Page 46 - JSOM Spring 2021

Commercial and Improvised Pelvic Compression Devices

Applied Force and Implications for Hemorrhage Control

Rachel Bailey ; Erica Simon, DO, MPH, MHA ; Aerial Kreiner, PhD *;
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Dana Powers ; Livia Baker ; Connor Giles ; Robert Sweet ; Stephen Rush, MD 8
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ABSTRACT
Uncontrolled hemorrhage secondary to unstable pelvic frac- identify on clinical examination. Current military Tactical
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tures is a preventable cause of prehospital death in the military Combat Casualty Care guidelines direct the application of a
and civilian sectors. Because the mortality rate associated with pelvic compression device to all patients who experience se-
unstable pelvic ring injuries exceeds 50%, the use of exter- vere blast or blunt traumatic injury and exhibit one or more
nal compression devices for associated hemorrhage control is of the following: pelvic pain, unconsciousness, shock, major
paramount. During mass casualty incidents and in austere set- lower extremity amputation or near amputation, or exam-
tings, the need for multiple external compression devices may ination results suggestive of pelvic injury. Similarly, Tacti-
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arise. In assessing the efficacy of these devices, the magnitude cal Emergency Casualty Care guidelines advocate the use of
of applied force has been offered as a surrogate measure of pu- pelvic binding techniques during the provision of care in the
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bic symphysis diastasis reduction and subsequent hemostasis. warm zone (i.e., indirect threat), and Advanced Trauma Life
This study offers a sensor-circuit assessment of applied force Support guidelines recommend pelvic stabilization for hemo-
for a convenience sample of pelvic compression devices. The dynamically unstable patients with mechanisms suggestive of
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SAM (structural aluminum malleable) Pelvic Sling II (SAM pelvic injury. 5,16,17
Medical) and improvised compression devices, including a
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SAM Splint tightened by a Combat Application Tourniquet Early pelvic stabilization has been shown to improve mean
(C-A-T; North American Rescue) and a SAM Splint tightened arterial blood pressure, decrease blood transfusion require-
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by a cravat, as well as two joined cravats and a standard- issue ments, 9,19,20 decrease length of stay in intensive care units,
military belt, were assessed in male and female subjects. As and shorten duration of hospital stay. 19–21 Numerous hospi-
hypothesized, compressive forces applied to the pelvis did tal-based studies have identified commercial compression de-
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not vary significantly based on device operator, subject sex, vices (i.e., the SAM Pelvic Sling II, the T-PODCombat Pelvic
and subject body fat percentage. The use of the military belt Stabilization Device [Pyng Medical]) as capable of effectively
as an improvised method to obtain pelvic stabilization is not reducing and stabilizing pelvic ring injuries; 16–18,21 therefore,
advised. the prehospital application of external pelvic compression
may be life-saving. For military members serving in austere
Keywords: pelvic ring fractures; pelvic injuries; commercial environments or personnel responding to mass casualty inci-
pelvic compression devices; improvised pelvic compression dents, access to commercial pelvic compression devices may
devices; mass casualty incidents be limited. We sought to assess the magnitude of force applied
to the pelvis at the level of the greater trochanters, following
the application of a convenience sample of commercial and
improvised external compression devices to male and female
Introduction subjects.
Blast injuries are the most common cause of pelvic fractures
among military members. 1,2 Data from Operations Iraqi and To the best of our knowledge, this is the first study to evaluate
Enduring Freedom identify anterior compression injuries as compressive forces applied by improvised pelvic compression
associated with a 48% mortality rate. Each year, nearly devices at the greater trochanters. There are no published data
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120,000 civilians experience pelvic ring injuries as a result of regarding a minimum compressive force necessary to reduce
motor vehicle accidents or falls. 5–7 Historically, mortality rates the symphysis diastasis. Identifying a threshold force required
as high as 54% have been reported in this population. 5,7–13 In to reduce an unstable pelvis would identify improvised devices
the setting of severe pelvic ring injury, massive hemorrhage as acceptable for use. We hypothesized that the applied force
occurs secondary to bone extravasation, vascular disruption, for all devices would not vary significantly, based on device op-
and an increase in pelvic volume. 9,10,12 An unstable pelvic erator, subject sex, or body fat percentage, and that the SAM
fracture (e.g., open book, vertical shear injury) is difficult to Pelvic Sling II would apply the greatest force to the pelvis.
*Correspondence to aerial.kreiner@us.af.mil
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1 Ms Bailey is affiliated with the Air Force Life Cycle Management Center, Wright-Patterson Air Force Base, OH. Maj Simon is affiliated with the
San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, TX, and is an assistant professor of Military and Emergency
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Medicine, University Services University of the Health Sciences, Bethesda, MD. Dr Kreiner is affiliated with the Air Force Research Laboratory,
Wright Patterson AFB. Ms Powers is affiliated with Ohio University, Athens, OH. Ms Baker, Ms Giles, and Mr Sweet are affiliated with
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Wright State University, Dayton, OH. Lt Col Rush is affiliated with the 103d Rescue Squadron, New York Air National Guard, Westhampton
Beach, NY.
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