Pressure injury management for the highest-acuity patients in your census.
In the Level I trauma bay, the burn ICU, and the spinal cord injury unit, the patients at greatest risk of hospital-acquired pressure injuries are precisely the patients least able to tolerate the standard intervention. Hemodynamic instability, external fixation, unstable spinal precautions, and extensive graft sites all constrain repositioning at exactly the moment tissue tolerance is lowest. Mountain American Medical equips acute care teams with two complementary technologies: continuous visibility into interface pressure, and a therapeutic surface engineered to preserve perfusion when offloading through position change is not clinically available.
When the patient cannot be turned, the protocol has to change.
Hospital-acquired pressure injuries (HAPIs) remain among the most consequential preventable adverse events in critical care, and the acute environment concentrates every contributing variable at once. Vasopressor-dependent patients present with compromised microcirculatory perfusion, so tissue tolerance to interface pressure falls well below the threshold assumed by a standard q2h turning schedule. Polytrauma patients in external fixation, patients under unstable spinal precautions, and patients with extensive donor and recipient graft sites are functionally non-turnable for defined clinical windows.
The result is a well-documented failure mode. Deep tissue pressure injuries (DTPI) initiate at the bone–muscle interface, where cellular deformation and sustained tissue ischemia produce damage that is invisible at the skin surface for 48 to 72 hours. By the time the characteristic maroon discoloration presents, the injury is established and the window for reversal has closed. Sacral and heel decubitus ulcers follow the same trajectory. Sustained capillary occlusion drives ischemic cascade; ischemia drives necrosis; necrosis drives full-thickness loss.
Two capabilities close this gap. The first is visibility — knowing where interface pressure is actually concentrating on this patient, on this surface, right now, rather than inferring it from a schedule. The second is perfusion retention — a support surface that minimizes cellular deformation and preserves microcirculatory blood flow during the intervals when repositioning is not an option.
48–72 hrs
Typical latency before a deep tissue pressure injury becomes visible at the skin surface
87%
Perfusion retention measured on the Dolphin FIS surface — versus 16% on standard mattresses¹
11% → 0%
Heel HAPI rate change in a single VA medical center evaluation following Dolphin implementation²
WellSense M.A.P.® — make interface pressure visible, and make turning protocol compliance provable.
The WellSense M.A.P.™ (Monitor, Alert, Protect) system is a continuous bedside pressure mapping (CBPM) platform. A sensor coverlet applies over the existing support surface — no bed change, no surface swap, no capital displacement — and renders a live, color-coded map of interface pressure distribution on a bedside monitor.
For the ICU nurse, this converts repositioning from a scheduled task into a verified clinical intervention. Rather than executing a turn and inferring that pressure has been offloaded, the clinician sees the redistribution occur in real time and confirms that the sacrum, trochanters, scapulae, and heels have actually been unloaded. When a patient is repositioned but a wedge has shifted or a heel remains in contact with the surface, the map shows it immediately rather than at the next skin assessment.
What the system contributes to an acute protocol
Real-time offloading verification. Color-coded visualization of interface pressure confirms that a repositioning maneuver achieved actual pressure redistribution, not just a change in body position.
Cumulative pressure-over-time tracking. Because pressure injury etiology is a function of magnitude and duration, M.A.P. records pressure accumulation at each anatomical region between turns.
Repositioning interval alerting. Configurable per-patient intervals, integrable with the existing nurse call infrastructure, so protocol timing surfaces where staff already look.
Documented compliance evidence. Recorded pressure and repositioning data supports turning protocol compliance documentation for quality reporting, root-cause analysis after a HAPI event, and unit-level competency training.
Rounding and education tool. The visual map gives wound care teams, residents, and families a shared and immediately legible reference during rounds.
Joerns Dolphin® Fluid Immersion Simulation® — perfusion retention when repositioning is not clinically available.
Fluid Immersion Simulation (FIS) is a distinct therapeutic category. Rather than cycling pressure between zones on a fixed schedule, or fluidizing ceramic beads on a forced-air stream, the Dolphin system continuously simulates immersion in a fluid medium — approximating a state of near-neutral buoyancy across the patient's full contact area.
The system samples the support surface over one hundred times per second and builds an individualized immersion profile from the patient's own mass distribution and surface area, adjusting continuously as the patient is repositioned or as body habitus changes. Three-dimensional volumetric engagement distributes load across the largest available contact area, which minimizes cellular deformation at the bone–tissue interface. Because the patient is supported rather than compressed against a resisting plane, gradient shear forces are substantially reduced — the mechanism that drives deep tissue pressure injury propagation beneath intact skin.
