Traumatic musculoskeletal injuries in the technical rescue field are commonplace. Unfortunately, fracture management is generally breezed over in training with a “you already know how to do this” attitude that leads to excessive verbalization and incomplete skill development. Training scars are formed when training is incomplete, verbalized, or the right supplies are not made available for the scenario.
Everything is perishable and skills need to be practiced and completed accurately to build muscle memory. This completed training also develops the ability to adequately manage the injury in atypical situations through the application of concepts. By building adequate concept understanding you reduce the possibility of additional injury, such as internal bleeding, possible nerve damage, and additional fragment displacement.
By practicing your skills in the training environment, you will be better prepared to utilize them in atypical or austere conditions.
Splints should meet the following three requirements:
1. Splints need to provide circumferential COMPRESSION.
2. They need to be COMFORTABLE.
3. They need to be COMPLETE.
Now let’s discuss construction. Think about a cast. Casts are the end state for many fractures. The first layer of the cast is gauze that is pulled tight around the injury and shrinks a little to create the internal compression needed to provide support and reduce swelling. The second layer is padding to make the cast comfortable, and the outer layer is hard to provide rigid support and protect the injury from further damage.
Our field splints need to be similar but are generally built in a slightly different order. We start by selecting our rigid support materials. These can be sticks, SAM splints, trekking poles, etc. We size up the rigid support to be able to hold up the injury and place it where gravity will pull down on the injury. Then we need to apply our padding on top of our rigid support; and no, the padding on SAM splints and padded board splints are not adequate! Your padding should be 1-3 inches thick and be 360 degrees around the injury to adequately fill void spaces and provide the necessary support. Then we use our elastic wrap to compress all the soft material into a solid object.
As we sit and contemplate Newton’s Laws, we must remind ourselves of the 3rd law that discusses “equal and opposite reactions.” This law is very pertinent to our construction. The rigid support, placed where gravity is pulling down, allows for support and pushes back up. The padding placed on top provides more support and comfort. Lastly, the compressive wrapping pushes back down against the injury, compressing the tissues and materials, so that when movement occurs the bones and fragments stay put. This leads to comfort. Finally, if the splint is “complete,” it contains all the materials used so that the splint looks relatively presentable and holds together during the rescue.
Applying these concepts to any fracture will enable you to better manage your patient. You will need to be far less aggressive in your pain management, which in turn makes for a less needy patient so you can focus on the rescue. The tradeoff is that we need to take the time to do this correctly. Which means we may have a longer on scene time. Take that time! Fractures are just one of the situations where if we don’t follow these concepts, we can potentially increase the damage and negative long-term outcomes for our patients. A poorly constructed splint is the same as no splint at all! Do your patients a favor and take the time to practice correctly and apply these concepts. I promise they will thank you later!
Jason Tartalone, NRP, FAWM, WEMT-P, TP-C, EMPF
Sergeant Rescue Training & Consulting