Greater Sydney Area HEMS

Inspired by Roger Harris and Craig Hore’s escharotomy training video, we have created our own escharotomy model for HEMS physician training.

Our model is based on Roger Harris’ original design with a few minor modifications. With the exception of the arterial line pressure bag, all items were sourced from Bunnings hardware store and the local supermarket. The whole thing takes about five minutes to assemble.

Ingredients:

• Bone: 4-inch diameter PVC pipe, cut with a hacksaw blade into 50 cm lengths.
• Muscle: A very cheap cut of steak or chicken breast.
• Deep fascia: Gladwrap reinforced with a layer of silver duct tape.
• Subcutaneous fat: 6-8 sheets of thin packing foam (the sort of thing your new TV comes wrapped in).
• Skin / eschar: White Gaffer tape.
• An arterial line pressure bag is used to simulate tense, oedematous soft tissues.

Fig 1 – Arterial line pressure bag and PVC pipe

Fig 2 – Glad-wrapped piece of meat to simulate muscle

Step 1

Wrap the arterial line pressure bag around the length of PVC pipe.

Step 2

Wrap a layer of Glad Wrap around the pipe. This will protect it from being contaminated by the overlying meat layer.

Step 3

Using Glad Wrap, bind the “muscle” onto the pipe, ensuring that it lies directly on top of the pressure bag.

Step 4

Secure the meat with circumferential straps of silver duct tape.

Step 5

Add a longitudinal layer of silver duct tape to simulate the deep fascia.

Step 6

Fold the foam packing material around 6-8 sheets thick and apply on top of the deep fascia layer to simulate subcutaneous fat.

Step 7 

Secure the foam using the white Gaffer tape, which doubles up as the skin / eschar layer.

In this case, a hollowed-out glove box has been used as a base for the model. For greater realism, the limb could be attached to a mannequin.

Step 8

Pump up the pressure bag. This simulates tense oedematous soft tissues and will cause the skin layer to spring apart with a “pop” when incised.

Step 9 

Cut the skin!

Step 10

Skin layer can be repaired for re-use by applying additional layers of white Gaffer tape.

If anybody has any bright ideas on how to replace the meat layer with something less organic, please comment below!

Escharotomy model MK II designed by Ed Burns, Craig Hore and Cliff Reid based on original design by Roger Harris. 

Links

Chris Nickson’s guide to escharotomy from LITFL

Craig Hore explains escharotomy