Immobilization for femur fracture with makeshift items

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:      

• While hiking, a person fell from a height. You suspect a fracture of the right femur. You are in a place inaccessible to ambulance. Site of accident is save.
• Prepare the victim for transportation to the place where the ambulance arrives by immobilizing the injured limb with makeshift items. 

Equipment for the practical skill:

• simulator;
• sticks approximately 1.5 m long (which reaches from the simulator’s armpit to the foot);
• universal first aid kit;
• belts;
• strips of fabric (triangular bandages);
• blanket.

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.
• Perform immobilization:
  • Place the splint (stick) against the injured side.
  • Insert padding between the casualty’s legs and between the splint and her body.
  • Tie the feet together with a narrow-fold bandage (1).
  • Secure the splint to the body with broad-fold bandages in the following order:
    • at the chest (2),
    • pelvis (3),
    • knees (4),
    • above and below the fracture site (5 and 6), and
    • at one extra point (7).
  • Do not bandage over the fracture site.

• Check the quality of immobilization.
• Ask the patient about the comfort of the body position, the presence of discomfort in the immobilized area.