Splints? Pain Killers?

Lumberjack

Adventurer
Hope this is the right spot for this...

Last May while jeeping in Moab I slipped on some gravel and broke my leg about a third of the way up the Moab Rim trail. At first we had no cell service and started to prepare to get me off the trail. We placed a SAM spint and started to rearrange the jeep to get me in. 911 then returned our original call (I have heard they can clear the tower so 911 calls take precedence?) Anyhow, they sent help and also said not to use the SAM splint. Does anybody know why they wouldn't want us to use the splint? Also during my recovery I came across this http://www.1staidsupplies.com/store.php?crn=107&rn=613&action=show_detail and was thinking about adding it to my first-aid kit. Does anybody have any experience with this kit? Price almost seems a little too reasonable. Before this trip I even checked to make sure I had the SAM splint with me because the previous year I helped a motorcycle rider bandage his fingers when he took a tumble just in front of me:roost: OUCH! Never thought I would need it for me!

While sitting there waiting for help, I began to think about past trips, mainly the Hole in Rock trip a few years ago, and a story Bill Burke told about a customer backing over his leg. I thought about what I would do if this happened there... instead of spitting distance from the Moab ER. I was thinking how remote that trail is, and how far it is to pavement, and no pain management other than ibuprofin. I can't imagine riding out of there without some form of pain "killer". I was so happy when they gave some morphine before they loaded me into that gurney with a wheelbarrow wheel under it and rolled me off the trail, I didn't feel a thing... although I did ask for a second dose when I saw that wheel and thought about that first turn on the Moab Rim Trail... didn't want to feel a thing if they dropped me off that 60' dropoff:smileeek: So, what are the options for pain management in the backcountry... other than :beer: ?

Dennis
 

4Rescue

Expedition Leader
Absolutely NO idea why they would advise that. In an emergency ANYthing can be used to immobilize a limb. That's just bad advice on their part.

A big part of wilderness medecine is "use what you've got" and frankly if you've got something designed to immobilize a limb, USE IT.

It's very similar to the use of the KED... they're the BEST spinal immobilization device (or C-spine)there is and they solve so many problems, yet they're never used because of a negative image and because apparently speed is the most imortant thing to alot of EMS people...

Use the Sam Splint if you need it, that's my professional opinion.

T he Air splints are also great because those type I'm guessing pack down to nothing but can imobilize limbs fairly well. We use things in the field that are similar but completely different :) hahahahaha basicly it's a big pouch with a ton of little pellets in them and after placing the limb in them you wrap and take the air out of the device making sort of a mold around the limb. Honestly one of the best knees imobilizers out in teh middle of nowhere is a good old sleeping pad. and you didn't even have to pack a special tool. I can and have riggedd make shift traction splints for a broken femur with a tent pole some cord and a roll of duct tape.

As for the use of pain killers: that's a fine balancing act between pain management and being able to get good clear vitals and info from teh PT. Give too much and you have no way to ascess the level of conciousness of the PT. did they fall and maybe have a slow head bleed that's effecting speach and thought process? Give too much of the heavy stuff and you'd never know. Now I know they don't have the "kick" of the Narco-PK's, honestly, Ibuprofen is a miracle drug. Now if it's an overnighter and you feel the PT. is stable and just needs to rest, then I personaly might turn up the pain management.

It also depends on the case. A clear broken bone w/displacement might need more pain mgt. with less concern of LOC changes while a fall or head injury would warrant keeping the pt. as sober and clear thinking as possible. Aso, sometimes in the bush the pt. has to aid in his/her own rescue/extractio0n and too many meds can make that all but impossible and certainly not feasable.

Short answer: it depends ;)

To give you an example, after partialy dislocating my shoulder rafting the Cal Salmon this year, I kept myself off the heavy stuff untill I was damn sure nothing was broken and that I hadn't injured myself in some other way as well. This was 12 hours later after packing up the boats etc. and getting back to camp. I had some strong stuff with me in my small river kit, but I kept away form the stuf for 12 hours and even tehn it was only to sleep really and for nagging pain that makes sleeping on a cot kinda tough. I wanted to be sure if anything reaered it's ugly head I was aware of it and could ascess myself acurately.

