The scope of this article is to give you an introduction to splinting techniques and materials. These guidelines are intended to be used when dealing with fractures of the arms or legs. Since medical aid will not always be available, it is worth learning as much as possible about taking care of yourself in an austere environment.
The reason for splinting a fracture (or a suspected fracture) is for immobilization. Movement of a fractured bone can be very painful. Proper splinting can relieve some of the pain, and, reduce the chance of further injury.
When do you apply a splint?
How do you recognize a broken (fractured) bone?
These are the two questions you should be able to answer before proceeding further with splinting.
Fractures vary in appearance. Talk to the victims. What they can tell you helps a great deal in deciding what to do. However, there are certain signs and symptoms of fractures that can be applied to almost every case whether the victim is conscious or not.
1. Look for obvious angulation or abnormality.
2. The victim may have heard the bone break.
3. In an open (compound) fracture you can sometimes see the bone ends.
4. Swelling or discoloration may occur in a specific area.
5. You or the victim may feel the bone ends grating inside the skin.
Safe Betting and splinting
Remember that the definitive diagnosis of a fracture is done by a doctor and X-rays. But, in a disaster or survival situation, doctors and X-ray machines may be in very short supply. It is always a safe bet to splint suspected fractures. Notice I did not say to reduce (set) a fractured bone. That is a professional’s job.
Fractures can be set up to several days later without extra problems. It’s just not worth the potential risk to nerves, blood vessels and, in some cases, a person’s life, to set a bone if there is (or will be) a doctor available.
In a worst case scenario, you must use your best judgment. But, remember, there is no substitute for “hands-on” training and experience. Splinting is an “art” well within anyone’s ability to learn, an art that is best learned before it is needed.
Here are a few general rules for splinting:
1. Do not move the victim (unless it is absolutely necessary) until you have splinted the fracture(s).
2. Cover all wounds on the injured limb with a dressing (bandage) before splinting.
3. Remove carefully (or cut away) all clothes that cover the injured limb.
4. Always be sure that your splint immobilizes the fracture above and below the break.
5. Before, during and after application of the splint, be sure to check the wrists or feet for pulses. Any changes in color or sensation of feeling, are indications of circulation problems if the splint is applied incorrectly (too tight).
6. When in doubt . . . splint!
Types of splints
There are many different types of splints available today. Some are quite specialized and complex. They can be as humble as a stick or newspaper, or as high-tech as inflatable or gel splints. Despite the great difference in how they are made, they can be broken down into three general categories: rigid splints, soft splints, and traction splints.
How you apply each type of splint is slightly different. The only thing that is done the same for each splinting situation is the principle of traction. To apply traction, you gently pull the limb in a straight line away from the body. The reason you use traction is to reduce the pain and lessen the chance of further injury. Note that traction is not to be used if there is a severely angulated fracture. Severely angulated fractures should be “splinted as they lay.” Femur (thigh bone) fractures are best treated with a traction splint. If you do not have one, then splint it as it lays.
The first type of splint is a rigid type. These can be made of any firm, non-flexible material. Commercially available types are the board splint, wire ladder splint, fiberglass, and cardboard splint. You can improvise this type of splint out of a staggering variety of materials. Some examples of improvised splinting materials are newspapers, magazines, tree limbs, broomsticks, popsicle sticks (for fingers), or, even a rifle (be sure it’s unloaded first!).
The rigid type of splint must be padded as it is applied for the support of the injury and comfort to the victim. Good padding could be rolled or folded sheets, towels or rags. The padding is placed between the splint and the injured limb, while the splint is being applied. The basic principle for application of the rigid type is the same for both arms and legs. Having two people to apply the splint(s) is very helpful.
Here are the steps to apply a rigid splint:
1. Apply dressings to any wounds on the injured limb.
2. One person gently supports the injured limb and applies slight traction.
3. The second person positions the splint alongside, over or under the injured limb.
4. The second person places the padding between the splint and the injured limb.
5. The splint is securely wrapped. The second person begins at the end of the splint closest to the body and works toward the hand or foot. You can improvise the wrappings, but any roller gauze will do.
While I was in the ambulance business, I developed a strong prejudice for using one type of rigid splint. I just loved cardboard! It stores well, can be customized with just a knife or scissors, and best of all, it’s cheap. You can make your own from cardboard boxes. They aren’t pretty, but they work.
Soft splints are generally constructed of a heavy-duty double-walled, transparent plastic. They come in a variety of sizes and shapes. Some even have zippers for ease in application. These air splints have some distinct advantage over the rigid types. They are very compact in storage, fairly light in weight, very comfortable to the victim, relatively easy to apply and they can apply gentle pressure to a bleeding wound when inflated properly.
There are some disadvantages and limitations to the air splint. It can be torn on sharp objects. It can leak and is not usable on severely angulated fractures. Lastly, it is not easily reshaped, so you need to keep more different types on hand. The air splint is applied in a different manner from the rigid splint. Again, two people to apply the air splint works the best.
