Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK.
BMJ Mil Health. 2024 Nov 25;170(6):495-500. doi: 10.1136/military-2022-002305.
The high prevalence of occipital ulcers in UK military casualties observed during the conflict in Afghanistan is a multifactorial phenomenon. However, the consensus is that ulceration is triggered by excessive pressure that is maintained for too long during the use of the general service military stretcher. Thresholds for capillary occlusion are accepted benchmarks to define excessive pressure, but similar thresholds for safe/excessive duration of pressure application do not exist. To address this gap in knowledge, we propose to use the time it takes for a healthy person to feel pain at the back of the head as an initial indication of safe exposure to pressure.
Healthy military personnel (16 male/10 female) were asked to lie motionless on a typical general service stretcher until they felt pain. Time-to-pain and the location of pain were recorded. To support the interpretation of results, baseline sensitivity to pain and pressure distribution at the back of the head were also measured. Independent samples t-test was used to assess differences between genders.
Twenty participants felt pressure-induced soft-tissue pain at the back of the head. The remaining six participants terminated the test due to musculoskeletal pain caused by poor ergonomic positioning. On average, pain at the occiput developed after 31 min (±14 min). Female participants were significantly more sensitive to pain (t(24)=3.038,p=0.006), but time-to-pain did not differ significantly between genders (p>0.05).
When people lie motionless on a typical military stretcher, the back of the head is the first area of the body that becomes painful due to pressure. The fact that pain develops in ≈30 min can help healthcare providers decide how frequently to reposition their patients who are unable to do this on their own. More research is still needed to directly link time-to-pain with time-to-injury.
在阿富汗冲突期间，英国军事人员中出现的枕部溃疡高发是一个多因素现象。然而，共识是溃疡是由在使用通用军用担架时过长时间保持的过大压力引发的。毛细血管阻塞的阈值被认为是定义过大压力的基准，但不存在安全/过大压力应用持续时间的类似阈值。为了解决这一知识空白，我们建议使用健康人感到头部后部疼痛所需的时间作为对压力安全暴露的初步指示。
要求健康的军人（16 男/10 女）躺在典型的通用担架上一动不动，直到他们感到疼痛。记录疼痛时间和疼痛位置。为了支持结果的解释，还测量了头部后部的基线疼痛敏感性和压力分布。使用独立样本 t 检验评估性别之间的差异。
20 名参与者感到头部后部压力引起的软组织疼痛。其余六名参与者因不符合人体工程学定位导致的肌肉骨骼疼痛而终止了测试。平均而言，枕部疼痛在 31 分钟后出现（±14 分钟）。女性参与者对疼痛的敏感性明显更高（t(24)=3.038,p=0.006），但性别之间的疼痛时间差异无统计学意义（p>0.05）。
当人们躺在典型的军用担架上一动不动时，头部后部是第一个因压力而感到疼痛的身体部位。疼痛在 ≈30 分钟内发展的事实可以帮助医疗保健提供者决定多久重新定位那些无法自行移动的患者。还需要更多的研究来直接将疼痛时间与受伤时间联系起来。
