How to Apply a Splint: A Step-by-Step Guide for First Responders and Caregivers
Splinting is a crucial skill for anyone who might encounter a bone fracture, sprain, or dislocation. Whether you’re a first responder, a caregiver, an athlete, or simply someone who wants to be prepared, knowing how to properly apply a splint can significantly reduce pain, prevent further injury, and facilitate healing. This comprehensive guide provides a step-by-step approach to splinting, covering various types of splints, assessment techniques, and essential considerations. Remember, this guide is for informational purposes only and does not replace professional medical training. Always seek immediate medical attention for serious injuries.
## Understanding Splints and Their Purpose
A splint is a rigid or semi-rigid support used to immobilize an injured bone or joint. Its primary purposes include:
* **Reducing Pain:** Immobilization minimizes movement, which in turn reduces pain signals sent to the brain.
* **Preventing Further Injury:** By restricting movement, a splint protects the injured area from further damage, such as displacement of bone fragments or aggravation of soft tissue injuries.
* **Supporting Healing:** Immobilization allows the body to begin the healing process without being constantly disrupted by movement.
* **Reducing Swelling:** Compression provided by some splints can help reduce swelling in the injured area.
* **Preventing Conversion of Closed Fracture to Open Fracture:** In cases of closed fractures (where the bone doesn’t break through the skin), a splint can prevent the sharp ends of the bone from further damaging surrounding tissues and potentially breaking the skin, turning it into an open fracture, which is more prone to infection.
## Types of Splints
Several types of splints are available, each suited for different injuries and situations. Common types include:
* **Rigid Splints:** These splints, often made of metal, plastic, or plaster, provide maximum immobilization. They are ideal for suspected fractures and dislocations. Examples include pre-formed aluminum splints (SAM splints), plaster splints, and fiberglass splints.
* **Soft Splints:** These splints, such as pillows, blankets, or triangular bandages, offer less rigid support but are useful for immobilizing injuries in awkward positions or when rigid splints are unavailable. They are often used as temporary measures.
* **Traction Splints:** Primarily used for femur fractures, traction splints apply gentle tension to the injured leg to reduce pain and muscle spasm, realign the bone, and prevent further damage to blood vessels and nerves. These require specialized training.
* **Vacuum Splints:** These splints consist of a malleable bag filled with polystyrene beads. Air is evacuated from the bag using a pump, causing the splint to become rigid and conform to the shape of the injured limb. They provide excellent support and are often used by emergency medical services.
* **SAM Splints (Structural Aluminum Malleable):** These are lightweight, reusable, waterproof splints made of a thin core of soft aluminum alloy sandwiched between two layers of closed-cell foam. They can be molded into various shapes to fit different injuries.
* **Air Splints:** Inflatable splints provide uniform compression and immobilization. They are transparent, allowing for visual monitoring of the injury site. However, they can be affected by changes in altitude or temperature, which can alter the pressure inside the splint.
## Assessment Before Splinting: The Critical First Steps
Before applying any splint, a thorough assessment is essential. This helps determine the nature and extent of the injury and guides the selection and application of the appropriate splint. Follow these steps:
1. **Scene Safety:** Ensure the environment is safe for you and the injured person. Remove any hazards that could cause further injury.
2. **Primary Survey (ABC):** Assess the injured person’s airway, breathing, and circulation. Address any life-threatening conditions immediately before focusing on the extremity injury.
3. **History:** If the person is conscious, ask about the mechanism of injury, the location and nature of the pain, any pre-existing conditions, and any allergies. If the person is unconscious, try to gather information from bystanders.
4. **Visual Inspection:** Carefully examine the injured area for:
* **Deformity:** Compare the injured limb to the uninjured limb. Look for any unusual angles, shortening, or rotation.
* **Swelling:** Note the location and extent of any swelling.
* **Bruising:** Observe for any discoloration, which may indicate bleeding under the skin.
* **Open Wounds:** Look for any breaks in the skin. Cover any open wounds with a sterile dressing before applying a splint.
* **Protruding Bone:** If a bone is protruding through the skin, do not attempt to push it back in. Cover the wound with a sterile dressing and stabilize the limb.
5. **Palpation:** Gently feel the injured area for:
* **Tenderness:** Identify the specific locations that are painful to the touch.
* **Crepitus:** Listen and feel for a grating sensation or sound, which may indicate a bone fracture.
* **Warmth:** Increased warmth may indicate inflammation or infection.
6. **Pulse, Motor, Sensory (PMS) Assessment:** This is a crucial step to assess nerve and blood vessel function distal to the injury. Perform this assessment *before* and *after* splinting. This is sometimes also referred to as CMS (Circulation, Motor, Sensory) assessment.