Air splints without a zipper:
1. Dress any wounds or bleeding on the injured limb.
2. The first person pulls the deflated splint onto and around one of his (or her) own arms, to hold it open.
3. You then apply gentle traction while the second person supports the limb.
4. The first person then gently slides the air splint onto the injured limb. Remember to maintain traction and support.
5. The second person can then inflate the splint. Use only lung power. Air pumps can overinflate the splint causing severe damage to the victim.
Air splint with a zipper:
1. Apply bandages to any bleeding wounds on the injured limb.
2. One person applies gentle traction to the injured limb while supporting the fracture site.
3. The second person then slides the deflated splint onto or around the limb.
4. The first person must then change hands from inside the splint to the outside, while the second person supports the fracture. Remember to maintain traction while changing hands.
5. The zipper is done up.
6. The splint is then inflated by the second person, by mouth.
We used to carry all the different sizes and shapes of air splints on the ambulance. But in my experience, the only ones we used very often were the full arm, half arm, and full leg and half leg. These seemed to do the job very well. If you feel the need for air splints, these four will do most any of the jobs that an air splint is good for.
Traction splints are a special type of splint. They have been around quite a while in one form or another. The famous Hare traction splint is a modern version of the Thomas half-ring splint. They were developed primarily to treat fractures of the femur (thigh bone). Although a lower leg (but not ankle) fracture can also be treated fairly well by their application.
What makes a traction splint so useful is its ability to develop a strong, even, steady pull which is able to overcome very strong muscles in the thigh. This in effect separates and immobilizes the bone ends.
Traction splints are very complicated to apply compared with an air splint. If you plan to have one, you must develop a good technique. The only way to do this is to practice, practice, practice.
Two persons are necessary to apply the traction splint:
1. Bandage any bleeding wounds on the injured leg.
2. The first person squats down by the victim’s foot. Place one hand under the ankle while the other hand goes on top of the foot.
3. The first person begins to apply gentle, even traction by slowly rocking backward.
4. The second person positions the splint with the padded collar against the hip. The newer types can also be adjusted for length. A good rule of thumb is to position the end of the footrest under the heel. It’s better to adjust it a little long than too short. Practice makes perfect.
5. Secure the splint using cravats or the straps that are provided.
6. Place the ankle hitch around the ankle and prepare to tighten up the ratchet.
7. Tighten up the ratchet. Keep tightening until the victim feels marked relief from pain. Never let the traction off once it is applied. (Traction is let off when the bone is set.)
8. Check all the straps for tightness. Then elevate the splint three to five inches off the ground.
9. Check the foot’s pulse. Check the toes for color.
10. Seek some sort of medical aid.
This is a very serious injury, and it can be life-threatening. (Should the femoral artery be severed, a person could “bleed out’ in a matter of minutes.)
Related reading: EMT – A Skill With Inestimable Value
The procedure for using the traction splint for lower leg (but not ankle) fractures is the same, except the straps, are positioned in a different manner to better support the broken bones. When the traction splint is used correctly, the victim will go from a state of excruciating pain to one of near painlessness.
I once treated an accident victim with a fractured femur, using a traction splint. He was in great pain, but when we applied the traction splint, he thought that we had repaired the damage. He felt well enough to go home, but he was hospitalized, He did go home after several weeks in the hospital.
Pain and splinting
And now about the dreaded pain. Fractures hurt. There is no way around it. Paramedics have sufficient pain killers, that can be dispensed. The rest of us have to use what we can get over the counter.
Experience has shown that a significant amount of pain relief can be had if you do three simple things when treating a fracture: Don’t panic, perform proper splinting techniques, and talk to the victim; let the victim know that you are there to help.
How about transportation? In a disaster situation, ambulances and fire department rescue teams will be nowhere in sight. You will probably have to move the victim yourself. There are several excellent commercial stretchers on the market if you can afford one. You might even locate a military surplus litter. More than likely, you’re going to have to improvise.
The Red Cross First Aid Handbook shows several good examples. Things such as ladders, doors or even lawn furniture can be used. The most popular improvised litter is the blanket/ pole type. Most homes have the materials needed to construct it.
Basics of splinting
We have just looked at the basics of splinting. You will notice that each type of splint has its own pros and cons. There is no one “perfect all-purpose” splint. You must mix and match them to your own needs. When I put together my own field first aid kit, I included two small wire ladder types along with full arm and leg air splints. They don’t weigh much, and they store well.
At home, I keep several arm and leg size cardboard splints handy. Because they are flat, storage is no problem.
Remember that just having the splinting materials on hand doesn’t guarantee your competence. You must practice! Practice! Practice!
I suggest that, if you haven’t already done so, get some sort of first aid instruction. Or better yet, enroll in an EMT course. The practice you will obtain is invaluable. Check with your local Red Cross, fire department, or community college for the availability of these courses. The time to learn is now, while you still have the time. Don’t put off learning emergency medical procedures. When the proverbial S hits the fan, it will be too late to start learning.
This article has been written by James H. Redford MD for Prepper’s Will.