An Improvised Pelvic Sling

21st January 2013, revised 27th July 2018

 

When a proprietary Pelvic Sling is not available, an effective device can be made.

There are mixed reviews iver the efficacy of improvised Pelvic Slings with a bed sheet being the most cited example.  (1).   This technique uses a foil blanket which overcomes the practical impediments of a large, bulky bed sheet which account for its lack of efficacy.

It is, however, elsewhere cited that an improvised device is more readily available, costs less, is more versatile, and is equally as efficacious at immobilizing the unstable pelvis as compared to proprietary devises and their usage should be encouraged. (2-4)

Prior to reading this, we strongly recommend you read the accompanying article Pelvic Injury, especially regarding the application of a pelvic sling.

 

What you need:

Stages

  1. Using a triangular bandage or alternative (tape, cord, belt etc) tie the casualty's ankles together; this is most comfortably and stably achieved applying a 'figure of eight' around the back of the casualty's ankles, across their shoe laces and tied off underneath their feet.  
     
  2. Tying the ankles together bring in the feet which prevents outwards rotational forces on the pelvis.
     
  3. Completely unfold a space blanket and while grasping the top edge with hands wide apart, gather up the entire blanket into pleats into your hands.
     
  4. Pass the gathered foil blanket under the natural hollows behind the casualty's knees to minimise movement.  Pull the blanket through until it is central.
     
  5. If needed, have an assistant stand astride of the casualty, above their waist and lift the casualty's bottom off the ground by grabbing them by their belt or waist band.  If they are wearing tracksuit trousers or something stretchy without a stable belt, have them reach under their bottom and lift them up by pulling  the seat of their trousers taut.  This should be done only enough to facilitate placement of the foil blanket.
     
  6. Quickly, slide the blanket under their bottom and unfurl the pleats so that the blanket is spread out from their waist down to the crease between their buttocks and the top of their thighs.
     
  7. The blanket must be centralised over the greater trochanters - the widest point of the casualty's hips.
     
  8. Gently lower the casualty only the blanket.
     
  9. Bring either side of the blanket around the casualty's hips, bring the ends together and start twisting to 'wind in' the blanket.   This will bring the hips in and stabilise the pelvis without applying direct pressure to the pelvis itself.
     
  10. Twist the ends until it feels snug; it must be tight enough to feel as though it is doing something but not so tight that you are 'crushing' the pelvis.  Remember, you want to stabilise, not compress!  The ends can be tucked in or taped in place.

Combined with the ankles tied together, you have effectively stabilised you  pelvic casualty ready for transport.

Related articles:

Spinal injury in remote environments

Pelvic Injury

Improvised Stretcher

 

References

  1. Sinha S, Ellicott H, Gee E and Steel A. (2015). “A bed sheet is not as effective as a pelvic circumferential compression device in generating pelvic compression in patients with a suspected pelvic fracture”. Trauma. 17. 128-133.
     
  2. Prasarn ML, Conrad B, Small J, Horodyski M, Rechtine GR.  (2013)  “Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability”.  Injury. 44. 1756–1759
     
  3. Shackelford S, Hammesfahr R, Morissette D, Montgomery HR, Kerr W, Broussard M, Bennett BL, Dorlac WC, Bree S, Butler FK. (2017)  “The Use of Pelvic Binders in Tactical Combat Casualty Care: TCCC Guidelines Change 1602 7 November 2016”.  Journal of Special Operations Medicine. 17(1):135-147.
     
  4. Schaller TM, Sims S, Maxian T.  (2005)  “Skin breakdown following circumferential pelvic antishock sheeting: a case report”.  Journal of Orthopaedic Trauma.  19:661–665.

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