The clinical consequence is perfusion retention. In a laser Doppler study conducted at the University of California San Diego, Kohanzadeh et al. measured 87% retention of tissue perfusion on the Dolphin FIS surface compared with 16% on standard mattresses — a statistically significant improvement in tissue blood flow.¹ Joerns reports more than 450,000 patients treated on FIS technology across acute, post-acute, and home care settings.³
Acute indications
Stage III and Stage IV pressure injuries. Full-thickness tissue loss with exposed adipose, fascia, muscle, tendon, or bone, where the surface must actively support the healing environment rather than merely avoid contributing to further breakdown.
Post-operative myocutaneous flaps and skin grafts. Preserving perfusion to the surgical site through the critical take period, with shear elimination protecting the suture line during the immobilization window.
Non-turnable and turn-restricted patients. Hemodynamic instability, unstable spinal precautions, external fixation, elevated intracranial pressure, or prone-position ventilation.
VA SCI/D populations. Patients with absent protective sensation carry lifetime pressure injury risk. Continuous pressure redistribution during acute stabilization and rehabilitation directly addresses the recurrent-breakdown pattern that drives repeat admissions.
Severe burn and complex donor site management. Extensive graft and donor sites constrain positioning options; immersion preserves perfusion across the available contact area.
Practical specifications
Fits existing bed frames including ICU, med/surg, and bariatric. Twelve-hour battery supports uninterrupted therapy during intra-facility transport. Closed system — no forced hot air, so it avoids the wound bed desiccation and patient dehydration associated with air-fluidized therapy. Available in standard, bariatric, and pediatric configurations, plus stretcher and wheelchair variants.
Tissue perfusion retention under load
Kohanzadeh et al., University of California San Diego. Laser Doppler measurement of tissue blood flow retention on the Dolphin FIS surface compared with standard bed and gurney systems; the difference reached statistical significance.
This measurement reflects retained tissue perfusion under load. It is not a measure of wound healing rate, time to closure, or HAPI incidence.
Clinical applications
Level I Trauma Centers
Polytrauma patients arrive with compromised perfusion, prolonged immobilization, and positioning constrained by fixation hardware and spinal precautions. M.A.P. identifies pressure concentration under and around hardware where visual skin assessment is obstructed. Dolphin FIS maintains tissue viability through the extended immobilization window.
Burn and Surgical ICU
Extensive graft and donor sites demand a surface that eliminates shear at the wound interface. Dolphin FIS supports post-operative flap and graft protocols with three-dimensional volumetric engagement, protecting the suture line and preserving perfusion to the surgical site.
VA Spinal Cord Injury & Disorders Centers
Absent protective sensation removes the physiological feedback loop that normally drives spontaneous position change. Continuous pressure redistribution paired with continuous mapping addresses both the mechanical and the behavioral dimension of the risk — and the M.A.P. display allows patients with preserved upper-body function to participate directly in their own offloading.
Medical ICU and Step-Down
Vasopressor dependence, mechanical ventilation, and prone positioning protocols compound HAPI risk while restricting repositioning. Continuous pressure mapping documents turning protocol compliance under conditions where the standard interval is frequently not achievable.
Monitor, mitigate, treat — the two systems in sequence
- 1
Monitor.
WellSense M.A.P. establishes objective visibility into interface pressure distribution across the at-risk census. Cumulative pressure-over-time data identifies which patients are accumulating load at which anatomical sites, and where repositioning is not achieving actual redistribution.
- 2
Mitigate.
Patients showing sustained pressure concentration, or who are clinically non-turnable, escalate to Dolphin FIS for perfusion retention and cellular deformation mitigation during the constrained window.
- 3
Treat.
Established Stage III and IV injuries, post-operative flaps, and grafts are managed on Dolphin FIS, with M.A.P. providing continuous verification that the surrounding tissue is not accumulating secondary load.
Bring these systems into your unit.
Mountain American Medical supports acute care facilities across Utah, Colorado, Arizona, New Mexico, and Wyoming, with dedicated experience in the VA system. We provide on-site clinical evaluation, in-service education for nursing and wound care staff, and capital acquisition structures built for facility procurement rather than open-ended rental.
References
- 1. Kohanzadeh S, et al. University of California San Diego. Laser Doppler assessment of tissue perfusion on the Dolphin Fluid Immersion Simulation® system compared with standard bed and gurney surfaces. Measurement reflects retained tissue perfusion under load; it does not measure wound healing rate or pressure injury incidence.
- 2. Single-site evaluation at a VA medical center measuring hospital-acquired heel pressure injury rates in a high-risk population before and after Dolphin implementation; reported via the Advisory Board Company Nursing Executive Center. Single-site observational finding; results are not generalizable to all facilities or populations.
- 3. Cumulative patients treated on Fluid Immersion Simulation® technology across care settings, as reported by Joerns Healthcare.