Returning to the basics of paramedicine. Splinting is a fundamental skill required by paramedics to perform their duties in pre-hospital emergency health care. Unfortunately, with the rise of our higher medical skills, such as IV cannulation, intubation, advanced drug administration, fundamentals of the paramedic profession have sometimes been forgotten.
So, lets return to the principles of splinting fractures:
1. Inspect the wound site and determine that the patient may benefit from splinting. If a patient is not neurovascularly compromised and is comfortable, don’t try and change it. Whatever position works for them is usually the best one.
2. Assess neurovascular status distal to the injury site prior to application of a splint (this means marking the pedal pulse with a pen in leg trauma or checking a radial pulse in a fractured arm).
3. Manage any wounds that require interventions at the site that is going to be splinted (because you may not have access once the splint is applied).
4. Pad the splint well to reduce movement of the injured limb and increase comfort. Large trauma pads are commonly used for lower limb fractures.
5. Support the injured limb from above and below the fracture site while applying the splint.
6. Consider the need for traction if the limb is out of alignment or there is poor distal perfusion.
7. Splint firmly, but ensure that distal circulation is maintained.
8. Avoid covering fingers and toes as these are the easiest indicators of good or poor circulation.
9. At the completion of the application of any splint always check for distal colour, warmth, movement and sensation (and pulses).