Page 164 - Journal of Special Operations Medicine - Spring 2017

Figure 5 SAM splint plus tourniquet. Figure 7 Cravats.

Photograph by Lt Col James Wiedenhoefer. Photograph by MSG Daniel Morissette

Figure 6 Trousers cut with windlass. Figure 8 Ankles secured.

Photograph by Lt Col James Wiedenhoefer.

Photograph by Lt Col James Wiedenhoefer. Techniques that include simply tying a cravat around

the pelvis or placing linked tourniquets around the pel-
vis may not achieve adequate tension or may not be
wide enough to achieve the expected result, and should
be discouraged.
( Figure 8). Securing the toes also prevents external rota-
tion of the lower extremities, further stabilizing fracture Improvised techniques, in order to be effective, must be
motion (Figure 9). thoroughly trained, practiced, and planned in advance.

Improvised pelvic splints have been described using a Conclusion: There is very weak evidence to suggest that
combination of SAM splint and CAT tourniquet. This a commercial device is more effective in controlling hem-
63
technique uses a familiar tourniquet in combination orrhage than an improvised sheet. Level of evidence: C.
with a SAM splint, and in the opinion of the authors ap- There is no evidence that any commercial compression
pears to achieve adequate tension comparable to a com- device is better than another. Level of evidence: B. Other
mercial device (see Figure 5). This technique, slightly improvised pelvic binders have not been studied.
modified, is also taught at the Special Operations Com-
bat Medic Skill Sustainment Course (SOCMSSC). Overall recommendation
There is consistent evidence in cadaver studies that
An additional improvised technique, also taught at unstable pelvic fractures are reduced and stabilized by
SOCMSSC, involves cutting the trouser legs, using the pelvic binder placement. There is clinical evidence sup-
cut ends to encircle the pelvis and a large stick or pole to porting pelvic binder placement to reduce hemorrhage,
tighten as a windlass (see Figure 6). although evidence of improved survival is overall weak

140 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017