Page 162 - Journal of Special Operations Medicine - Spring 2017

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fractures recommended early and liberal application Figure 1 PelvicBinder .
of pelvic binders in high energy blunt trauma. In the
presence of high-energy blunt trauma, the FPHC rec-
ommended that a pelvic binder should be used if any
one of four risk factors is present: (1) heart rate > 100,
(2) systolic blood pressure < 90mmHg, (3) GCS score
≤ 13, or (4) distracting injury and/or pain on pelvic
examination. 27

The Royal London Hospital subsequently reported in a
retrospective review that had they used the FPHC crite-
ria, six of eight missed pelvic fractures would have met
criteria for a pelvic binder. 59

Physical examination findings associated with pelvic
fracture may include a hematoma above the inguinal
ligament, on the proximal thigh, or over the perineum, Photograph by Lt Col James Wiedenhoefer.
or ecchymosis of the flank. Additional findings include
pelvic pain or instability, neurologic deficits of the lower
extremities, blood at the urethral meatus, rectum, or
vagina, massive hematuria, high-riding prostate, and
unequal leg length. 4,20,21 Pelvic “springing” as a patient Figure 2 SAM Pelvic Sling .
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assessment technique is a poor predictor of the presence
or absence of pelvic fracture and may dislodge adherent
clot and further exacerbate hemorrhage, and it is painful
to a conscious patient. Physical examination findings
60
are not sensitive for identification of pelvic fracture. 20

Conclusion: after consideration by the committee, the
indications selected for pelvic binder placement include
suspected pelvic fracture based on a mechanism of se-
vere blunt force or blast injury with one or more of the
following indications: Photograph by Lt Col James Wiedenhoefer.

• Pelvic pain
• Any major lower limb amputation or near amputation
• Physical examination findings suggestive of a pelvic
fracture
• Unconsciousness
• Shock (NSN 6515-01-526-2788) is a one-size-fits-all, cut-to-
Level of evidence: C fit product, with a mechanical advantage pulley lacing
system (Figure 3). 32

What Is the Best Type of Pelvic Binder?
Two CoTCCC approved junctional tourniquets (the
There are three commercial devices that have been SAM Junctional Tourniquet and the Junctional Emer-
evaluated in clinical and cadaveric studies. The Pelvic gency Treatment Tool) can also be used to provide cir-
Binder (NSN 6515-01-618-9137) is a one-size-fits-all, cumferential pelvic compression. When used for this
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cut-to-fit product with a Velcro fastener and shoelace purpose, the inguinal compression devices need not be
cinching mechanism (Figure 1). The SAM Pelvic Sling deployed.
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(NSN 6515-01-509-6866) is made in three standard
sizes and contains an “autostop” buckle that limits the Sheet wrapping techniques vary slightly in various stud-
amount of compression applied; the device is narrower, ies and likely in clinical use. In general, this technique
leaving more space to access the abdomen or femoral involves wrapping a folded sheet around the pelvis and
vessels (Figure 2). The belt mechanism is identical to securing the sheet with zip ties or clamps. 33,42 Other im-
the belt portion of the SAM junctional tourniquet. The provised pelvic splints have also been described but have
medium-size SAM sling fits 96% of adults. The T-POD not been studied.
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138 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017