Page 63 - Journal of Special Operations Medicine - Summer 2014

using straps, cordage, and a stick. It did not examine time all other splints. Participants had a very negative out-
to application or provider preferences. Its primary out- look on the RS. Participants rated the RS least of all four
comes included a measure of pounds of traction applied splints for ease of use and suitability for dismounted
as well as a simulated patient’s self-rating of “stability” carry. Its use is contraindicated with associated pelvic
and comfort after 30 minutes of continuous application. fracture, a limitation not found with the other three
Under these criteria, the authors of this study concluded splints but noted in up to 38% of civilian multisystems
there was no significant difference between any of these trauma patients. Further, 9.4% of casualties in the cur-
devices, including the improvised splint. 33 rent conflict who were wounded in the lower extremity
had an associated pelvic injury.
6
Study Findings
Of the splints tested, the RS is the heaviest and bulkiest de-
First, overall competence in traction splinting among vice. In addition, it is more than twice as costly as the next
enlisted field medical providers in this cohort was poor. most expensive splint. It should be noted the device is ad-
Although participants reported an average of six itera- vertised as a multipurpose splint for other lower extremity
tions of training with traction splints during their ca- injuries, but this function could be replicated with the dis-
reer, roughly one in five (20%) splint applications in this posable foam/aluminum “SAM”-type splints that are all
study failed to produce any traction or the participant but universal in field medical kits. The authors believe that
“gave up” and asked to terminate the application. It the RS has persisted for so long due to its length of service
was common for participants who failed to obtain trac- and due to the continuing use in civilian EMS systems of
tion with one device to fail to do so with multiple de- Hare-type splints. Due to the multitude of negative factors
vices. Subjective overall confidence was low, with many and poor performance in this study, the authors recom-
participants reporting little or no experience with trac- mend the RS be removed from military service.
tion splinting in training, and only one in six (16.7%)
had used a traction splint on a patient. This was most Of the remaining three splints, the STS had the fastest
pronounced with the most junior Air Force participants average application time, both overall and with all splint
fresh from initial training. Many reported they had no failures removed. Testing showed no significant differ-
hands-on time with traction splinting and may have ence between the quantities of traction applied between
only seen them demonstrated once. splints, with all splints applying adequate traction. The
STS was ranked highest in all four categories of par-
Because the civilian National Registry of Emergency ticipant confidence and preference evaluated in the post-
Medical Technicians exam does not currently include testing survey. It had the greatest participant confidence
traction splinting, it is often not taught at initial train- in their ability to apply the splint and that it would ef-
ing nor is it included in sustainment training conducted fectively treat femoral fracture. It was ranked as the best
at the assigned unit. As with many other procedures, design for dismounted carry and had the highest rating
such as cricothyrotomy and tourniquets, the priority for being the most appropriate splint for battlefield use.
is different on the battlefield than in the civilian sector.
The needs of civilian certification and testing should not It is interesting to note that these beliefs changed from
be the primary influence on the training provided to the initial survey where the most common selection for
those who will care for wounded in combat. While field free-response in these categories was the CT-6. The CT-6
medical providers must maintain many skills, traction objectively performed and was subjectively rated as the
splinting should be an expected competency for initial next highest performing splint. In addition, the CT-6
and refresher training. There should be no difference has the lowest price of all splints tested. The STS is able
within the Armed Forces in the training of enlisted field to be used with a concomitant pelvic fracture, similar
medical personnel, when all except Coast Guardsmen to KTD and CT-6. However, it stood alone among the
are trained at the joint Medical Education and Training four splints with the ability to apply the “ankle hitch”
Campus at Fort Sam Houston, Texas. high on the calf in the event of an amputation or other
foot/ankle/calf injury that would preclude the use of the
The REEL Splint is, by doctrine at least, the most widely others. This situation is not unusual with dismounted
used traction splint within the Armed Services, autho- complex blast trauma that has typified the modern bat-
rized for use by the Army, Navy, Air Force, and Coast tlefield. In the authors’ opinion, the STS’s construction
Guard. The RS had replaced the previous canvas-cased of multiple aluminum poles within each other, coupled
Thomas splint kits—“Splint Set, Telescopic Splints”— with the mid-leg strap securing both lower extremities to
ubiquitous on field litter ambulances and similar even each other, provides a degree of stability not seen with
into the 1990s. The RS was the most common device the CT-6 and KTD. Additionally, it is the only splint that
with which participants had training experience. De- does not extend past the end of the leg, allowing easier
spite this, it had the second-highest failure rate and a carriage in Stokes or SKED litters commonly used in cur-
significantly longer time to successful application than rent conflicts. With its superior objective performance in

Evaluation of Traction Splints for Battlefield Use 53