title: Emergency care in patients wearing body casts.
abstract: OBJECTIVE
  To describe a body cast modification that allows rapid chest exposure for cardiopulmonary resuscitation and alert the medical community to the 3% to 5% incidence of cardiopulmonary arrest in the hospital while wearing such a cast. DESIGN. Single trial timed cast cutting, multiple trial cast shell loading, and clinical observations of perforated casts for cracking or breakage.
  
  
  METHODS
  University hospital castroom, mechanical engineering laboratory.
  
  
  METHODS
  Body casts mounted on a life-sized torso mold were perforated at 2-inch (50 mm), 1-inch (25 mm), or 1/2 inch (12 mm) intervals around the chest with a 12-mm-diameter vibrating drill. Using a cast saw, the chest piece of each body cast was removed and the time recorded. Engineering studies were performed on two cast shells with and without 12-mm-wide holes up to 1/2" (12 mm) apart, loading the fiberglass to the point of failure and recording the data. Body casts with 1" (25 mm)-interval holes worn by 40 patients were examined after 12 weeks for evidence of failure.
  
  
  METHODS
  Chest piece removal times of body cast shells with and without holes were compared. Loading data of cast shells were compared to determine if holes as close as 1/2" (12 mm) significantly weakened the cast. Forty casts, perforated at 1-inch (25 mm) intervals, were observed for failure after 12 weeks of wear.
  
  
  RESULTS
  Chest exposure time of a mold encased in a fiberglass cast was reduced from 1 minute to 15 seconds; plaster cast removal was reduced from 3 minutes to 1 minute. Engineering studies of perforated casts showed no significant decrease in strength. Casts with and without holes could support chest forces of up to 330 pounds. No failure was observed in casts with perforations 1 inch (25 mm) apart worn for 12 weeks.
  
  
  CONCLUSIONS
  Perforated body casts reduced removal time to 15 seconds without weakening of the cast and provide lifesaving time to perform effective CPR.
authors.affiliation: Rehabilitation Medical Associates, P.A., Gainesville, FL, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Lipnick
authors.forename: S R
authors.initials: SR
authors.lastname: Jacobs
authors.forename: J M
authors.initials: JM
authors.lastname: Cotler
authors.forename: R
authors.initials: R
authors.lastname: Seliktar
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002370:Casts, Surgical / Q000592:standards*; D004632:Emergency Medical Services / Q000379:methods*; D004867:Equipment Design; D004868:Equipment Failure; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008422:Materials Testing; D013997:Time Factors