Immobilization of a arm with a broad arm sling (triangular bandage)

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:      

• A casualty has a forearm injury. He is conscious and asks you for help and takes him to the hospital's trauma center.  
• Immobilize his arm with a triangular bandage

Equipment for the practical skill:

• triangular bandage
• safety pin
• two rolls of bandage

The procedure for performing a practical skill:

• Make sure the scene is safe.
• Introduce yourself.
• Identify the person.
• Obtain informed consent to the procedure:
  • give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure;
  • explain what you are going to do;
  • ask the patient to consent to procedure.
• Identify a type of the injury:
  • examine the person from head to toe;
  • verify the injury;
  • choose a way to immobilization.
• Call for help: ask a bystander to assist you in providing first aid.
• Prepare the triangular bandage: 
  • o   prepare the triangular bandage (scarf);
  • o   prepare a safety pin (if this is available).

• Perform immobilization:
  • Ensure that the injured arm is supported with the hand slightly higher than the elbow.
  • Fold the base of the bandage under to form a hem.
  • Place the bandage with the base parallel to the casualty’s body and level with his little fingernail.
  • Slide the upper end under the injured arm and pull it around the neck to the opposite shoulder.

• • Fold the lower end of the bandage up over the forearm and bring it to meet the upper end at the shoulder.

• • Tie a square knot (opposite) on the injured side, at the hollow above the casualty’s collarbone. Tuck both free ends of the bandage under the knot to pad it.

• • Adjust the sling so that the front edge supports the hand – it should extend to the top of the casualty’s little finger.
  • Hold the point of the bandage beyond the elbow and twist it until the fabric fits the elbow snugly, then tuck it in or knot it.

• •  Alternatively, if you have a safety pin, fold the fabric and fasten it to the front.
  • Bind the finished sling to the body with a roll bandage.

• Check the quality of immobilization.
• Ask the patient about the comfort of the arm position.
• Check the circulation in the fingers. Recheck every ten minutes. If necessary, loosen and reapply the bandages and sling.