EMT Standing Order:

• Routine Patient Care.
• Manually stabilize the injury.
• For open fractures, control bleeding and treat for shock. See Tourniquet & Hemostatic Agent Procedure Adult & Pediatric-, Shock Protocol- Adult or Shock Protocol - Pediatric. Remove obvious debris, irrigate open wounds with saline solution, and cover with moist sterile dressing.
• For significantly angulated fractures, attempt to reposition to the anatomical position of function, so long as the fracture is not at/near a joint.
• Assess PMS distal to injury before and frequently after immobilization.
  • Splint extremity as required.
  • Traction splinting is the preferred technique for isolated adult and pediatric midshaft femur fractures.
  • Do not apply traction splints to proximal (hip) or distal femur fractures, partial amputations, or if lower leg or ankle injury.
  • Do not delay transport to apply a traction splint in the multi-trauma patient.
  • Traction splinting may be used for open fractures if no contraindications.
• All patients that have a mechanism of injury that could cause a spinal injury, including high risk or questionable injury mechanisms, should have an advanced spinal assessment and spinal motion restriction if indicated. See Spinal Motion Restriction Protocol and Advanced Spinal Assessment Procedure.
• Stabilize suspected pelvic fractures with the commercial device (preferred) or bed sheet.
  • It is preferable to use a scoop stretcher rather than to log-roll a patient with a suspected pelvic fracture.
    Amputations should be dressed with bulky dressings and assessed for uncontrolled bleeding. See Tourniquet & Hemostatic Agent - Adult & Pediatric.
• The amputated part should be placed in a plastic bag and transported on ice to hospital with patient.
• See Trauma Triage and Transport Decision Policy and Pain Management Protocol - Adult & Pediatric.
• Call for AEMT/Paramedic intercept. & Assisst AEMT/Parmedic in patient care

AEMT/PARAMEDIC Standing Order:

• Establish IV access.
• For significant injury, consider administration of 0.9% NaCl 500 mL bolus IV for adults; 20 mL/kg for pediatric.
• Assess pain level and consider pain control measures. See Pain Management Protocol - Adult or Pediatric.

PEARLS:

• Use ample padding when splinting possible fractures, dislocations, sprains, and strains. Remove and secure all jewellery. Elevate injured extremities, if possible.
• Consider the application of a cold pack for 30 minutes.
• Musculoskeletal injuries can occur from blunt and penetrating trauma. Fractures of the pelvis and femur, as well as fractures or dislocations involving circulatory or neurological deficits, take priority over other musculoskeletal injuries.
• Hip dislocations, pelvic, knee, and elbow fractures/dislocations have a high incidence of vascular compromise.
• Do not manipulate the pelvis once a fracture is suspected. Repeated manipulation can increase internal haemorrhage.