Use of a Shear Reduction Surface for Prehospital Transport: A Randomized Crossover Study

• Published in: Advances in skin & wound care Vol. 37; no. 3; p. 155
• Main Authors: Tescher, Ann N, Berns, Kathleen S, Call, Evan, Koehler, Patrick J, Salzwedel, Kip W, McCormack, Heather E, Myers, Lucas A, Hagen, Clinton E, Mandrekar, Jay, Russon, Marianne
• Format: Journal Article
• Language: English
• Published: United States 01.03.2024
• ISSN: 1538-8654
• DOI: 10.1097/ASW.0000000000000044

To compare the effectiveness of an antishear mattress overlay (ASMO) with a standard ambulance stretcher surface in reducing pressure and shear and increasing patient comfort. In this randomized, crossover design, adults in three body mass index categories served as their own controls. Pressure/shear sensors were applied to the sacrum, ischial tuberosity, and heel. The stretcher was placed in sequential 0°, 15°, and 30° head-of-bed elevations with and without an ASMO. The ambulance traveled a closed course, achieving 30 mph, with five stops at each head-of-bed elevation. Participants rated discomfort after each series of five runs. Thirty individuals participated. Each participant had 30 runs (15 with an ASMO, 15 without), for a total of 900 trial runs. The peak-to-peak shear difference between support surfaces was -0.03 N, indicating that after adjustment for elevation, sensor location, and body mass index, peak shear levels at baseline (starting pause) were 0.03 N lower for the ASMO than for the standard surface ( P = .02). The peak-to-peak pressure difference between surfaces was -0.16 mm Hg, indicating that prerun peak-to-peak pressure was 0.16 mm Hg lower with the ASMO versus standard surface ( P = .002). The heel received the most pressure and shear. Discomfort score distributions differed between surfaces at 0° ( P = .004) and 30° ( P = .01); the overall score across all elevations was significantly higher with the standard surface than with the ASMO ( P = .046). The ASMO reduced shear, pressure, and discomfort. During transport, the ambulance team should provide additional heel offloading.