* **Pulse:** Check for a pulse distal to the injury (e.g., radial pulse for a forearm injury, dorsalis pedis or posterior tibial pulse for a lower leg injury). A weak or absent pulse may indicate a vascular injury.
* **Motor:** Ask the person to move their fingers or toes (depending on the injury location). Assess their ability to move each digit individually. Note any weakness or inability to move.
* **Sensory:** Ask the person if they can feel light touch on their fingers or toes. Test sensation on both sides of the digit and compare to the uninjured limb. Note any numbness, tingling, or loss of sensation.
**Important Considerations for PMS Assessment:**
* If you cannot feel a pulse, and the limb is pale, cold, and numb, suspect a serious vascular injury and seek immediate medical attention.
* If the person has significant numbness or weakness, suspect a nerve injury and seek immediate medical attention.
* Document your findings clearly before and after splinting.
## General Principles of Splinting
Before delving into specific splinting techniques, it’s essential to understand the general principles that apply to all types of splints:
* **Immobilize the Joint Above and Below the Injury:** The splint should extend beyond the joints immediately above and below the fracture or sprain. This ensures adequate immobilization and prevents movement at the injury site. For example, if the injury is to the radius or ulna, the splint should immobilize the wrist and elbow.
* **Pad the Splint:** Use padding (e.g., cotton padding, gauze, or foam) to protect the skin from pressure points and prevent skin breakdown. Pay particular attention to bony prominences, such as the wrist, elbow, ankle, and knee.
* **Apply the Splint Snugly but Not Too Tightly:** The splint should be snug enough to provide support and immobilization but not so tight that it restricts circulation. You should be able to insert one or two fingers between the splint and the skin.
* **Maintain Proper Alignment:** When possible, splint the injured limb in the position found, unless there is significant deformity or vascular compromise. If necessary to realign, do so gently and stop if you encounter resistance or increased pain.
* **Elevate the Injured Limb:** Elevation helps reduce swelling and pain. Elevate the limb above the heart whenever possible.
* **Reassess PMS:** After applying the splint, recheck the pulse, motor function, and sensation distal to the injury. If there is any decrease in pulse, motor function, or sensation, loosen the splint immediately and reassess. If the problem persists, seek immediate medical attention.
* **Document:** Record the date, time, type of splint applied, location of the injury, the person’s complaints, and the results of your pre- and post-splinting assessments (PMS or CMS). This information is crucial for healthcare providers who will be taking over care of the injured person.
## Step-by-Step Guide to Applying Different Types of Splints
The following sections provide detailed instructions for applying some of the most common types of splints.
### Applying a Rigid Splint (e.g., SAM Splint, Pre-Formed Aluminum Splint)
This technique is suitable for suspected fractures or dislocations of the extremities.
**Materials Needed:**
* Rigid splint (e.g., SAM splint, pre-formed aluminum splint, plaster splint)
* Padding (e.g., cotton padding, gauze, foam)
* Adhesive tape, elastic bandage, or roller gauze
* Scissors
* Gloves
* Sterile dressing (if open wound present)
**Steps:**
1. **Prepare the Injured Area:**
* Don gloves.
* Expose the injured area by removing clothing or jewelry.
* Cover any open wounds with a sterile dressing.
2. **Apply Padding:**
* Apply padding generously around the injured area, paying particular attention to bony prominences.
* Ensure the padding extends beyond the intended length of the splint.
3. **Shape the Splint (If Necessary):**
* For SAM splints, mold the splint into the desired shape to provide support and immobilization. Common shapes include a C-curve, a T-shape, or a trough.
* For pre-formed splints, select the appropriate size and shape for the injured limb.
4. **Position the Splint:**
* Carefully position the splint along the injured limb, ensuring it extends beyond the joints above and below the injury.
* Maintain proper alignment of the limb.
5. **Secure the Splint:**
* Use adhesive tape, elastic bandage, or roller gauze to secure the splint in place.
* Start wrapping distally (away from the body) and work proximally (toward the body).
* Apply the bandage snugly but not too tightly. Ensure you can still insert one or two fingers between the bandage and the skin.
* Avoid wrapping the bandage too tightly, as this can restrict circulation.
6. **Reassess PMS:**
* Recheck the pulse, motor function, and sensation distal to the injury.
* If there is any decrease in pulse, motor function, or sensation, loosen the splint immediately and reassess.
* If the problem persists, seek immediate medical attention.
7. **Elevate and Stabilize:**
* Elevate the injured limb above the heart whenever possible.
