Two methods of Improvising a Pelvic Splint

21st January 2013, revised 27th July 2018 and 9th May 2019

 

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

There are mixed reviews over the efficacy of improvised Pelvic Splint with a bed sheet being the most cited example.  (1).   One of the techniques shown here utilises 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 splint.


Method 1: Tourniquets and a SAM splint

 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.

Tying the ankles together bring in the feet which prevents outwards rotational forces on the pelvis.

2. Joint two tourniquets together and adjust their length to be long enough to go around the casualty’s hips with at least 6 inches overlap.

3. Tape the joined tourniquets to a SAM splint, centralised both vertically and horizontally. It is imperrative the tape prevents the tourniquets from slipping off the SAM Splint.

4. Position the device underneath the casualty, centralised over the greater trochanters - the boney processes at the widest point of the hips.

5. Fold the SAM splint around the casualty’s hips, join the tourniquets.

6. The tourniquet should be tightened to compress enough that is is difficult to get a finger underneath the SAM splint.

Having used this method in various training scenarios, it’s benefit is that it can be made relatively quickly with materials that would commonly be found in a remote first aid kit or medical bag but there are a couple of drawbacks to this method:

  1. Because of muscle-memory, there is a tendency to over-tighten the tourniquets as if they were being applied to arrest a catastrophic haemorrhage.

  2. Tourniquets are an important item of equipment if your Needs Analysis suggests they should be in your medical kit. Really, they should be preserved for their primary purpose.

  3. This design can slip from the optimum position at the greater trochanters more easily than Method 2.

Method 2: Foil Blanket

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.

Tying the ankles together bring in the feet which prevents outwards rotational forces on the pelvis.

2. 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.

3. 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.

4. 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.

The blanket must be centralised over the greater trochanters.

5. 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.

6. 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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