTTM Mannequin Simulation The HydraSim® has the capability of attaching to multiple simulation mannequins allowing the user to “recycle” training equipment they ® already have. The HydraSim is worn by live simulated casualties and mannequin simulated casualties in the same manner. The simulated drink tube is routed underneath the mannequin’s clothing and connected to a series of predetermined injuries. MultiSim® Fabricated Injuries can be applied to training mannequins in the same manner as live simulated casualties. The user is responsible for remotely activating and ® deactivating bleeding wounds during the simulation exercise. The HydraSim has insertion capability for virtually any type of hollow training mannequin (i.e. Crash Kelly – Laerdal). FEBSS™ Mannequin Modification Kits increase durability of hollow mannequins and allow for joint articulation during bleeding simulation. *Courtesy of Dan Olesnicky, MD, ABEM, ABIM International School of Tactical Medicine FEBSS Impact Simulation Trainer (FIST)TM Optional Upgrade The FEBSS Impact Simulation Trainer (FIST)TM adds a loud yet safe auditory effect to bleeding simulation by utilizing one of the most common items in the medical community – the examination glove. No pyrotechnics ics or CO2 compressed gas required. uired. *Twist handle to lock and unlock. 11 Loading FISTTM Charging Handles Caution: Never point the FISTTM charging handle directly at face. Separate the charging handle body and insert. Tightly stretch both layers of one examination glove over the charging handle body. Helpful Hints: The tighter the examination glove is around the charging handle body – the louder the impact simulation will be. XL examination gloves can be used on average up to 15 times. Firmly push the charging handle insert into the glove covered charging handle body until the set screw is reached - ensure that the charging handle insert is seated firmly within the charging handle body to prevent the insert from ejecting from the handle body upon activation. Reloading FISTTM Charging Handles Once discharged, step on the insert separation loop and pull the charging handle body until the body and insert separate. Repeat the previous steps to reload the FIST™ charging handles. Helpful Hint: The expended FISTTM charging handles may be hard to separate if the examination gloves get wet. If this occurs, rip the excess glove out of the handle and separate the insert and handle body using the insert separation loop. If the handle is still hard to separate, spray airway mannequin lubrication between the insert and the handle body to loosen the two pieces. Connecting the FISTTM Charging Handle TM TM The FIST charging handle can be connected inside the HydraSim® pack or connected to the FIST Air Out (coyote brown color coded) TM coupler body within the HydraSim® simulated drink tube. Each connection has its own advantage. Connecting the FIST charging handle TM within the HydraSim® pack creates a consolidated system but the live simulated casualty cannot reload the FIST without taking the TM HydraSim® off their back. Connecting the charging handle to the FIST Air Out line gives the live simulated casualty immediate access to the TM TM FIST charging handle allowing them to reload the FIST quickly, but forces the user to conceal the charging handle in a exterior pouch or pocket. 12 Connecting outside the HydraSim® pack TM Connect one end of the FIST TM adapter line to the FIST Air Out line (coyote brown) within the simulated drink tube. Ensure the FISTTM charging handle is loaded. Connect the other end of the FISTTM adapter line to the charging handle coupler body. Conceal the loaded FISTTM charging handle with the open end of the handle exposed. Helpful Hint: Ensure that the open end of the TM FIST charging handle is not covered. Covering the open end of the FISTTM charging handle will muffle the impact simulation. ® Connecting inside the HydraSim pack Unzip the HydraSim® side pocket and top flap. Disconnect the FISTTM Air Out line within the simulated drink tube from the FISTTM Air Out coupler body (coyote brown) Route a free end of the FISTTM adapter line to the FISTTM Air Out coupler body. (coyote brown) Connect the FISTTM adapter line to the FISTTM Air Out coupler body. (coyote brown) Connect the other end of the FISTTM adapter line to the charging handle coupler body. ® Within the HydraSim , place the opened end of the FISTTM charging handle out of the opening near the shoulder strap of the HydraSim® pack. (top left) 13 Charging the FISTTM TM Connect the FIST Charger to the color coded OD Green coupler body within the simulated drink tube. TM Charge the FIST with up to 30 compressions of TM the charger – do not overcharge the FIST with more compressions. Disconnect the FIST lines. TM Charger and conceal all Operating the FISTTM TM The FIST operates off of the same remote transmitters TM as the HydraSim®. The FIST and HydraSim® will simultaneously activate when either arterial or venous transmitters are used. TM Once the simulation has completed, the FIST can be reset by disconnecting the spent charging handle and connecting a loaded charging handle. 