1. Doctors…I read the sciencedirect.com article with interest. I was fascinated with the idea of a “fist in the gut” when first reading about it on the PHARM site recently. So, basically, if there was someone not familiar with the concept on scene then the patient would likely die before EMS arrival.

    If an EMS provider trained to do the procedure just happened to be nearby then there would be a chance the patient might survive, at least until it came time to begin transport to the trauma center (in my service area the transport time would be 30 minutes, give or take a few), at which point the patient would likely die en route.

    How about an improvised (at least for now) device that would replace, or at least supplement, the efforts of the paramedic or EMT? Use a tennis ball, or a baseball/softball, or bowling ball for that matter in place of the “fist” and secure it in place with a SWAT-T tourniquet. If the tourniquet would put too much circumferential pressure on the patient’s abdomen then wrap it around the improvised “fist” AND a backboard. The EMS provider could then apply minimal pressure in the ambulance if any was needed, or use his/her hands to keep the improvised “fist” centered.

    I don’t know. Just trying to think of a way to get that ambulance transport problem solved. Sort of an external REBOA.

    Grant Jonsson, MSc, CC-paramedic

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