Surgical

"“Unlock the potential of design"

Surgical SCRAM™ - Emergency Surgery Module

Haemorrhage resulting from trauma is the leading preventable cause of death in military settings (up to 90%) and the second most common cause of trauma-related deaths in civilian settings [1]. In some cases where other options are limited, a surgical approach may be necessary at the scene to address noncompressible bleeding of the trunk, such as intrabdominal, intrathoracic, and intrapelvic bleeding [2]. Resuscitative thoracotomy (RT) is a radical technique that can relieve cardiac tamponade, perform aortic cross-clamping, pulmonary hilar clamping or twisting, and internal cardiac compression [1]. However, newer techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and extracorporeal life support (ECLS) may replace some indications for RT as more evidence emerges [3].

Perimortem caesarean section (PMCS) or “resuscitative hysterotomy” is a rare and clinically challenging procedure for practitioners, but swift and decisive action can save the life of the mother [4]. Other procedures, such as surgical airway, finger-thoracostomy, escharotomies, and amputation, are also part of the surgical interventions integrated into prehospital emergency medicine (PHEM). To improve the safety and efficiency of surgery during these high-stress, high-stakes events, it is crucial to design processes, equipment, and environments that optimize human performance [5].

Our goal was to develop a brain-friendly tool that enhances the safety and efficiency of surgical interventions outside the operating theatre. We aimed to reduce cognitive load, time to intervention, and errors during rare, high-acuity surgical procedures.

To achieve this goal, Paul Swinton and Stian Mohrsen utilised the same design principles and philosophy that led to the creation of the SCRAM™ portfolio to develop Surgical SCRAM™. This brain-friendly tool is specifically tailored to meet the requirements of resuscitative emergency surgical procedures and aims to improve performance.

| The Brain-Friendly Tool for High-Stakes Surgical Interventions: Inside Surgical SCRAM™

To create the Emergency Surgery Module, we conducted a survey of pre-hospital critical care services in several European countries. Our objective was to determine the standard equipment used for thoracotomies and resuscitative hysterotomies. We gathered data from services in Norway, Germany, Switzerland, Sweden, and Finland and worked closely with respondents to understand the reasoning behind and necessary items in their equipment.

Using this information, we developed a standardised load-out and used it to design the Emergency Surgical Module. We extensively tested the prototype through various methods, including bench-top interaction, simulation, and user feedback at the Emergency Medical Retrieval Service base in Glasgow, Scotland. Critical care clinicians also provided continuous feedback, which allowed us to refine and improve the bag to meet the needs of pre-hospital emergency surgery.

As a result, we created a compact, protected, and functional bag that simplifies the process of emergency surgical procedures. The stepwise packaging, ergonomic colour schemes, and easily identifiable stencils make it easy to access equipment and guide clinicians through the procedure. This frees up cognitive bandwidth and allows clinicians to focus on making critical decisions and planning ahead. Surgical SCRAM™, is the first of its kind and a valuable addition to the armamentarium of PHEM.

| Simplify to amplify: Less load, more flow, fewer mistakes

What do clinicians say?

"I like that I don’t have to scramble around for equipment but, it is right there ready to be used".

"I think this will make the procedure easier and quicker particularly in situations where you don’t have a proper work surface or poor light".

"I like that the bag is ergonomic from both sides of the chest. It is a common operating field for the team doing a team job".

The Emergency Surgery Module easily fits into a response bag or be carried independently. It was designed as a compact solution for the prehospital and retrieval setting where manual retraction is a common technique.

We also have designs for a larger version offering the same system as this module which can also accommodate Finochietto rib spreaders. The benefits of Surgical SCRAM™ could be seen in the ED. However, we are great believers in co-development, your feedback is invaluable and we would greatly appreciate any interest for an ED-version, or suggestions on how we can make either solution better catered to your needs. We look forward to hearing from you.

Features of Surgical SCRAM™

Stencilled kit dump that standardizes the layout and enables efficient pre-stocking.
Gross motor indicators that reduce cognitive load.
Sharps management solution.
Removable surgical panels that allow for flexibility in working on both sides of the patient.
Compact design.
Structured and easy-to-orientate layout.
Auditing options such as unique barcodes, checklist pocket, and RFID / NFC pocket (tag not included).
Lockable zips that are compatible with tamperproof seals.
Designed around common surgical equipment required for emergency surgical procedures.
Removable components for a modular approach adaptable to any situation.
Developed by clinicians with experience in prehospital critical care and ergonomic design.
Durable and padded design for two-way protection.
Weatherproof – portable and easy to use
Wipe clean – MicrAgard™

|“Wipe Down”

Prevent Cross-Contamination

SCRAM™ is made from micrAgard™ wipe clean durable anti-bacterial, anti-microbial material. This along with the durable anti-microbial webbing and the anti-microbial hook and loop help to prevent cross-contamination.

References:

Van Oostendorp SE, Tan EC, Geeraedts LM. Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016 Dec;24(1):1-3.
Boffard KD (2015) Manual of definitive surgical trauma care. CRC Press.
Seamon MJ, Haut ER, Van Arendonk K, Barbosa RR, Chiu WC, Dente CJ, Fox N, Jawa RS, Khwaja K, Lee JK, Magnotti LJ. An evidence-based approach to patient selection for emergency department thoracotomy: a practice management guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery. 2015 Jul 1;79(1):159-73.
Battaloglu E, Porter K. Management of pregnancy and obstetric complications in prehospital trauma care: prehospital resuscitative hysterotomy/perimortem caesarean section.
Marshall SD, Touzell A. Human factors and the safety of surgical and anaesthetic care. Anaesthesia. 2020 Jan;75:e34-8.

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