Cheers

DAve
 
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travel dodge

Adventurer
yea I agree, check CMS (pulse cap refill movement) and splint.. pain meds all depend on the situation... it's nice to have a pulse ox and some O2 if you get into the big drugs
 

travel dodge

Adventurer
yea I agree, check CMS (pulse cap refill movement) and splint (sam's are great).. pain meds all depend on the situation... it's nice to have a pulse ox and some O2 if you get into the big drugs
 

4Rescue

Expedition Leader
travel dodge said:
yea I agree, check CMS (pulse cap refill movement) and splint (sam's are great).. pain meds all depend on the situation... it's nice to have a pulse ox and some O2 if you get into the big drugs
Agreed, but honestly carrying a pulse OX is a bit of a pain on raftring trips (but maybe I will with my soon to arive Pelican EMS case YEEHAW!!!!!!!!!!. Course if I have the truck then I've got Oxygen a BVM a pulse ox and a few other goodies ;) Another good thing to have that often get's overlooked is a simple Oral pharengeal Airway and a nasal pahrengeal airway (NOSE TRUMPET). if the pt. is simply not maintianing his airway. ver well and you're concerned about it. pot in teh airway and you have the peace of mind that they're not going to choke on their tounge. They're also good for anaphalactic issue where there might be swelling of the tounge adn face leading to a comprimised airway. Remember, this is wilderness medecine and really you're trying to knock down teh big stuff that's gonna kill a PT. Airway, Breathing, circulation...ABC's a broken limb is usualy not a life threatening injury and some pain might have to be dealt with because hey you're out in teh boonies and you're doing what you can eh. I'd highly suggest taking a Wilderness First responder course if you're in teh back country often and Buck Tiltons wilderness medecine book is a great resource to have. Sorry for teh long winded responcees, but this is my passion, I work in EMS and at a local ER as well as being a Wilderness EMT and "that guy" in my group of friends.

Cheers

Dave
 
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kellymoe

Expedition Leader
At work we started using a type of air splint that works great. It's kind of like a air splint filled with tiny Styrofoam balls. You use a pump to suck the air out of the bag which causes it to wraps around the fx extremity. They are lightweight but take up more room than a regular air splint. I dont see the reason they would tell you not to use the SAM. They may have been telling you to just not splint it at all out of concern that if you readjust the fx you may pinch or sever a artery or vessel.

Pain management for isolated extremity fx's I believe is indicated. If there is the possibility of head trauma then holding off on morphine, hydrocodone and other opiates may be contraindicated. I carry hydrocodone in my kit. At work we have been more aggressive in pain management of trauma patients and heart patients. Reduces the level of pain and reduces the level of distress which is especially helpful in potential heart patients.
 
The air splint you pointed out would be great to have. The vacuum splint like 4Rescue was describing is a superior splint, but it is very bulky and quite expensive. One of the good things about the air splint is it is can also be used for treating a patient in shock. And I don't want to question the logic of the EMS personnel who told you not to use the SAM, but I would've done the same thing in your situation.
 

Lumberjack

Adventurer
Purple People Eater said:
The air splint you pointed out would be great to have. The vacuum splint like 4Rescue was describing is a superior splint, but it is very bulky and quite expensive. One of the good things about the air splint is it is can also be used for treating a patient in shock. And I don't want to question the logic of the EMS personnel who told you not to use the SAM, but I would've done the same thing in your situation.

Not sure what thier reason was behind not using the SAM splint, we were going to use it anyhow if we had to. The EMS crew used the air splint descibed above, felt really nice, comfortable. I guess my concern for the one I linked is the price, seems a little to good to be true. I like the fact that it packs small and if it would work properly it would be worth it to me for my piece of mind.
 

Lumberjack

Adventurer
As far as pain meds go, when I slipped I saw exactly what happened. I knew I had no other injuries. If this had happened earlier in the day at the end of Amasa Back (Cliffhanger), I would have given anything to have something stronger than Ibuprofin with me, that would have been a long ride out.
I was very glad to see the EMS crew, and the morphine was great :ylsmoke: I was not looking forward to ride down the hill, I knew it was going to hurt.