* Provide additional support and stabilization as needed.
### Applying a Soft Splint (e.g., Pillow Splint, Blanket Splint)
This technique is useful for immobilizing injuries in awkward positions or when rigid splints are unavailable. It is often used as a temporary measure until more definitive care can be provided.
**Materials Needed:**
* Soft padding (e.g., pillow, blanket, towels)
* Adhesive tape, elastic bandage, or roller gauze
* Safety pins (optional)
* Gloves
* Sterile dressing (if open wound present)
**Steps:**
1. **Prepare the Injured Area:**
* Don gloves.
* Expose the injured area by removing clothing or jewelry.
* Cover any open wounds with a sterile dressing.
2. **Position the Soft Padding:**
* Carefully position the soft padding around the injured limb, ensuring it provides adequate support and immobilization.
* Shape the padding to conform to the contours of the limb.
* Ensure the padding extends beyond the joints above and below the injury.
3. **Secure the Padding:**
* Use adhesive tape, elastic bandage, or roller gauze to secure the padding in place.
* Start wrapping distally (away from the body) and work proximally (toward the body).
* Apply the bandage snugly but not too tightly. Ensure you can still insert one or two fingers between the bandage and the skin.
* Avoid wrapping the bandage too tightly, as this can restrict circulation.
* Safety pins can be used to secure the edges of the padding, if needed.
4. **Reassess PMS:**
* Recheck the pulse, motor function, and sensation distal to the injury.
* If there is any decrease in pulse, motor function, or sensation, loosen the splint immediately and reassess.
* If the problem persists, seek immediate medical attention.
5. **Elevate and Stabilize:**
* Elevate the injured limb above the heart whenever possible.
* Provide additional support and stabilization as needed.
### Applying a Sling and Swathe (Shoulder and Upper Arm Injuries)
A sling and swathe is a common method for immobilizing shoulder, clavicle, and upper arm injuries. The sling supports the weight of the arm, while the swathe secures the arm to the body, preventing movement.
**Materials Needed:**
* Triangular bandage (for the sling)
* Wide bandage or cloth (for the swathe)
* Padding (optional, for comfort)
* Gloves
**Steps:**
1. **Prepare the Injured Area:**
* Don gloves.
* Assess the injury as described above.
* Remove any jewelry or restrictive clothing from the injured area.
* If there is an open wound, cover it with a sterile dressing.
2. **Apply the Sling:**
* Position the triangular bandage with one point at the elbow of the injured arm and the base extending towards the uninjured shoulder.
* Bring the other end of the bandage up and over the uninjured shoulder.
* Adjust the bandage so the hand is slightly elevated. The elbow should be flexed at about 90 degrees.
* Tie the two ends of the bandage together behind the neck. The knot should be off to the side of the neck to avoid pressure on the spine.
* Ensure the sling is snug enough to support the arm but not so tight that it restricts circulation.
3. **Apply the Swathe:**
* The swathe is used to further immobilize the arm against the body.
* Take a wide bandage or cloth and wrap it around the injured arm and the torso.
* The swathe should be positioned high enough to support the upper arm and shoulder but low enough not to interfere with breathing.
* Secure the swathe tightly enough to prevent movement of the arm away from the body, but not so tight that it restricts breathing or circulation.
* Tie the ends of the swathe together on the uninjured side.
4. **Reassess PMS:**
* Recheck the pulse, motor function, and sensation distal to the injury (in the hand and fingers).
* If there is any decrease in pulse, motor function, or sensation, loosen the sling and swathe immediately and reassess.
* If the problem persists, seek immediate medical attention.
5. **Provide Support and Immobilization:**
* Ensure the arm is well supported and immobilized.
* Instruct the injured person to keep the arm still and avoid any unnecessary movement.
* Transport the injured person to a medical facility for further evaluation and treatment.
### Traction Splints
This type of splint is specialized for femur fractures and *requires specific training to use safely and effectively*. Applying traction to a fractured femur helps reduce pain and muscle spasms, realign the bone, and prevent further damage to blood vessels and nerves.
**Important Note**: *Traction splints are only for mid-shaft femur fractures. Do not use them for fractures near the knee or hip.*
**Materials**:
* Traction splint (e.g., Hare traction splint, Sager traction splint)
* Ankle hitch
* Straps to secure the leg to the splint
* Padding
* Gloves
**Steps**:
1. **Manual Traction**: Before applying the splint, manually stabilize and apply inline traction to the injured leg to relieve pain and restore alignment. Someone should maintain manual traction while the splint is being applied.
2. **Apply Ankle Hitch**: Place the ankle hitch around the ankle and foot of the injured leg. Ensure it is snug but not too tight.
