The prehospital management of pelvic fractures: initial consensus statement

© Gary Wilson/ Pre-hospital Research Forum

Emerg Med J 2013;30:1070-1072

Serious pelvic injuries are associated with a high mortality rate which has remained persistently high even with advances in hospital care. Hypovolaemia is often a significant contributing factor to these deaths. If haemorrhage from pelvic injuries could be controlled or reduced in the prehospital environment, then survival rates might increase.

Improved mortality has been seen with catastrophic haemorrhage from limb injuries after the introduction of the battlefield tourniquet and topical haemostatic dressings. However, compared with bleeding from pelvic injuries, external haemorrhage is simple to recognise and the success of intervention easier to observe.

Pelvic binding devices provide a simple alternative to surgical fixators. These devices can be applied in the prehospital environment, potentially allowing control of unseen major haemorrhage.

This article reports the finding of a consensus meeting on the prehospital management of pelvic injuries held in March 2012 and examines the evidence associated with pelvic binding devices and their application. Key findings are:

1. Pelvic Binder is a treatment intervention and should be applied early

2. A select group of patients may not need a binder applied

3. No one pelvic binder device can currently be recommended over another.

4. Adequate training must be provided to avoid misplacement of devices.

5. Associated femoral fractures should also be reduced.

6. Patients should not be log rolled or transported on a spinal board

7. The use of pelvic binders is associated with the risk of low pressure necrosis

8. The pelvic binder should be placed next to skin.

9. A pelvic binder should be applied prior to extrication.

http://emj.bmj.com/content/30/12/1070.extract

Copies of this statement can be downloaded freely here:

http://www.fphc.co.uk/content/Portals/0/Documents/2013-12%20Pelvic%20Consensus%20COMPLETE.pdf