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Some good news - the CFHS requested Health Canada Special Access Program access to RescueFlow - a 7.5% hypertonic saline - 6% Dextran 70 resuscitation IV solution, and this has apparently been approved this month.
RescueFlow is already used in several European countries and NATO armies.
The relative benefits of this solution over isotonic crystalloids like Ringer's Lactate or Normal Saline have been the subject of many clinical studies, which overall have been inconclusive. The Resuscitation Outcomes Consortium is a large scale clinical study in US and Canada looking at RescueFlow in traumatic shock, among other things, however this SAP approval is not part of the ROC.
The CFHS' argument for RescueFlow was an equivalent solution to isotonic solutions at reduced weight. 250ml of RescueFlow is equivalent to about 2 litres of normal saline, or a weight saving of about 1.75 kg per dose.
The intention is for CFHS is to issue RescueFlow to patrol MedTechs to reduce their weight burden. The protocol for usage is still being decided, but most likely will be restricted to casualties with hemorrhagic shock who have lost their radial pulse (or have a SBP < 90 torr). Up to two doses of 250 ml of RescueFlow will be administered, with the timing and infusion rate to be yet decided.
While IV solutions probably are not indicated in most penetrating torso injuries, the soldier who is losing his BP or radial pulse may be minutes from death, and IV fluid in that situation may allow a last rally of vital signs long enough to reach surgery. Large volumes of prehospital IV Saline or RescueFlow are still not indicated in the majority of casualties, except IVs are useful for drug access. RescueFlow will likely not be authorized via IO needle. RescueFlow will likely only be issued to MedTechs.
The SAP was necessary because no North American manufacturer wishes to market what is essential seawater +/- colloid, sadly basic business sense means that the costs of development and FDA/Health Canada approval would be unrecoverable in a product that may not be patentable. Some US manufacturers have actually refused to manufacture hypertonic saline on request of the US military, which is why both the ROC and this SAP have first resorted to RescueFlow, a Swedish product made by BioPhausia.
This is excellent news for both the deployed MedTech and the CFHS. While the exact protocol, monitoring and training program have yet to be decided, it seems to be a priority that this solution will be fielded sometime this year, hopefully soon. It should reduce the MedTechs' burden of having to carry so much IV fluid weight, any additional benefits will just be gravy.
Sawbones
RescueFlow is already used in several European countries and NATO armies.
The relative benefits of this solution over isotonic crystalloids like Ringer's Lactate or Normal Saline have been the subject of many clinical studies, which overall have been inconclusive. The Resuscitation Outcomes Consortium is a large scale clinical study in US and Canada looking at RescueFlow in traumatic shock, among other things, however this SAP approval is not part of the ROC.
The CFHS' argument for RescueFlow was an equivalent solution to isotonic solutions at reduced weight. 250ml of RescueFlow is equivalent to about 2 litres of normal saline, or a weight saving of about 1.75 kg per dose.
The intention is for CFHS is to issue RescueFlow to patrol MedTechs to reduce their weight burden. The protocol for usage is still being decided, but most likely will be restricted to casualties with hemorrhagic shock who have lost their radial pulse (or have a SBP < 90 torr). Up to two doses of 250 ml of RescueFlow will be administered, with the timing and infusion rate to be yet decided.
While IV solutions probably are not indicated in most penetrating torso injuries, the soldier who is losing his BP or radial pulse may be minutes from death, and IV fluid in that situation may allow a last rally of vital signs long enough to reach surgery. Large volumes of prehospital IV Saline or RescueFlow are still not indicated in the majority of casualties, except IVs are useful for drug access. RescueFlow will likely not be authorized via IO needle. RescueFlow will likely only be issued to MedTechs.
The SAP was necessary because no North American manufacturer wishes to market what is essential seawater +/- colloid, sadly basic business sense means that the costs of development and FDA/Health Canada approval would be unrecoverable in a product that may not be patentable. Some US manufacturers have actually refused to manufacture hypertonic saline on request of the US military, which is why both the ROC and this SAP have first resorted to RescueFlow, a Swedish product made by BioPhausia.
This is excellent news for both the deployed MedTech and the CFHS. While the exact protocol, monitoring and training program have yet to be decided, it seems to be a priority that this solution will be fielded sometime this year, hopefully soon. It should reduce the MedTechs' burden of having to carry so much IV fluid weight, any additional benefits will just be gravy.
Sawbones
