Deformity in conjunction with protruding bone ends is a clear sign of a fracture. Complications associated with fractures are damaged blood vessels and damaged nerves. Damage to blood vessels can result from the sharp ends of broken bones slicing into veins or arteries and causing excessive bleeding. Nerve damage can occur in much the same way. Lack of movement or loss of sensation are clues that point toward nerve damage.


It is always best to keep splinting as simple as possible. If you expect to arrive at your destination shortly, simply keep the patient from moving the injured extremity and stay as comfortable as possible. Patients will usually put themselves in a position of comfort. An example of this is a female patient with broken arm cradling it against her body and securing it with her other arm. If this patient is comfortable and you are close to landing, leave her where she is. If you need to splint because you are a significant distance from landing, you will need to remember these key concepts:


• Never attempt to straighten a fracture involving a joint.


• Do not push protruding bone ends back inside a wound.


• Splint fractured bones in the position you find them.


• Stabilize joints above and below the injury site.


Utilize your Aircare Access Medical Kit. If you do not have splints handy, you will need to utilize items located around you and a little common sense. You can create great splints using items like rolled up newspapers or magazines, umbrellas, broom handles or pillows. Always pad the splint you are using with towels or clothing and secure the splint with a bandage.


Injured fingers can be splinted to each other simply by taping them together. The same is true of an injured leg. Arms can be splinted to the body by wrapping bandages around the patient’s torso or having the patient hold the injured arm. Ankles can be splinted by wrapping a large pillow around the foot and ankle and taping it in place.


Utilizing these simple principles will help prevent damage to surrounding nerves and blood vessels. When professional medical care arrives, they will have a variety of specialty splints designed to stabilize these injuries.


After bandaging and splinting are complete, it is imperative that you check 3 specific body functions— circulation, motor function and sensation.


76 Trauma


Circulation—Try to locate the pulse beyond the fracture site. To do this, press your index and middle finger over an artery and feel for a pulse. If unsure whether the extremity has a pulse, you may also check for capillary refill.


Motor Function—The patient should be able to move or wiggle the fingers or toes of a splinted extremity.


Sensation—Gently touch the skin beyond the fracture site to determine if feeling remains by asking if the patient can feel your touch.


Collectively, these 3 tests check for the major concerns that remain after a fracture has been splinted. Report to Aircare Access the function of circulation, motor skills and sensation.


EMERGENT MUSCULOSKELETAL INJURIES


Many types of musculoskeletal injuries can be life- threatening and life-altering. In addition to bandaging and splinting, these injuries may require specialized surgical intervention and physical therapy during the healing process.


The femur, or upper leg bone, is the longest and heaviest bone in the body. Because of the size of this bone and the muscle and tissue that surround it, bleeding into the area can be life- threatening. You are also faced with the femoral artery running right down the center of your leg. The femoral artery is a central artery about the diameter of your thumb. Femur fractures may be characterized by a shortening of the affected leg and an inward rotation of the corresponding foot.


To prevent life-threatening injury from a femur fracture, manual stabilization is needed for the injured leg. If access to professional medical care is expected within the next several minutes, you need do little else. However, if you are in a remote location where additional help is unavailable, you must take some other action. While supporting the leg above and below the fracture site and gently straighten the leg while at the same time applying traction.


Traction is the act of gently but continually pulling the leg away from the body. At first, this will hurt as you pull the muscles out of spasm, but will then make the patient feel more comfortable. Once you make the decision to apply traction, you must maintain it either manually or with a splint. If traction is released, the broken bone ends will slide back, possibly creating further damage to surrounding nerves and blood vessels.


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