RESQDOC
07-06-02, 22:48
Here is a DRAFT (1st draft at that) generic protocol for care of fractures & dislocations, etc., under austere conditions. It is generic in the sense that it could be used for a US SAR unit or a 3rd world with some material added/deleted to suit local capabilities. Tear it up, correct it, fix it, flush it as needed.
DRAFT #1
Fracture Repositioning &
Dislocation Reduction Protocol In The
Wilderness, Remote, & Disaster Setting
Purpose:
This protocol has been developed for use by appropriately trained individuals to aid in the repositioning of fractures and reduction of dislocations. It is based on principles defined by the United States Department of Transportation, State of Nebraska Department of Health & Human Services, the Wilderness Medical Society, and the National Association of EMS Physicians.
Scope:
This protocol is limited to the use of XXXXX personnel and XXXXX Hospital medical care staff while working in wilderness, remote, or disaster settings where immediate medical care is not available. Isolation due to weather conditions, loss of transportation and communications, and/or loss of road access is included in this definition. It is not for use when transport times are short, routine systems and services are not impaired, and access to medical care is readily available.
Application & Use:
This protocol may be employed if the following conditions are met:
1. The patient is in a wilderness, remote, or disaster setting where medical care is not immediately available, as defined in “Scope” above.
2. Those using this protocol have been trained, tested, and approved by the Gordon Rescue/EMS Medical Director, and will be re-certified every 6 months.
3. Every effort will be made to communicate with the Medical Director or receiving hospital medical control physician prior to initiating therapies given in this protocol, however if communication is not available therapy will be initiated and contact made as soon as is feasible.
General Principals:
1. Fractures should be repositioned when there are no pulses below the site of the injury, or when the limb position is such that it will interfere with the effective movement and evacuation of the patient.
2. Fractures should be repositioned using the principles of gentle in-line traction and anatomical position.
3. The best time to undertake a dislocation reduction is immediately after the injury, as there is minimal muscle spasm and resistance.
4. Hip and knee (not knee-cap/patella) dislocations can result in serious interruptions of the blood supply and should be evacuated as soon as possible.
5. If repositioning or reduction attempts result in increasing pain or resistance, do not continue, immobilize in place, and evacuate the patient.
6. Anesthesia by ice/cold application, distraction, and relaxation techniques before and after repositioning is encouraged. Advanced practice providers may use pain relief
and sedative medications per SOP’s as individually authorized by the Medical Director.
Treatment:
1. Evaluate all suspected fractures noting position, pulse, motor, and sensory function below the fracture site. If these are normal and the fracture position allows easy movement of the patient the fracture should be splinted as found, and repeat pulse, motor, and sensory checks done frequently while the patient is evacuated.
2. If there is impaired pulse, motor, or sensory function, or if the patient cannot be easily evacuated with the limb’s current position, use gentle traction down the limb to straighten and place the injured segment back into a normal (or as normal as possible) anatomical position. Stop if this results in increased pain or resistance. Check pulse, motor, and sensory function frequently after this is done, splint
appropriately, and evacuate the patient.
3. Shoulder dislocations may be reduced by either the in-line traction/outside rotation “baseball throw” method or the hanging traction method.
4. Finger/toe dislocations are reduced by in-line traction and repositioning.
5. Kneecap (patella) dislocations are reduced by the straight leg/push method.
6. Hip and true knee dislocations are difficult to reduce in the field. Make every attempt to contact Medical Control for instructions and evacuate as soon as possible. If this is not possible reduction may be attempted by the two person traction/reposition technique.
7. Pulse, motor and sensory function will checked frequently after dislocation reduction.
8. All dislocations will be immobilized in anatomical position and the patient evacuated for further evaluation.
________________ ____________
Medical Director Date
DRAFT #1
Fracture Repositioning &
Dislocation Reduction Protocol In The
Wilderness, Remote, & Disaster Setting
Purpose:
This protocol has been developed for use by appropriately trained individuals to aid in the repositioning of fractures and reduction of dislocations. It is based on principles defined by the United States Department of Transportation, State of Nebraska Department of Health & Human Services, the Wilderness Medical Society, and the National Association of EMS Physicians.
Scope:
This protocol is limited to the use of XXXXX personnel and XXXXX Hospital medical care staff while working in wilderness, remote, or disaster settings where immediate medical care is not available. Isolation due to weather conditions, loss of transportation and communications, and/or loss of road access is included in this definition. It is not for use when transport times are short, routine systems and services are not impaired, and access to medical care is readily available.
Application & Use:
This protocol may be employed if the following conditions are met:
1. The patient is in a wilderness, remote, or disaster setting where medical care is not immediately available, as defined in “Scope” above.
2. Those using this protocol have been trained, tested, and approved by the Gordon Rescue/EMS Medical Director, and will be re-certified every 6 months.
3. Every effort will be made to communicate with the Medical Director or receiving hospital medical control physician prior to initiating therapies given in this protocol, however if communication is not available therapy will be initiated and contact made as soon as is feasible.
General Principals:
1. Fractures should be repositioned when there are no pulses below the site of the injury, or when the limb position is such that it will interfere with the effective movement and evacuation of the patient.
2. Fractures should be repositioned using the principles of gentle in-line traction and anatomical position.
3. The best time to undertake a dislocation reduction is immediately after the injury, as there is minimal muscle spasm and resistance.
4. Hip and knee (not knee-cap/patella) dislocations can result in serious interruptions of the blood supply and should be evacuated as soon as possible.
5. If repositioning or reduction attempts result in increasing pain or resistance, do not continue, immobilize in place, and evacuate the patient.
6. Anesthesia by ice/cold application, distraction, and relaxation techniques before and after repositioning is encouraged. Advanced practice providers may use pain relief
and sedative medications per SOP’s as individually authorized by the Medical Director.
Treatment:
1. Evaluate all suspected fractures noting position, pulse, motor, and sensory function below the fracture site. If these are normal and the fracture position allows easy movement of the patient the fracture should be splinted as found, and repeat pulse, motor, and sensory checks done frequently while the patient is evacuated.
2. If there is impaired pulse, motor, or sensory function, or if the patient cannot be easily evacuated with the limb’s current position, use gentle traction down the limb to straighten and place the injured segment back into a normal (or as normal as possible) anatomical position. Stop if this results in increased pain or resistance. Check pulse, motor, and sensory function frequently after this is done, splint
appropriately, and evacuate the patient.
3. Shoulder dislocations may be reduced by either the in-line traction/outside rotation “baseball throw” method or the hanging traction method.
4. Finger/toe dislocations are reduced by in-line traction and repositioning.
5. Kneecap (patella) dislocations are reduced by the straight leg/push method.
6. Hip and true knee dislocations are difficult to reduce in the field. Make every attempt to contact Medical Control for instructions and evacuate as soon as possible. If this is not possible reduction may be attempted by the two person traction/reposition technique.
7. Pulse, motor and sensory function will checked frequently after dislocation reduction.
8. All dislocations will be immobilized in anatomical position and the patient evacuated for further evaluation.
________________ ____________
Medical Director Date