Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols.
The present study was completed to establish an epidemiologic database defining the prehospital occurrence of midthigh trauma/suspected femoral shaft fractures, and the use of/need for traction splints (TS) in hope of developing recommendations for further treatment protocols. On review of 4,513 paramedic run reports for the 12-month period from January 1999 through December 1999, from a low-volume urban emergency medical services (EMS) system, 16 persons (0.35% total patients) presented with midthigh injuries. Data collected included patient chief complaint/injury, mechanism of injury, clinical findings, splint application, additional interventions, iatrogenic complications, patient age, and ambulance field time. Paramedics noted injuries suspicious for femoral shaft fractures in 5 patients (31.25% study patients, 0.11% total patients). TSs were applied successfully only twice (12.50% study patients, 0.04% total patients). Fourteen patients (87.50% study patients) were managed with long backboard immobilization, rigid splinting, and/or patient transportation in a position of comfort. No sequelae as a result of such care occurred. No inappropriate use, point estimate (PE) [(0)/(16) (0.00% to 20.60%)] or unmet need, PE [(0)/(4), 497) (0.00% to 0.08%)] of care was noted. The data presented in this study suggest that given similar EMS system characteristics, prehospital midthigh injuries/suspected femoral shaft fractures occur on an extremely rare basis, and treatment with long backboard immobilization, rigid splinting, and/or patient transportation in a position of comfort may constitute an acceptable course of care. Including TSs as essential ambulance equipment may be unnecessary.
Department of Emergency Medicine, Baptist Medical Center, Jacksonville, FL 32207, USA.
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Abarbanell
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D002648:Child; D002985:Clinical Protocols; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007869:Leg Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D016134:Organizational Policy; D012189:Retrospective Studies; D013165:Splints / Q000706:statistics & numerical data*; D013848:Thigh; D014143:Traction; D014600:Utilization Review