Equipment & Purpose

[MasterMedicMan]

OPENING NOTE: THIS IS A REFERENCE SHEET, BUT READ/SKIM IT ANYWAYS

 

CREDIT TO YANKEESAMURAI

 

HEMORRHAGE

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Extremity tourniquet

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- Wide, sturdy nylon band with windlass rod. Slip it over a bleeding limb to a few inches below the shoulder or groin, then tighten the attached rod until bleeding stops. The tourniquet can be applied with one hand. Note that a properly applied tourniquet is very painful. Ischemic (lack of circulation) damage will occur after two to three hours, so make sure you write the time of application on the tourniquet label and/or on the patient's forehead. Tourniquet removal should only be attempted by a senior combat medic (or preferably a physician), and then only if definitive care is ready to be provided. When the tourniquet is ready to be removed, loosen it gradually to prevent sudden massive release of accumulated toxins in the limb.

Abdominal aortic and junctional tourniquet (AAJT)
 

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- Thick, sturdy belt-like device with attached inflatable pads to control extremity hemorrhage where normal tourniquets lack room for use - namely the armpits/shoulders (axilla hemorrhage) and groin (inguinal hemorrhage). The AAJT can also be placed around the abdomen in order to safely occlude circulation to the pelvis and lower extremities in the event of pelvic internal bleeding or external hemorrhage from the pelvis or lower extremities. When applied circumferentially around the hips, the AAJT functions as an effective pelvic splint. The AAJT is very expensive.

 

 

 

 

Simple gauze dressing
 

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- Plain white gauze in sterile packaging. Apply with pressure directly to wounds to control bleeding and protect from contamination.

 

 

 

 

Hybrid combat bandage
 

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- Thick, absorbent gauze dressing attached to an elastic bandage roll. The bandage is designed to stay rolled even when dropped; it will not unravel on its own. A plastic clip attached to the bandage is designed to secure slack and prevent inadvertent loosening or unraveling. The clip can also be used as an easy twist point during application of a pressure dressing. The clip itself will further intensify and focus the pressure when positioned over a wound.

 

 

 

 

 

Hemostatic dressing

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- Sterile and rather stiff gauze impregnated with kaolin, an inert mineral that causes rapid coagulation to stop bleeds. Treat massive hemorrhage by packing the wound cavity with the dressing and applying the remainder on top with direct pressure. Very expensive. Note- hemostatic [ipowder[/i has fallen out of favor due to its reliance on gravity for application, its potential to accidentally enter the eyes and mouth, and the potential for clumps to enter circulation and damage the heart.

 

Occlusive dressing

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- Airtight and watertight sterile gauze impregnated in a waxy substance or petroleum jelly. Apply to open neck wounds and minor abdominal eviscerations. In the absence of a valved chest seal, occlusive dressings can also be used to treat open chest wounds (pneumothorax) by covering the wound and taping down three edges, leaving one edge open to serve as a flutter valve to prevent the development of a tension pneumothorax.

Polytrauma/abdominal dressing
 

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- Large, thick, absorbent sterile gauze dressing for use with abdominal evisceration or massive complex trauma. In the event of major evisceration, the packaging should be placed sterile-side-down over the dressing and secured with tape, to serve as a large occlusive covering.

 

 

 

 

 

Biofoam canister / DARPA-foam

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- Mild sealing and hemostatic agent. Delivered as a liquid into open abdominal wounds, sets as a soft but firm foam in seconds. For use in open abdominal wounds only.

 

 

 

X-STAT

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- The X-STAT sponges are composed of standard medical sponge that is coated with a hemostatic agent and compressed. It works by applying a group of small, rapidly-expanding sponges into a wound cavity using a lightweight applicator.

 

 

 

[MasterMedicMan]

AIRWAY/BREATHING

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Valved chest seal

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- Transparent circular occlusive (non-breathable) dressing for treatment of penetrating chest wounds, designed to aggressively adhere to skin despite the presence of blood, sweat, and sand. The triple-valve system in the seal's center allows air and blood to escape while preventing their re-entry.

 

Manual suction kit

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- A squeezable rubber bulb connected to a catheter. Several sizes of rigid-tip and flexible "whistle-tip" catheters are included. Suctioned material is deposited in an attached bag for disposal. If the patient is breathing, do not suction for more than ten seconds at a time. If the patient is apneic (not breathing at all), suction until the airway is clear.

