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EMSWORLD.com | AUGUST 2017 39 of EMS and Disaster Medicine, Medical Col- lege of Wisconsin EMS providers and physicians alike are taught to monitor a patient's vital signs for signs of shock. But in some cases, waiting for changes in vital signs proves too late: The patient may be past the point of successful resuscitation. Measuring the body's intravascular volume could give providers a way to recognize and treat these life threats earlier. A noninvasive pulse-ox finger sensor can measure what is termed the compensatory reserve index (CRI). By providing real-time beat-to-beat data, the CRI device can indicate a state of shock much sooner than traditional methods, helping providers intervene with appropriate lifesaving treatments. Flashback Technologies has partnered with Victor Convertino, PhD, senior scientist with the Combat Casualty Care Research Program at the U.S. Army Institute of Surgical Research, to create this device. Conver tino and his team conducted human experiments that examined arterial waveforms critical to Flashback's creation of the CRI algorithm. The two arterial waveforms are the ejected wave, which measures the contraction of the heart, and the reflected wave, a measure of the pressure reflected back from the arterial vasculature. The CRI device is marketed as a "fuel gauge" for the body: The number reads as a percentage, telling how much "fuel" is left in the tank and indicating how much of the body's compensatory mechanisms are available to manage the shock state. Convertino focused on simplicity of design for two reasons. The pulse oximeter is a device available to combat medics and the fuel gauge output gives providers a familiar concept that they could act upon. The FDA recently cleared the device. In the meantime, the Israel Defense Forces are currently testing it as a triage decision support tool for prioritizing helicopter transport. A wearable technologies working group within military operational medicine is considering its use as a way for unit commanders to assess the combat readiness of their troops. While there may be some limitations to using the finger for measurement, the designers are conducting tests on reflective oximeters placed on parts of the body such as the torso that will be less impacted by movement and environmental temperatures. Convertino says that results from continuing laboratory and clinical studies are promising. "The measurement of the compensatory reserve provides the most accurate, sensitive and specific early indicator of a patient's trajectory to the onset of hemorrhagic shock," he says. As an emergency physician, Riccardo Colella is excited about the possibilities of this new "vital sign" measurement. "CRI may be able to provoke an earlier intervention and could help EMS providers in determining an appropriate destination," he says. THE LATEST AND GREATEST IN Explore these essential paramedic resources at go.psglearning.com/Paramedic2017 Visit go.psglearning.com/Paramedic2017 to explore and order these must-have paramedic resources. Use Coupon Code PMED17 * at checkout to save 25% and receive free shipping on your order. *Offer valid through 09/15/2017. Must use coupon code: PMED17. Suggested U.S. list price. Prices are subject to change. Not valid with other offers or on prior purchases. Offer not valid on retail, trade, or wholesale orders. Individual purchases only. Free ground shipping to U.S. addresses only. Sales tax will be applied to your order. If you are not completely satisfied with your purchase, please return it within 30 days for a full refund or replacement copy. PARAMEDIC EDUCATION For More Information Circle 24 on Reader Service Card