I realize that every situation is different, when I broke the same leg 20 years ago, that was a compound fracture... big difference from this one and pain meds would have been a different story.

We are moving out west next spring and I hope to take a wildernest first aid class, something that isn't offered back here. I carry a nice first aid kit, but need to take a refresher in first aid, it has been way to long. The kit isn't much good if you don't know how to use it.
 

762X39

Explorer
Personally, for pain meds, I carry T3's. I get a fresh script every year and they are for my use only if TSHTF and there are no contraindications. I often travel alone (don't lecture me on this) and I feel it is prudent for me to not only be responsible for myself but to be able to help myself as required.I update my 1st responder every 3 years as required and will be upgrading to WFR this winter.
 
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roberto

Adventurer
Nonin Pulse Ox is awesome and very small and comes with a little pelican case, at least the ones we get in the military do? SAM splints are great as well and fold up in just about any config you need it to in storing.

R
 

jh504

Explorer
I am interested in why they would advise you not to use the SAM splint. Does anyone know if there are procedures in place in that area that 911 dispatchers are told to discourage pt care from someone who is not a professional? Thats the only thing I can think of.
It does irritate me when I hear about stories of 911 dispatchers saying or doing something stupid simply because they do not know or do not care. It happens quite often around our country and every now and then you hear of someone dying because of a careless 911 dispatcher (not passing judgement in this case but I would like to hear an explanation).
In some cases a broken bone in your leg, if moved improperly, could damage an artery. A guy here in NC broke his femur a while back and was taken to the emergency room. One of the doctors advised his aids to remove the traction splint because it was not needed anymore. After removing it the man was taken to Xray where he bled out and died because the bone punctured the artery. I would always encourage properly splinting a fracture, especially in the backcountry.
 

kellymoe

Expedition Leader
I dont think it has to do with using the SAM splint specifically but rather any splint. I know the dispatchers for our department tell callers not to try and splint extremities because it could cause more harm than good, such as severing a vessel artery or nerve. Of course where I work, Los Angeles it is only a matter of minutes before we are on scene. If you have first aid training and are comfortable with your skill then I would say ignore the advice and go ahead and splint, reduce or tourniquet or whatever the treatment may be. I feel very secure in my skills but I couldn't imagine someone with just a first aid class but no experience being comfortable reducing a fx or even splinting in some cases.
 

jh504

Explorer
kellymoe said:
I dont think it has to do with using the SAM splint specifically but rather any splint. I know the dispatchers for our department tell callers not to try and splint extremities because it could cause more harm than good, such as severing a vessel artery or nerve. Of course where I work, Los Angeles it is only a matter of minutes before we are on scene. If you have first aid training and are comfortable with your skill then I would say ignore the advice and go ahead and splint, reduce or tourniquet or whatever the treatment may be. I feel very secure in my skills but I couldn't imagine someone with just a first aid class but no experience being comfortable reducing a fx or even splinting in some cases.

I was kind of thinking that might be their procedure. If the person isnt properly trained then maybe their policy is to advice against it. There is definitely a right and wrong way of splinting, and if it isnt done right it can cause serious problems. Obstructing circulation, and as you pointed out, damage to the tissue by bone fragments or sharp edges.
It will be different per situation. If a person can stay immobile and wait for medical assistance I would say dont worry about splinting unless you are confident in what you know. However if you are in a situation where you need to move or get out of a place I would say it is better to splint. This is also a very good reason why EVERYONE should go through some type of medical training should you be spending time in the outdoors.

EDIT: Also, here our urban dispatchers would advice not to splint as well, I am interested in whether our not they differentiate between backcountry injuries and urban?
 
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Speaker

Adventurer
4Rescue said:
Agreed, but honestly carrying a pulse OX is a bit of a pain on raftring trips

Come on now, I can carry more stuff on my 14ft raft than I can in my Trooper. Besides, the small ones (Healthdyne) are smaller than my palm.

Also, not so sure about the KED without a backboard. Pendulum legs, no good.
 

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