 

Powered suction unit

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- More powerful than the manual device issued to field medics. Noisy.

 

Simple mask

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- Also known as a pocket mask. A small transparent plastic mask with a one-way valve. Used rarely to deliver mouth-to-mask positive pressure ventilation (PPV). The vast majority of providers prefer the bag valve mask.

 

Oropharyngeal airway (OPA) kit

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- Contains several sizes of orally-inserted plastic OPAs. Often are jostled out of position, only use if unable to place an NPA, SGA, or other advanced airway. Contraindicated by intact gag reflex or severe oral trauma.

 

Nasopharyngeal airway (NPA) kit

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- Contains several sizes of nasally-inserted rubber NPAs as well as a packet of water-based lubricant. Although uncomfortable, the NPA is the only airway adjunct that can be tolerated by conscious patients. Contraindicated by severe head/facial trauma or suspected skull fracture.

 

Subglottic airway (SGA) kit

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- Contains various sizes of the single-lumen SGA, along with water-based lubricant and a syringe. The blind-insertion plastic airway is passed into the esophagus and secured with inflatable cuffs. Ventilations exit the SGA through holes in its side and enter the trachea. Able to be placed faster and easier than a combitube or endotracheal tube. Contraindicated by intact gag reflex or ingestion of acidic/caustic substances.

 

Intubation kit

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- Contains Lidocaine cream (local anaesthetic), laryngoscope, various sizes of endotracheal tubes, water-based lubricant, bougie, stylet, syringe, Magill's forceps, and tape.

 

Bag valve mask (BVM)

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- The preferred delivery device for positive pressure ventilation (PPV). A transparent plastic mask with an attached rubber bag, as well as a bladder for optional supplemental oxygen. When squeezed, the bag forces air (or 90-100% fraction of inspired oxygen AKA FiO2 at 15 litres per minute, if attached to an O2 tank) into the patient's airway. Use when your patient's own respirations are inadequate. By providing PPV, you are essentially breathing for your patient.

Oxygen cylinder

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- Contains pure medical-grade oxygen, available in stationary and portable sizes. Attached flow regulator. Oxygen is a volatile substance, do not expose the cylinder to heat, spark, or fat/grease/oil-based substances. Handle with care, a full D-size portable cylinder is pressurized to 2500 psi. Ruptured cylinders become missiles able to penetrate concrete and brick.

 

 

Nonrebreather mask (NRB)

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- Transparent oxygen delivery mask with one-way valves. Must be attached to oxygen tank. Delivers 80-90% fraction of inspired oxygen (FiO2) at 12-15 litres per minute (L/min).

 

Nasal cannula

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- Transparent plastic tubing with two nasal prongs for oxygen delivery. Delivers 24-44% FiO2 at 1-6 L/min.

 

Continuous Positive Airway Pressure (CPAP) device

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- Maintains a constant airflow into the patient's respiratory system.

 

Biphasic Cuirass Ventilator (BCV)

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- Noninvasive automatic ventilator that controls patient's inspirations and expirations. Requires patient to wear a cuirass-like garment on his/her torso.

 

Cricothyroidotomy kit

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- Includes Lidocaine cream (local anaesthetic), scalpel, endotracheal tube, syringe, curved Crile hemostat, and tracheal hook. Used when unable to intubate or ventilate otherwise. An incision is made in the cricothyroid membrane in the neck, into which the endotracheal tube is inserted. Difficult under the best of circumstances, but can be performed within minutes by a skilled provider.

 

Needle chest decompression kit

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Includes needle, catheter, and syringe. Used to relieve tension pneumothorax to a simple pneumothorax by puncturing the chest wall with the needle and catheter, allowing air to escape the chest cavity.

 

Tube thoracostomy kit

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- Includes Lidocaine cream, scalpels, syringes, needles, Kelly clamps, curved Mayo scissors, suturing, occlusive gauze, various-sized chest tubes. Used to surgically insert tubes through the chest wall into the pleural cavity for drainage of air, blood, or other substances.

 

Pulse oximeter

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- Small device that clamps to the patient's fingertip to monitor the level of his/her blood oxygenation (peripheral capillary oxygen saturation AKA SpO2). If a fingertip is unavailable, the pulse ox can get a reading from a toe or even an earlobe. Normal SpO2 is 96%. Patients with an SpO2 of under 95% should be given supplemental oxygen if it's available.

