Resuscitation 83 (2012) e195
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Resuscitation
journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor
Removal of plaster jackets in an emergency situation be carried out before determining that this is a suitable treatment
and information should be given to patients and carers on what to
Sir, do in an emergency situation. In addition to this systems should be
in place in hospital environments where these patients are looked
We would like to raise awareness of the issue of resuscitation of after for immediate access to a plaster saw and staff competent in
patients in full plaster jackets. Whilst the application of this prob- removal of a plaster jacket should the need arise.
lem applies only to a very small number of patients it is nevertheless We hope that our findings raise awareness of this issue and that
something for consideration in hospitals where the application of where patients have plaster jackets steps are taken to reduce the
plaster jackets is still used to correct scoliosis. We estimate that risk of delays to resuscitation should this be required.
at the Royal National Orthopaedic Hospital this applies to around
50 patients per annum. The vast majority of these patients will be
Conflict of interest
children.
It is impossible for effective CPR to be performed on patients
None.
in a plaster jacket and likewise it would not be possible to apply
defibrillator pads in appropriate positions to allow for the delivery
References
of a shock should they be in ventricular fibrillation or tachycar-
1. Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP. Estimating effectiveness
dia. The evidence is clear that the faster that chest compressions
of cardiac arrest interventions: a logistic regression survival model. Circulation
are commenced in a patient suffering a cardiac arrest the bet-
1997;96:3308 13.
ter the chance of survival1,2 and each minute of delay before
2. Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy GA. Importance of continuous chest
compressions during cardiopulmonary resuscitation: improved outcome during
defibrillation reduces the probability of survival to discharge by
a simulated single lay-rescuer scenario. Circulation 2002;105:645 9.
10 12%.3
3. Stiell IG, Wells GA, Field BJ, et al. Improved out-of-hospital cardiac arrest
With this in mind we sought to determine how long it took to
survival through the inexpensive optimization of an existing defibrillation pro-
remove a plaster jacket to allow for the commencement of CPR and gram: OPALS study phase II. Ontario prehospital advanced life support. JAMA
1999;281:1175 81.
application of defibrillator pads. In order to achieve this one of the
resuscitation officers volunteered to have a plaster jacket applied
Kofi Agyare
which was undertaken by the plaster technicians and carried out
Jan Lehofsky
as if it was a real patient. The jacket was allowed to set fully and a
Royal National Orthopaedic Hospital, Brockley Hill,
simulated scenario was carried out.
Stanmore, Middlesex HA7 4LP, United Kingdom
We found that it took 3 min and 5 s from the point that the
"
plaster saw started to cut the plaster jacket until it was removed
Christopher Kurt-Gabel
sufficiently to allow CPR to commence. The simulation was carried
A to E Training and Solutions Ltd, 74a Chetwynd
out in the plaster theatre and the jacket was cut off by someone
Road, London NW5 1DH, United Kingdom
very familiar with the use of the plaster saw. Therefore it could be
Shiona O Brien
assumed that the actual time in other areas for removal of a plaster
Royal National Orthopaedic Hospital, Brockley Hill,
jacket would be considerably longer.
Stanmore, Middlesex HA7 4LP, United Kingdom
Many of the patients in plaster jackets have these on for many
months and are discharged back into the community where there
"
Corresponding author. Tel.: [phone].
will be even more delays as ambulance services do not carry plaster
E-mail address:
saws which would allow their removal. Additionally most emer-
[e-mail]
gency departments will not have been exposed to patients who
(C. Kurt-Gabel)
have these devices applied.
What we have highlighted is that there should be consideration
14 June 2012
of the considerable delays that would occur to providing adequate
resuscitation to this small group of patients. Risk assessment should
0300-9572/$  see front matter © 2012 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.resuscitation.2012.06.009