As a patrol officer, there is a high probability you will be the first on scene to provide aid to an injured person. Although stabilizing fractures is a first-aid skill, enhancing your knowledge could aid you in reducing further injury, relieving a victim’s pain and even saving a limb.
Learning objectives
- How to determine if there is a fracture.
- How to assess the fracture.
- How to stabilize the fracture.
- How to determine when it is an emergency.
Injury assessment
Is it broken? Most of the time the answer to that is, “I don’t know.” Other times, it is painfully obvious. No pun intended.
So, what does a fracture look like when it is not obvious?
Some things I look for in the field as a paramedic include swelling, bruising, extreme pain, and feeling the bones move and grind as I press on the injured area. Swelling is usually profound and can happen in an instant.
Differentiating between soft tissue swelling and a fracture cannot be definitively done with the naked eye. Bruising is usually dark and circumferential, although it is important to note that the lack of presence of bruising does not mean an extremity is not fractured.
Breaking a bone is a painful injury for the most part, so extreme pain is a clue that something inside is broken. This is especially true in children where a fracture will make them inconsolable.
When it comes to feeling an injury, it is important to know that you won’t cause further damage by touching it, but it will probably hurt the victim, so a warning is usually necessary before proceeding. Be as gentle as possible to get the answers you are looking for.
If you feel bone ends or bones grinding when you touch the injury location, as a police officer, the assessment is best stopped right there.
It is important to see if there is feeling below the injury site, like in the hands, fingers, feet, or toes, as well as if there is a pulse present below the injury site. If the answer to either of those is no, there is a risk of losing the limb and EMS should be requested to respond emergently.
Treatment
For obvious injuries, the simplest first aid answer is to splint the extremity in the position it is found. In other words, restrict its movement with anything possible so the broken bone ends don’t cause further damage internally.
EMS will come and either keep it the way it is or do something different depending on their local protocols.
For me, if the splinting is doing the job, I will forgo anything fancy and administer some pain meds. The human body is pretty miraculous in how it instinctively acts. For instance, when someone breaks their arm, the natural reaction is to pull it in across the body and hold it with the other hand. This action is referred to as “self-splinting.” This would be a case where splinting the extremity how it is found is most beneficial.
The objective of splinting is to immobilize the joint above and below the injury or to restrict the movement of the broken bone. This is achieved by using something rigid to hold the area you believe is injured in place. There are numerous commercial options, such as the SAM SPLINT, which is a moldable piece of hard foam you fit and secure in place. Since this might not be practical for police cars, you might have to get creative. Using anything from a pillow to a book, magazine or clipboard are all creative substitutes that might do the job in a pinch. All of these and any other objects you have at your disposal would be secured in place using tape, bandages, or strips of material.
Emergency cases
There are a few instances where a fracture is a true emergency. Although for most fractures there can be little done in the field to prevent the loss of an extremity, it is important to know when things should move quickly.
Let’s consider open or compound fractures. This is when the broken bone has penetrated the skin, whether or not it is still sticking out. These can be emergent injuries based on associated bleeding. These are not injuries you would typically want to use a tourniquet on, however for first aid/response purposes if the person will die without a tourniquet, use it.
If a victim has loss of sensation, mobility, or signs of circulation (pale, cool, or no pulse) below a fracture then the extremity could be in danger of losing the limb. This is known as a pulseless extremity. Time is of the essence in a situation of this nature and therefore an emergency response from EMS should be requested.
Mangled or partially amputated extremities are emergencies that should be managed with bleeding control (tourniquet, pressure pressings, etc.). Once bleeding is controlled, splinting the extremity to prevent rebleeding or further injury is appropriate.
In situations where a fracture is accompanied by other life-threatening emergencies, the life threat should be managed first (i.e., chest seal placement, tourniquet placement, etc.).
As always, follow your agency’s policies and procedures.