 

Capnograph

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- Small device that can be manually held in front of a patient's nose/mouth but is most commonly attached to oxygen delivery devices - particularly blind-insertion devices such as SGAs and endotracheal (ET) tubes. Measures the concentration of CO2 in the patient's respirations, which provides critical insight to the medic in a myriad of applications, including confirmation of SGA and ET placement, adequacy of positive-pressure ventilation (PPV), and effectiveness of CPR. To the knowledgeable medic, a capnograph can even indicate conditions like fever, hypothermia, pulmonary embolus, and acidosis.

 

 

[MasterMedicMan]

CIRCULATION

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Automated External Defibrillator (AED)

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- Self-contained, compact unit absolutely essential to the survival of patients in cardiac arrest. To operate, simply open the AED and turn it on, apply the pads, plug in the pads,  then stand by as the AED analyzes the patient's heart rhythm. Can identify and defibrillate pulseless ventricular tachycardia and ventricular fibrillation in an attempt to revert the heart to a normal rhythm. CANNOT defibrillate asystole (flatline). Surprisingly light, but expensive.

 

Sphygmometer (blood pressure cuff)

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- Attached pressure gauge reads in millimeters of mercury (mmHg). To obtain a blood pressure by auscultation (listening), palpate (feel) for a brachial pulse in the antecubital fossa (elbowpit), then place the stethoscope where you felt it. Inflate the cuff to around 180mmHg and make sure you don't hear a pulse anymore, then begin slowly deflating the cuff. The first thud you hear is the patient's systolic blood pressure (top number). The first thud you hear to sound muffled or quieter than the rest is the patient's diastolic blood pressure (bottom number). 120/80 is a normal reading. You can also acquire a blood pressure by palpation. To do this, palpate for a radial pulse in the wrist. Once you find it, inflate the cuff as normal, keeping your fingers on the radial pulse. Once you reach 180 mmHg and can no longer feel the pulse, begin slowly deflating the cuff. The first pulse you feel is the patient's systolic blood pressure. Deflate the cuff once you get the systolic reading; a diastolic blood pressure cannot be obtained by palpation. Palpation is also somewhat inaccurate compared to auscultation.

Stethoscope

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- Used largely to auscultate for lung sounds and blood pressures. Lung sounds should always be present and equal bilaterally (on both sides). Inequality is presence and equality may indicate pneumothorax or tension pneumothorax. Note any unusual sounds coming from the lungs - a fine crackling sound may indicate hemothorax (blood in the chest cavity). Can also be used to listen for muffled heart sounds, an indicator of cardiac tamponade.

 

 

Intravenous access kit

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Includes lines, cannulas, syringes, catheters, locks, lock extension sets, flushes, gauze, Tegaderm dressing, and elastic IV tourniquet. Used to intravenously deliver volume expanders, blood, or medications for fast-acting effects.

 

Intraosseous Infusion Device (IOID)

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- With 12 peripheral stabilizing needles and 1 central hypodermic needle, the IOID is designed to penetrate through the chest skin and into the sternum, creating access directly into the sternum's bone marrow. Medication administered using the sternal intraosseous (IO) route is extremely fast-acting, affecting the heart and lungs within seconds, though placing the device and pushing the drugs will cause the patient pain. Expensive. Use in an emergency where IV access is impractical.

 

Cardiac monitor

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- All-in-one machine that monitors blood pressure, blood oxygen saturation (SpO2), heart rate, and rhythm. Can identify shockable rhythms and deliver electric shocks to defibrillate. Also functions as a 12-lead electrocardiogram machine. Heavy, somewhat fragile, and very expensive.

 

Automated chest compression system (ACCS)

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- Automatically delivers at least 100 compressions per minute at a depth of two inches.

 

Peripheral Intravenous Central Catheter (PICC) kit

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- Although the PICC line is inserted into the arm, the catheter is advanced up the vein until the end is placed in the larger veins closer to the heart. PICC lines are ideal for long-term administration of medications such as antibiotics or fluids. Requires regular maintenance, including flushing of the line with antibiotics to prevent infection and blood-thinning medication to prevent occlusion.

 

Red blood cell (RBC) bag

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- Available in all blood types. Blood bags are stored frozen and are considered unsafe for use after 24 hours outside. Generally, RBC transfusions are administered for significant blood loss and resulting hypoxia (low oxygenation).

