Immobilisation and Support

Immobilisation and support refers to the process of holding a joint or limb in place with a splint or sling. This is done to prevent an injured area from moving and reduce the chances of further injury.

General Principles

Always assume a fracture
Treat fractures before moving unless safety of yourself or the patient prevents this
Support and immobilise the affected area to prevent further movement and to control part affected
Immobilise fractures using padding, blankets, bandages or splints (Vacuum or box).
Use your initiative to immobilise an injury if you don't have a certain piece of equipment e.g. A patient with a fractured neck of femur (#NOF), place a blanket between their legs (comfort), pass 3 bandages under both legs (using natural hollows) and tie against good leg (top, middle and bottom). The patients good leg is acting as the splint and it's a lot easier to move the patient this way
Put patient in a comfortable position with affected part elevated to reduce swelling.
Do not put pressure on the site of an injury. Gently pad an open wounds
Use the body's natural hollows to pass bandages to opposite side of injury. (Under knees, ankles and small of back. etc)
Always check that bandages are not reducing circulation to affected part if the limb starts to swell. (capillary refill and distal pulse check)
Immobilise the fracture above and below point of injury and never over the top.

Correcting Deformities

As described in the section on injuries to Bones, Joints, ligaments and Tendons I mentioned in the management section, "if there is any deficit in circulation or sensory then the fracture will need to be reduced to near as normal".

Generally only attempt to correct the deformity if:

There is evidence that circulation is restricted. e.g. Lack of distal pulse
The injury is very severe
The skin is very tight over the injury site and looks lifeless and very pale

Equipment for immobilisation and support

Splints - Splints are used to immobilise an injured arm or leg immediately after an injury. Before moving a person who has injured an arm or leg some type of temporary splint should be applied to prevent further injury to the area. More....(new window)

Slings - Slings are used to support the arm after a fracture or other injury. They are generally used along with a splint, but sometimes are used alone as a means of immobilisation. A patient can hold their own arm in a comfortable position if this is less painful.

Traction - Immobilisation may also be secured by traction. Traction involves using a method for applying tension to correct the alignment of two structures (such as two bones) and hold them in the correct position. For example, if the bone in the thigh breaks, the broken ends may have a tendency to overlap. Use of traction will hold them in the correct position. this also reduces pain for the patient. (Sager Emergency Traction Splint) fitting instructions.

Cervical Collar - Stiff collars are generally used to support the neck when there has been a suspected fracture in one of the bones of the neck. Cervical collars are widely used at the scene of injuries when there is a potential neck or head injury. More....(new window)

Spinal Board - A spinal, or back board, is used in conjunction with a collar for the treatment of a suspected cervical or back injury to maintain inline immobilisation. The spinal board is very good for extracting a patient from an RTC although it is used as a transporting device but the casualty may be very uncomfortable. Another transporting option, if available, is the vacuum mattress (see below) More....(new window)

Vacuum Mattress - used for the immobilisation of patients, especially in case of a neck, back, pelvis or limb trauma. The vacuum mattress is constructed of a tough outer lining and filled with small polystyrene balls. The balls allow the mattress to be moulded around the casualty. Once the mattress has been moulded the air is removed with a pump. The vacuum mattress is a preferred way of transporting a casualty with the injuries mentioned as it moulds to their contours and makes the journey far more comfortable than a spinal board. More....(new window)

Kendrick Extrication Device or KED - a device that is used in vehicle extrication to remove a casualty. More....(new window)