Page 163 - Journal of Special Operations Medicine - Spring 2017

Figure 3 T-POD . Improvised Pelvic Binder Techniques
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It is likely that commercial pelvic binders will achieve
more consistent results with less training and should
therefore be encouraged to be packed and used when-
ever the environment and tactical situation allow.
Circumferential junctional tourniquets may be used as
equivalent to a commercial binder.

The constant need to reduce additional gear require-
ments has led us to also consider improvised pelvic com-
pression techniques as well.

When properly applied, it has been demonstrated that
circumferential sheets are as effective as commercial
binders to stabilize pelvic fractures; however, in actual
Photograph by Lt Col James Wiedenhoefer. among users. 42,44 in-
practice, it is likely that there is significant variability

The technique of placing the circumferential sheet as
described in studies evaluating this intervention
volves the combination of manually tightening the sheet
to reduce the pelvis and then securing the sheet with
clamps or zip ties, generally done with at least two med-
ical personnel. For a single rescuer, it is likely that ten-
Cadaver Studies sion would be lost with this improvised technique due
In cadaver studies, the Pelvic Binder , the SAM Pelvic to the need to maintain tension while at the same time
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Sling , the T-POD , circumferential sheets, and exter- securing the sheet (Figure 4).
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nal fixation have been compared in various combina-
tions. 32-34,61 All of the devices tested did not differ with Figure 4 Sheet/blanket.
regard to pelvic ring closure and motion of fracture
fragments.

Clinical Studies
In the previously described German Trauma Registry
study, the use of sheet wrapping was associated with a
significantly higher mortality (23% for sheet versus 4%
for binder versus 8% for C-clamp). The authors com-
mented that higher level and busier trauma centers may
have been more likely to use a specialized device rather
than a sheet, and that it may have been more likely for a
sheet to be applied improperly or removed prematurely Photograph by Lt Col James Wiedenhoefer.
to facilitate additional interventions. It is therefore not
clear from this study whether the use of the sheet is a
marker for less-experienced providers or whether the
sheet is less effective at controlling hemorrhage. 41
Other improvised pelvic compression techniques have
In an evaluation of application time, ease of use, and been described but have not been formally studied
user preference in a classroom setting comparing the (Figures 5–7). When considering the use of an impro-
T-POD and SAM Pelvic Sling, both were correctly ap- vised technique, it is important to ensure that the same
plied 100% of the time, the SAM was quicker to apply principles are rigidly applied in order to achieve simi-
(18 versus 31 seconds), and 78% of users preferred the lar results: the improvised pelvic binder must be cen-
T-POD. 62 tered at the level of the greater trochanters and pubic
symphysis, the device must be applied tightly enough to
A properly applied draw sheet, combined with binding reduce the fracture without overtightening, the device
the thighs and ankles loosely together effectively im- must be wide enough to distribute pressure evenly, and
proved hemodynamics in seven patients. 42 the thighs or ankles should be bound loosely together

Pelvic Binders TCCC Guidelines Change 139