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multiple patients may require rapid stabilization and the sup- surgical teams deployed to Afghanistan. Mil Med. 2011;176(1):
ply of commercial devices may quickly be depleted. 67–78.
2. Bailey JR, Stinner DJ, Blackbourne LH, Hsu JR, Mazurek MT.
The effect of the improvised compression device material on Combat-related pelvis fractures in nonsurvivors. J Trauma. 2011;
71(1 Suppl):S58–S61.
diagnostic imaging is of some importance. Removal or re- 3. Shackelford S, Hammesfahr R, Morissette DM, et al. The use of
placement of the device prior to imaging, or obscuration of pelvic binders in Tactical Combat Casualty Care: TCCC Guide-
images, may delay patient care. Commercial devices are com- lines change 1602 7 November 2016. J Spec Oper Med. 2017;17
patible with radiographs and CT. Although the SAM Splint (1):135–147.
was designed with an aluminum core, the low effective atomic 4. Foris A, Waseem M. Fracture, Pelvic. NCBI Bookshelf: StatPearls.
number of this metal makes it less prone to producing scatter 2017. https://www.ncbi.nlm.nih.gov/books/NBK430734/. Ac-
cessed 12 August 2018.
in CT scans. 27 5. Heetveld MJ, Harris I, Schlaphoff G, Sugrue M. Guidelines for
the management of heamodynamically unstable pelvic fracture
Limitations patients. ANZ J Surg. 2004;74(7):520–529.
This study examined the compressive force generated by pelvic 6. Lee C, Porter K. The prehospital management of pelvic fractures.
compression devices in healthy volunteers. Pain was not as- Emerg Med J. 2007;24(2):130–133.
sessed as a limitation of compression device application; how- 7. Kapur GB, Hutson HR, Davis MA, Rice PL. The United States
ever, given that applied forces did not vary significantly in the twenty-year experience with bombing incidents: implications for
terrorism preparedness and medical response. J Trauma. 2005;59
application of the compressive devices between researchers, (6):1436–1444.
we do not suspect that this served as a significant confound- 8. Knops SP, Schep NWL, Spoor CW, et al. Comparison of three dif-
ing factor. A convenience sample of study subjects aged 18 ferent pelvic circumferential compression devices: a biomechan-
to 48 years were recruited to participate. The average body ical cadaver study. J Bone Joint Surg Am. 2011;93(3):230–240.
fat percentage for males was 26.5% and for females, 25.2%. 9. Hsu S-D, Chen C-J, Chou Y-C, Wang S-H, Chan D-C. Effects of
Although there are limited studies detailing body fat percent- early pelvic binder use in the emergency management of suspected
ages among military members, current estimates identify male pelvic trauma: a retrospective cohort study. Int J Environ Res
Public Health. 2017;14(10):1217.
and female Army service members, aged 18 to 53 years, as 10. White CE, Hsu JR, Holcomb JB. Haemodyamically unstable pel-
possessing a body fat percentage of 26.7 ± 3.8% and 40.3 ± vic fractures. Injury. 2009;40(10):1023–1030.
3.7%, respectively. Therefore, we believe that our sample is 11. Grotz MRW, Allami MK, Harwood P, Pape HC, Krettek C,
28
reflective of male members of the current military population. Giannoudis PV. Open pelvic fractures: epidemiology, current con-
Additional studies are required in the female population. The cepts of management and outcome. Injury. 2005;36(1):1–13.
SAM Splint and C-A-T are FDA-approved devices. Applica- 12. Stover MD, Summers HD, Ghanayem AJ, Wilber JH. Three-
®
dimensional analysis of pelvic volume in an unstable pelvic frac-
tions previously described constitute off-label uses. ture. J Trauma. 2006;61(4):905–908.
13. Chesser TJS, Cross AM, Ward AJ. The use of pelvic binders in the
emergent management of potential pelvic trauma. Injury. 2012;
Conclusions 43(6):667–669.
In our study of 30 participants (13 males, 17 females), the SAM 14. Shlamovitz GZ, Mower WR, Bergman J, et al. How (un)useful
Splint and tourniquet device performed well, and thus may be an is the pelvic ring stability examination in diagnosing unstable
pelvic fractures in blunt trauma patients? J Trauma. 2009;66(3):
improvised device option when time and tactics permit. Other- 815–820.
wise, two cravats tied together may apply a similar force to the 15. Tactical Emergency Casualty Care (TECC) Guidelines. Current
pelvis as that of the commercial SAM Pelvic Sling. Application as of June 2015. http://www.c-tecc.org/images/content/TECC
of cravats to the traumatized pelvis is a simple procedure using _Guidelines_-_JUNE_2015_update.pdf
lightweight, compact, and inexpensive materials that are easily 16. Cullinane D, Schiller HJ, Zielinski MD, et al. Eastern Association
removed for assessment and do not affect diagnostic imaging. for the Surgery of Trauma practice management guidelines for
All applied forces were assessed while subjects remained motion- hemorrhage in pelvic fracture–update and systematic review. J
Trauma. 2011;71(6):1850–1868.
less; future work should examine the effect of patient transfer on 17. Qureshi A, McGee A, Cooper J, Porter K. Reduction of the pos-
force characteristics. At this time, we do not recommend the use terior pelvic ring by non-invasive stabilisation: a report of two
of a military belt as an improvised pelvic compression device. cases. Emerg Med J. 2005;22(12):885–886.
18. Tan ECTH, van Stigt SFL, van Vugt AB. Effect of a new pelvic
®
stabilizer (T-POD ) on reduction of pelvic volume and haemody-
Author Contributions namic stability in unstable pelvic fractures. Injury. 2010;41(12):
SR conceived the study concept. AK recruited a student engi- 1239–1243.
neering team. RB enrolled study participants. RB, DP, LB, CG, 19. Vermeulen B, Peter R, Hoffmeyer P, Unger PF. Prehospital sta-
and RS performed study trials and collected data. DP analyzed bilization of pelvic dislocations: a new strap belt to provide
the data. ES and AK wrote the study manuscript. All authors temporary haemodynamic stabilization. Swiss Surg. 1999;5(2):43–
read and approved the study manuscript. 46.
20. Croce MA, Magnotti LJ, Savage SA, Wood GW 2nd, Fabian TC.
Emergent pelvic fixation in patients with exsanguinating pelvic
Conflict of Interest Statement fractures. J Am Coll Surg. 2007;204(5):935–939.
The authors have no conflicts of interest to report. 21. Fu C-Y, Wu Y-T, Liao C-H, et al. Pelvic circumferential compres-
sion devices benefit patient with pelvic fractures who need trans-
Financial Disclosure fers. Am J Emerg Med. 2013;31(10):1432–1436.
®
The authors have no financial relationships relevant to this 22. SAM Medical. “Pelvic Sling II.” 2017. https://www.sammedical
article to disclose. .com/assets/uploads/SLI-M-SS-02.pdf. Accessed 25 August 2018.
23. North American Rescue. Combat Application Tourniquet (C-A-T).
2018.https://www.narescue.com/combat-application-tourniquet
References -c-a-t. Accessed 25 August 2018.
1. Shen-Gunther J, Ellison R, Kuhens C, Roach CJ, Jarrard S. Opera- 24. North American Rescue. SAM Splint II. 2018. https://www.narescue
tion Enduring Freedom: trends in combat casualty care by forward .com/sam-splint-ii. Accessed 25 August 2018.

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