Page 56 - Journal of Special Operations Medicine - Summer 2014

Evaluation of Commercially Available
Traction Splints for Battlefield Use

Nicholas M. Studer, MD, EMT-P; Seth M. Grubb, BS;
Gregory T. Horn, MD; Paul D. Danielson, MD, FACS, FAAP

ABSTRACT
Background: Femoral fracture is a common battlefield the wounded are stabilized, evacuated, and treated, es-
injury with grave complications if not properly treated. pecially in the recent conflicts in Southwest Asia. How-
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Traction splinting has been proved to decrease morbid- ever, the recommendation to initially treat traumatic
ity and mortality in battlefield femur fractures. However, femoral fractures with splinting has not changed signifi-
little standardization of equipment and training exists cantly since this time. Before the modern reintroduction
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within the United States Armed Forces. Currently, four of tourniquets, traction splinting held the honor of be-
traction splints that have been awarded NATO Stock ing the only prehospital intervention shown to improve
Numbers are in use: the CT-6 Leg Splint, the Kendrick survival for limb-injured combat casualties. 3
Traction Device (KTD), the REEL Splint (RS), and the
Slishman Traction Splint (STS). Objective: The purpose A review of the Joint Theater Trauma Registry indicated
of this study was to determine the differences between that approximately 2% of those wounded in combat in
the four commercially available traction devices sold to Iraq and Afghanistan from October 2001 through Janu-
the U.S. Government. Methods: After standardized in- ary 2005 sustained a femoral fracture. Eighty-six per-
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struction, subjects were timed and evaluated in the ap- cent of these fractures were open with accompanying
plication of each of the four listed splints. Participant soft tissue injury. A single closed femoral fracture alone
confidence and preferences were assessed by using Lik- can lead to 1000 to 2000mL of internal blood loss. An
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ert-scaled surveys. Free response remarks were collected open fracture may be less amenable to hemorrhage con-
before and after timed application. Results: Subjects had trol with a tourniquet due to multiple wound fragments
significantly different application times on the four de- and impaired ability to compress vessels. The substantial
vices tested (analysis of variance [ANOVA], p < .01). blood loss frequently associated with femoral fractures
Application time for the STS was faster than that for might require transfusion before entry into the medical
both the CT-6 (t-test, p < .0028) and the RS (p < .0001). evacuation system. Those casualties presenting with
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Subjects also rated the STS highest in all post-testing extremity wounds are more likely to be injured by gun-
subjective survey categories and reported significantly shot (20.5% versus 11.5%) and to have a higher Injury
higher confidence that the STS would best treat a femo- Severity Score (21.4% versus 11.9%) than those injured
ral fracture (p < .00229). Conclusions: The STS had the elsewhere in the body. Non–battle-related injuries such
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best objective performance during testing and the high- as motor vehicle accidents and falls may also result in
est subjective evaluation by participants. Along with its femoral fractures. Traction splinting of a femoral frac-
ability to be used in the setting of associated lower ex- ture is recommended to help reduce pain, hemorrhage,
tremity amputation or trauma, this splint is the most and the risk of fat emboli syndrome while also prevent-
suitable for battlefield use of the three devices tested. ing further soft tissue injury during transport. 7

Keywords: combat medic, medical training, traction splint- The Committee on TCCC (CoTCCC) has identified trac-
ing, Tactical Combat Casualty Care, femoral fracture tion splinting as an appropriate skill for Combat Lifesav-
ers and more advanced providers. Little standardization
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of equipment and training exists for traction splinting in
the U.S. Armed Forces. Four traction splints are in use
Introduction
to some degree and have been awarded NATO Stock
Battlefield medicine has changed markedly since the Numbers: the CT-6 Leg Splint (FareTec, Painesville, OH;
American Expeditionary Force deployed to France in http://www.faretec.com/CT-EMS-traction-splint.html),
June 1917 as part of World War I. Tactical Combat Ca- a component of Army Medical Equipment Set (MES)–
sualty Care (TCCC) doctrine has revolutionized how Combat Medic; the Kendrick Traction Device (KTD,

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