Trauma rescue and immobilization techniques
Trauma rescue and immobilization test whether you can move a damaged body without adding new injury: spinal motion restriction, fracture splinting, pelvic and long-bone stabilization, and handling of impalements, amputations, and crush injuries.
Core rules
- Spinal motion restriction is applied on mechanism and findings: altered consciousness, midline pain, neurological deficit, distracting injury, or a dangerous mechanism. Stabilize the head manually first, then apply a collar and move the patient as a unit.
- Use a backboard for extrication, not as a long-term transport surface; a vacuum mattress or scoop stretcher is preferable for comfort and pressure care.
- Splint fractures in the position found, immobilizing the joint above and below. Check colour, warmth, movement, and sensation before and after every splint, bandage, or traction device.
- Femur fractures: a traction splint reduces pain and blood loss; apply only to mid-shaft fractures with no knee or pelvic injury.
- Suspected pelvic fracture: apply a pelvic binder at the level of the greater trochanters, not the iliac crests.
- Impaled objects stay in place, padded and stabilized, and are removed by the surgical team.
- Amputated parts: wrap in sterile gauze, seal in a plastic bag, and place the bag in ice water; never place tissue directly on ice.
- Crush injury: anticipate crush syndrome after prolonged entrapment and request advanced care before release.
Worked example
A motorcyclist has an obviously deformed thigh and a cold, pulseless foot. Reasoning: control bleeding, assess distal circulation, apply a traction splint to the mid-shaft femur, then recheck pulses, sensation, and colour. If the pulse does not return after alignment, reassess the splint tension and the mechanism, and transport urgently, reporting the vascular findings.
Traps
- Backboarding every trauma patient regardless of findings.
- Pulling a motorcycle helmet off a rider without a clear reason and without a second rescuer.
- Checking circulation only after splinting, so a deterioration goes unnoticed.
- Applying a traction splint to a suspected knee dislocation or a fracture near the knee.
- Removing an impaled object to clean the wound.