 

White blood cell (WBC) bag

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- Available in all blood types. Blood bags are stored frozen and are considered unsafe for use after 24 hours outside. Generally, WBC transfusions are administered to boost the body's natural defenses against infection.

 

Fresh Frozen Plasma (FFP) bag

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- Plasma is the liquid component blood. It's mainly water, but it also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. Generally, FFP transfusions are the most effective form of fluid replacement and are administered in the event of severe burns, liver failure, or sepsis. FFP bags are stored frozen and are considered unsafe for use after 24 hours outside.

 

Platelet bag

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- Includes platelets and other clotting factors. Generally, platelet transfusions are administered to boost the body's natural clotting processes, particularly in the event of internal bleeding. Platelet bags are stored frozen and are considered unsafe for use after 24 hours outside.

Normal Saline (NS) bag

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- Essentially, sterile salt water (0.9% NaCl). Primarily used for intravenous fluid resuscitation (restoration) to treat hypovolemia, particularly dehydration. However, in the case of hemorrhagic shock, Lactated Ringers and Hextend are more efficient solutions. On the other hand, over long periods of time during which "maintenance fluids" are required, NS is safer than Lactated Ringers. Notably, NS must be used if a blood transfusion is anticipated, as NS is the only fluid able to be administered simultaneously with blood. Due to its identical water-salt ratio with the human body's natural cellular environment, NS is also the prefered fluid for pain-free wound flushing.

 

Lactated Ringers solution (LR) bag

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- Saline with small amounts of lactate, potassium, and calcium added to mimic the composition and ionization of blood plasma. LR given over an extended period of time will result in chemical imbalances, but in regard to the "fluid challenge," in which large amounts of fluids are rapidly given, LR is considered superior to NS. LR possesses superior properties of volume expansion, resulting in more efficient restoration of blood pressure and stroke volume. Acidosis, a chemical imbalance that often accompanies acute fluid loss, is counteracted by the byproducts of LR's metabolism in the liver. Compared to NS, LR keeps the blood at a more stable PH level for the duration of sustained large-volume resuscitation.

 

Hextend bag

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- A solution similar in formulation to LR, but with an added 6% hetastarch. Usage of Hextend to rehydrate patients is unsafe and will result in metabolic acidosis and other chemical imbalances. Hextend's main purpose is to treat hemorrhagic shock - it's an incredibly efficient volume expander. One 500mL bag of Hextend is equivalent to three 1000mL bags of LR and its volume expansion effects will last for an unprecedented eight hours. Use caution when giving Hextend to non-medically cleared casualties, as Hextend is contraindicated by bleeding disorders, congestive heart failure, and renal disease - all of which are common in the civilian population.

 

Pericardiocentesis kit

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- Includes lidocaine cream, syringes, scalpel, needles, spinal needle, catheter, nasogastric intubation mini-kit, and compact ultrasound machine. Pericardiocentesis, also known as a pericardial tap, is an extremely invasive, difficult, and risky procedure in which a needle is inserted through the chest wall into the pericardial sac surrounding the heart, in order to drain accumulated blood and other fluids in the event of cardiac tamponade. A single mistake could result in the piercing of the aorta or the heart itself, leading to exsanguination in as little as thirty seconds.

 

 

[MasterMedicMan]

BANDAGES/MUSCULOSKELETAL

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Moldable splint

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- Lightweight but sturdy foam splints designed to be cut and conformed as needed.

Short, medium, and long rigid splints
- Rarely used if moldable splints are around.

 

 

Traction splint

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- Used solely in the event of mid-shaft femur fractures to "pull traction," thus keeping the broken bone ends from overlapping or touching each other. Can pull traction on both legs at once if necessary. Do not use if injury exists to the knee, lower leg, ankle, hip, or pelvis. The midshaft femur fracture must be the only injury on that leg. The splint itself is rather bulky and heavy.

 

Cervical collar (C-collar)

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- Lightweight foam-and-plastic brace that helps stabilize a patient's head and neck to prevent further injury to the cervical spine.

 

Cravat

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- Large triangle-shaped bandages for creating slings, securing splints, serving as improvised tourniquets, and a hundred other uses. They do make superb bandanas.

 

Elastic bandage roll

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- Long roll of elastic bandage used to secure dressings and splints, and create bulky dressings to stabilize impaled objects. Much more sturdy and easy to handle than cling gauze bandages, but not very absorbent or breathable.

