First Aid Guide 05
Sprains, Fractures, and Immobilization
Injury & Splinting
An injured arm or leg can be difficult to evaluate in the field. A painful injury that limits use could be a sprain, strain, dislocation, or fracture. When in doubt, protect the part, limit movement, and get appropriate medical evaluation.
Sprains and strains
- Stop the activity and avoid motions that increase pain.
- Apply a cold pack wrapped in a damp cloth for up to 20 to 30 minutes at a time. Do not place ice directly on the skin.
- A comfortable compression wrap may help an ankle sprain, but it must not reduce circulation. Loosen it if there is numbness, tingling, increasing pain, or color change.
- Seek medical care when the person cannot use the limb normally, pain is severe, there is significant swelling or deformity, or a fracture is possible.
Recognizing a possible fracture
- Severe pain, swelling, bruising, or inability to move or bear weight
- An unusual angle, shortening, or obvious deformity
- Bone visible through the skin or an open wound near the suspected fracture
- A hand or foot beyond the injury that becomes pale, blue, purple, cold, numb, or weak
Call 911 for an open fracture with severe bleeding, a badly deformed limb, loss of circulation, a suspected thigh or pelvis fracture, or any injury associated with major trauma.
Splinting principles
Splinting can reduce pain and further injury, especially when transportation to care is delayed. It should be done only within the responder's training and should never delay emergency medical care.
- Control serious bleeding and cover open wounds before splinting.
- Support the injured part in the position found. Do not force a deformed limb straight unless trained professionals direct it or circulation is absent and evacuation requires it.
- Pad rigid splints. When practical, immobilize the joint above and the joint below a suspected long-bone fracture.
- Secure the splint firmly enough to prevent movement but not so tightly that circulation is reduced.
- Check circulation, sensation, warmth, and color below the injury before and after splinting and periodically during evacuation.
- A sling can support an injured arm; a swathe around the upper arm and chest can reduce movement when needed.
Cravat bandages and improvised materials
A triangular bandage can be folded into a cravat for tying a splint or securing an arm. Padded boards, trekking poles, rolled magazines, sleeping pads, or the uninjured limb can sometimes serve as splints. Improvised equipment should make the patient more comfortable and stable, not create new pressure points or circulation problems.