14 Maintenance Guidelines Maintenance SKEDCO INC. products are designed to last and we stand behind our one year factory warranty. However, any tampering or activity outside the instructed use will void the warranty for this product. Battery Maintenance Disconnect the HydraSim® battery and recharge after each use. If stored for an extended amount of time, recharge the battery for 8-10 hours before use. Remember to unplug the FEBSSTM battery when training is finished for the day – failure to do so may result in damage to the FEBSSTM battery. HydraSim® Transmitter Battery Maintenance The HydraSim® transmitters require a Type 27 - 12 Volt batteries in order to operate correctly. Duracell makes this type of battery and it can be purchased at many retail stores. New HydraSim® transmitter batteries should be installed when the operational distance of the transmitters has significantly decreased. ® Remove the securing screw located on the back of the HydraSim transmitter using a Phillips head screwdriver. Carefully expose the transmitter circuit board and remove the discharged battery paying close attention to the polarity of the terminals. Install a new battery and replace the circuit board within the enclosure. Then fasten the enclosure together with the securing screw. Monthly Maintenance: Flushing the HydraSim® Empty the Refill Tank and wash with warm water. A long brush may be used to scrub the simulation blood residue off of the bottom of the tank. Once completed, fill the Refill Tank to the fill line with warm water and ensure that no simulation blood remains in the tank. ® Install the HydraSim battery. Fill the HydraSim® with clean, warm water. ® Connect at least one MultiSim Fabricated Injury to the venous and arterial lines ensuring that the fluid will exit into a sink or bucket. Activate both venous and arterial lines. ® Continue the previous steps until the entire contents of the Refill Tank have been flushed through the HydraSim . Deactivate the venous and arterial lines and unplug the HydraSim® battery. 15 Trouble shooting Troubleshooting tips The blood flow from the HydraSim® may diminish over time due to debris within the simulation blood. To correct this situation, the HydraSim® valve plungers must be wiped clean. You will need: 1 - 9/16” wrench 1 – Medium sized flat head screwdriver Ensure that the HydraSim® is empty before you begin. Remove the interior HydraSim® bladder bag from the hydration pack. Remove the FISTTM Air cylinder. Disconnect the simulated drink tube refill line from the refill coupler body. Push the refill coupler body back through its corresponding rubber grommet until it is free. Open the bladder bag until the manifold valves are exposed. 16 Disconnect the fluid output line by squeezing the manifold push-to-connect fitting and pulling on the fluid output line. Loosen one of the coil fasteners with a 9/16” wrench and remove the coil from the valve. Replace the coil fastener on the valve plunger stem ensuring that the spacer washer is contained within the valve plunger stem. Carefully unscrew the valve stem with a flat head screw driver – the valve plunger will be exposed – do not lose the plunger, spring, or O-ring. Wipe off the rubber plunger and replace the plunger and spring back into the valve stem. Carefully thread the valve stem back onto the valve body ensuring that the O-ring is seated within the valve body. Tighten the valve stem with the flat head screwdriver. Remove the coil fastener and replace the coil ensuring that the spacer washer separates the coil and the valve body – tighten until snug with the 9/16” wrench – do not over tighten. Repeat the previous steps on the second valve if needed – DO NOT MIX UP THE VALVE COILS. Reconnect the fluid output line by inserting the line into the manifold push-to-connect fitting until seated. Pull back on the fluid output line to ensure that the connection is made correctly. Push the refill coupler body back through its corresponding rubber grommet. Replace the FIST TM Air Cylinder. Zip up the bladder bag. Reconnect all coupling inserts to the corresponding color coded coupler bodies. Replace the interior HyraSim® bladder bag within the hydration pack. Fill and bleed air from inside the HydraSim® before the unit is put back into use. 17 Packing List FEBSS HydraSim® Basic Kit FS-2000B FS-2001 ® 4–FE 4–FEBSS HydraSim Remote C Control Transmitters with storage case 1–Re-chargeable Battery Packs 1–Battery Charger FS-1002 HydraSim 1– 3 gallon refill tank 1–FEBSSTM Field Pack FS-1004 SK-2311 Optional Upgrade FEBSS Impact Simulation Trainer (FIST)TM 4- FIST Charging Handles FISTTM Adapter Line FS-1013 1– MultiSim Injury Fabrication Kit FS-1005 2–Simulaid Simulation Blood Packets No. 225 1–Skedco Rope Tech Gloves-Modified FS-1016 12 Nitrile Examination Gloves OP-296003 18 FS-1015 FIST Pneumatic Charger FS-1014 Deluxe Packing List TM FEBSS Deluxe Kit TM The FEBSS TM Deluxe Kit includes all items in the FEBSS 2–SOF-T Tourniquets 2–Emergency Trauma Dressings OP-SOF-T OP-FCP-05 FS-2000D Basic Kit plus these additional items. 2–QuikClot Combat Gauze moulage Trainer 1–Storm Case IM2750-00000 OP-170 Optional Upgrade FEBSS Impact Simulation Trainer (FIST)TM 4- FIST Charging Handles FISTTM Adapter Line FS-1013 FS-1015 Velcro Seam 1–ACU Simulation Blouse 1–ACU Simulation Trouser FS-1006 FS-1007 12 Nitrile Examination Gloves OP-296003 FIST Pneumatic Charger FS-1014 19 “This pain that you hear in someone’ s voice when they’ re hit and disbelief… You just didn’ t want to hear anyone scream anymore. That was the big difference between training and the reality.” SGT Keni Thomas U.S. Army Ranger Operation Gothic Serpent October 3, 1993 Mogadishu, Somalia SKEDCO INC. PO Box 3390 10505 SW Manhasset Drive Tualatin, OR 97062 Web Site: www.skedco.com Tel: 503.691.7909 Fax: 503.691.7973 Order: 800.770.SKED (7533) E-mail: [email protected] Copyright 2010 Skedco Inc. All rights reserved