 

Cling gauze bandage roll

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- Long roll of clinging gauze used to secure dressings and splints, and create bulky dressings to stabilize impaled objects. Prone to tearing and falling apart when wrapped thinly, but very soft, breathable, and more absorbent than elastic bandages.

 

Long spine board

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- Usually called the "longboard," "backboard," or "spine board." Body length surfboard looking object, hard plastic. Patient is log rolled onto the longboard if spinal injury is suspected. Secure at the chest, hips, lower legs, and head, in that order. Uncomfortable.

 

Extrication vest

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- A bulky, semi-rigid garment that, when fully secured on a patient, will immobilize his/her head, neck, and torso in an anatomically neutral position. Used in conjunction with a C-collar to extricate patients from vehicles without further damaging the spine, and also protects the vital areas of the body from accidental injury during the extrication process.

 

Fasciotomy kit

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- Includes lidocaine, scalpel, and tissue forceps. Fasciotomy is an invasive procedure used to treat compartment syndrome, a condition in which pressure builds up in muscle compartments, usually due to crush injury. Compartment syndrome can cause permanent damage to muscles, nerves, blood supply, leading to limb loss and even death if left untreated. In a fasciotomy, certain fasciae (connective tissue fibers) are incised to release pressure from the muscle compartment.

 

 

[MasterMedicMan]

DRUGS

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Atropine-Pralidoxime

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- Antidote Treatment Nerve Agent Autoinjector (ATNAA). Use if endangered by nerve gas.

 

Activated charcoal

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- Ingested by patient. Counters oral poisoning by adsorbing poisons in the stomach to prevent absorption into bloodstream. Induces vomiting and bowel movements. Contraindicated by ingestion of caustic/acidic substances.

 

Epinephrine

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- Intramuscular autoinjector. Stimulant, counters anaphylaxis. Also used as a potential treatment for asystole.

 

Haldol

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- Intramuscular autoinjector. Antipsychotic for acute episodes. Contraindicated by head injury. 

 

Levaquin

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- Oral antibiotic.

 

Cefotan

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- Intravenous/intramuscular antibiotic.

Mobic
 

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- Oral antipyretic and analgesic for mild to moderate pain.

 

 

Morphine

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- Intravenous opoid analgesic, high potential for addiction. Only administer to casualties unable to fight. No, syrettes aren't included - intramuscular injections of morphine are incredibly slow to take effect. 20 minutes IM versus 5 minutes IV, and even faster for IO.

 

Narcan

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- Intravenous opoid antagonist. Reverses morphine's analgesic, sedative, and respiratory-depressing effects.

 

Phenergan

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- Intravenous anti-nausea treatment, also increases morphine's analgesic effects. Often administered alongside or immediately after morphine.

 

Propofol

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- Intravenous general anesthetic used for major surgical procedures. Dangerous to use without proper staff and equipment for patient monitoring.

 

Romazicon

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- Intravenous benzodiazepine antagonist. Reverses the effects of Valium.

 

Tranexamic Acid (TXA)

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- Intravenous antifibrinolytic. Minimizes dissolution of blood clots, thus minimizing blood loss. Administered to casualties entering hypovolemia due to internal hemorrhage.

 

Valium

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- Intravenous anticonvulsant and antianxiety psychotherapeutic drug. The medication of choice for status epilepticus. Also useful for anxiety, restless leg syndrome, and acute alcohol withdrawal. Contraindicated by shock, coma, alcohol intoxication, and depressed vital signs. Smoking decreases sedative and antianxiety effects.

 

Ketamine

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- Intravenous NMDA receptor antagonist and analgesic. Used in place of Morphine. Contained in an autoinjector with a Saline complement. Contraindicated by increased intraocular pressure and/or intracranial pressure.

 

 

"SNIVEL" (MORE DRUGS)

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Pepto Bismol tablets

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- For heartburn and minor digestive system upset such as nausea, stomachache, and diarrhea.

 

Pseudoephedrine

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- Nasal decongestant, minor stimulant.

 

Guaifenesin

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- Expectorant (aids in clearance of mucus from lungs and airway).

Loperamide

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- Anti-diarrheal.

 

Colace

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- Stool softener laxative.

 

Tylenol

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- Fast acting antipyretic, minor analgesic.

 

Benadryl

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- Antihistamine, minor sedative.

