Backcountry medicine: How to set a splint

Backcountry medicine: How to set a splint

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A broken ankle, arm, or leg can be painful, but when it occurs in the backcountry, far away from medical assistance or a quick ride to the hospital, it can be downright deadly. Such injuries lead to a lack of mobility, and being stranded in inhospitable wilderness can lead to a number of unfavorable outcomes. To protect yourself, it’s vital to know how to stabilize these injuries using a splint.

The first and most important thing to determine when dealing with a potential broken limb is whether or not to set it. If you have bones protruding or gross deformity of the limb, you need to splint the injury in place and facilitate bleeding control for any open bone breaks. There will be obvious swelling around the area, possibly accompanied by extreme pain.

A key concern with an open fracture is that, if you attempt to reset the grossly deformed limb, moving the broken ends could cut the arteries that run through the area of the injury. There’s also a chance of increasing the damage by moving the fragmented bones back into place, incurring more bleeding.

With a closed fracture or break, there can be mild deformity, swelling, bruising, and severe pain. When assessing the deformed area, you can feel if there is a lack of stability and/or crepitation. If you push on the area and feel a grinding/crunchy sensation, that is crepitation.

SAM splints are used in a variety of ways to stabilize a broken arm or leg as well as wrists, elbows, or ankles. They can be used to hold a deformed break in place or to maintain rigidity in a limb that has been set. It is small and compact option to keep in your backpack, hunting pack, etc.

The author carries his SAM splint and Coban wrap in an accessible exterior pocket of his pack. 

In addition to the SAM splint, you will need a way to secure it. ACE bandages and medical tape are two good options.

After identifying the location of the injury, establish your course of action and determine whether to put a splint in place or not. If you are on your own, you won’t be able to perform some of the actions necessary to splint the injured limb. Your best treatment in that case is to stabilize the injured limb in order to enable your egress and reach a hospital for treatment.

Implementing the SAM splint can be done in several ways. If it is an arm fracture, you can unroll the SAM splint to a length that covers approximately 1-2″ above the elbow and down to the hand. The unrolled end of the SAM splint should be placed in the palm. Once this is in place, use your ACE bandage or medical tape to secure the SAM splint, wrapping it with enough pressure to stabilize the injury without cutting off blood flow.

If the injury is not an open fracture, and you are unable to feel a pedal or radial pulse (depending on if the fracture is in the leg or arm, respectively), then traction is necessary to restore blood flow.

Warning: Real-world application; this video contains graphic images.

There are commercial devices available to apply traction to a limb, but they are typically large and not ideal for a hunting pack or backpack. If you are within range of 911 services, call immediately so they can bring their traction devices and other medical supplies to treat the injury. While you wait for 911 to arrive, have a second person pull on the hand or foot until there is a relief of pain. Once that is obtained, it’s important to maintain that pressure until 911 can reach you.

As with all injuries, you want to ensure you are maintaining bleeding and infection control. Calling 911 and getting to a medical facility should always be the primary goal with dealing with critical injuries.

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