3. **Adjust Splint Length**: Adjust the length of the traction splint to extend approximately 12 inches (30cm) beyond the injured foot.
4. **Position Splint**: Place the ischial pad (the padded part that sits against the groin) firmly against the ischial tuberosity (the bony prominence of the pelvis). Ensure proper placement for comfort and effective traction.
5. **Apply Traction**: Gradually increase traction using the traction device on the splint until pain is relieved, or muscle spasms subside. A general guideline is to apply traction equal to approximately 10% of the patient’s body weight, not to exceed 15 lbs.
6. **Secure Leg**: Secure the leg to the splint using the provided straps. Start with the strap closest to the groin and work distally, ensuring each strap is snug but not constricting circulation.
7. **Reassess PMS**: Check the pulse, motor function, and sensation in the foot *after* applying traction and securing the leg. Compare it with the uninjured leg.
8. **Secure Splint**: Ensure the splint is stable and won’t move during transport.
9. **Transport**: Carefully transport the patient to a medical facility while maintaining traction.
**Important Considerations**:
* *Continuous Monitoring*: Continuously monitor the patient’s condition, including pain level, distal pulse, motor function, and sensation.
* *Contraindications*: Do not use traction splints if there is a fracture near the knee or hip, pelvic fracture, or suspected associated injuries that could be worsened by traction.
* *Professional Training*: Proper training is essential before using a traction splint.
## Troubleshooting Common Splinting Problems
Even with careful technique, problems can arise during splinting. Here are some common issues and how to address them:
* **Tight Splint:** If the person complains of increasing pain, numbness, tingling, or swelling distal to the splint, or if the pulse is weak or absent, the splint is likely too tight. Loosen the bandage or straps immediately and reassess PMS. If the symptoms do not improve, remove the splint and reapply it with less tension.
* **Loose Splint:** If the splint is not providing adequate support or is slipping, it is likely too loose. Tighten the bandage or straps. If necessary, add more padding or use a wider bandage.
* **Skin Irritation:** If the person complains of burning or itching under the splint, skin irritation may be present. Remove the splint and inspect the skin for redness, blisters, or abrasions. Apply a sterile dressing to any open areas and reapply the splint with additional padding to protect the irritated skin.
* **Inadequate Pain Relief:** If the person’s pain is not adequately controlled by the splint, consider administering pain medication (if appropriate and available) and elevating the injured limb. Ensure the splint is properly applied and providing adequate immobilization.
* **Difficulty Assessing PMS:** If you are unable to assess the pulse, motor function, or sensation due to swelling, pain, or other factors, try to palpate for a pulse in a different location, ask the person to move their digits in a different way, or test sensation in a less painful area. If you are still unable to assess PMS, document your attempts and seek immediate medical attention.
## When to Seek Immediate Medical Attention
While splinting can provide temporary support and pain relief, it is not a substitute for professional medical care. Seek immediate medical attention in the following situations:
* **Open Fracture:** If a bone is protruding through the skin.
* **Significant Deformity:** If the injured limb is severely deformed.
* **Vascular Compromise:** If there is no pulse distal to the injury, or if the limb is pale, cold, and numb.
* **Nerve Injury:** If there is significant numbness or weakness distal to the injury.
* **Severe Pain:** If the pain is unbearable or not controlled by pain medication.
* **Loss of Function:** If the person is unable to move their fingers or toes (depending on the injury location).
* **Suspected Dislocation:** If a joint is obviously dislocated.
* **Head Injury, Neck Injury, or Back Injury:** If the person has any signs or symptoms of a head injury, neck injury, or back injury, such as loss of consciousness, confusion, headache, neck pain, or back pain.
* **Multiple Injuries:** If the person has multiple injuries.
* **Underlying Medical Conditions:** If the person has any underlying medical conditions, such as diabetes, peripheral vascular disease, or bleeding disorders.
## Conclusion
Knowing how to apply a splint is a valuable skill that can make a significant difference in the outcome of an injury. By following the steps outlined in this guide and adhering to the general principles of splinting, you can provide effective support, reduce pain, and prevent further damage until professional medical care is available. Remember to always prioritize scene safety, perform a thorough assessment, and reassess the person’s condition frequently. This guide is intended for informational purposes only and should not be considered a substitute for professional medical training. It is highly recommended to take a first aid or emergency medical training course to learn these skills in a hands-on environment under the guidance of qualified instructors.
**Disclaimer:** *This information is intended for educational purposes only and does not constitute medical advice. Always seek the advice of a qualified healthcare professional for any medical questions or concerns.*