 

 

 

 

[MasterMedicMan]

MISCELLANEOUS

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Thermal blanket

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- Used to passively warm hypoperfused (in shock) and hypothermic patients.

Temporal Artery Thermometer (TAT)

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- Noninvasive thermometer that uses infrared technology to measure body temperature. Place tip of device on center of forehead and drag to one temple. Rated superior in accuracy to oral, axillary (armpit), and tympanic (ear) thermometers.

Penlight

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- Primarily used to check pupils. Also useful for inspection of ears, nostrils, and open wounds.

Eye shield

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- Rigid shield shaped like a shallow bowl, surrounded by adhesive. Protects an injured eye from further damage.

Lateral Canthotomy kit

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- Includes lidocaine, syringes, iris scissors, needles, hemostats, and tissue forceps. Lateral canthotomy is an invasive procedure in which certain tendons surrounding the eye are severed in order to release pressure in the event of retrobulbar hemorrhage, or bleeding of the eyesocket. Retrobulbar hemorrhage is caused by trauma to the face, but occurs fairly infrequently. Retrobulbar hemorrhage can lead to permanent blindness if pressure is allowed to increase unabated.

Trauma shears

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- Heavy-duty shears used for cutting through clothing to expose patients and their wounds. Also used to cut dressings, bandages, and moldable splints.

Blister cushions

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- Sterile gel pad surrounded by adhesive. Cushions and protects the blister from contamination. Effective and comfortable, but prone to coming off unless secured with additional tape and/or bandages.

Sterile saline bottle

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- Can be used to moisten dressings for evisceration or minor burns.

Dermabond tube

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- Topical skin adhesive, or "glue," to close small lacerations and protect them from infection. Can be used in place of sutures, though sutures allow for more effective healing with minimal scarring.

Steri-strips kit

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- Small adhesive strips used to close small lacerations and protect them from infection. Can be used in place of sutures, though sutures allow for more effective healing with minimal scarring.

Suture kit

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- Includes curved hemostat, scalpel, suture lip scissors, forceps, and variously sized suture rolls with attached needles.

Surgical tape

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- Several variously-sized rolls of adhesive tape. Innumerable applications. Keep in mind that bloody/sweaty/dirty skin will make the adhesive much less effective.

Instant cold packs

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- For actively cooling hyperthermic patients.

Instant heat packs

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- For actively rewarming hypothermic patients.

Soft restraints

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- Padded but sturdy nylon cuffs to immobilize the wrists and ankles of combative patients. Intended to be secured to a litter, gurney, or other object by use of attached velcro straps.

Chucks

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- Disposable, absorbent pads placed beneath incontinent or just plain comatose patients. Will save you a lot of trouble.

Hand sanitizer

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- kills 99.9% of germs !!!

Biohazard bags

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- boldly labeled red plastic tear-resistant bags

Sharps container

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- Hard plastic container for safe disposal of needles and other sharp objects.

Nitrile exam gloves

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- Because at least 30% of the population is allergic to latex. Available in various colors, though many providers prefer light colors so they can easily spot blood and other fluids on their gloves.

Alcohol swabs

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- Primarily used to disinfect equipment and surfaces. Avoid use with open wounds.

Povidone-iodine swabs

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- Superior antimicrobial disinfectant primarily used for cleaning open wounds or preparing skin surface for surgery. Also can be used to purify water.

Band-aids

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- You get a choice of Scooby Doo or Barney.

Safety pins

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- Myriad of uses, can be used to help secure bandages or slings.

Casualty cards

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- Should be filled out with patient's information if conditions permit. Also double as triage tags.

Black surgical marker

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- Ink is formulated to stay visible on skin for longer than normal markers, and will not be washed off by povidone-iodine scrubbing. In the field, often used to mark tourniquet time or evacuation/triage category on the patient's forehead for easy spotting.

Foldable litter

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- Patients are secured by straps at the forehead, chest, hip, and calves. When folded and stood on its end, the litter comes up to about knee height. Fairly lightweight.

Gurney

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- Sturdy wheeled cot with built-in hydraulics to raise and lower it at the touch of a button. Dependent on a rechargeable battery pack. The feet and head of the mattress can be manually raised and lowered. A retractable IV stand is found on either side. Seatbelt-style straps at the chest, hips, and ankles. Kick the wheel brakes on and off. Very heavy.