Page 185 - PJ MED OPS Handbook 8th Ed

13. Packaging and Splinting

Packaging

1. C-spine control when indicated. Options:
a. C-collar
b. SAM splint if trained
c. Boots, rolled clothes, or other objects on side of head, duct tape or cravats around board
and across forehead, never across chin
d. Pad mastoid, chin, other bony prominences
e. Assure patient is comfortable, if not and time and tactics permit, fix it
f. Watch for anxiety, avoid pressure of the cervical collar on the larynx
2. Back board – pad bony prominences (occiput, elbows, hips, heels) or use a pad such as a sleep-
ing pad or blanket.
3. Ensure patients are warm and dry.
4. If patient is in blanket, survival blanket or other wrap, duct tape/secure blanket so it does not
get blown away or open under rotor wash.
5. Cover all wounds, amputations if not dressed to protect from contamination from rotor wash.
6. If patient is stable and anxious, consider 2mg midazolam (Versed) IV/IM/IO/IN.
7. Ensure stability of lines and tubes prior to movement and hoisting.
8. Place eye and ear protection on patient.
9. Double check rigging for hoist preparations, if possible, have second PJ check prior to signaling
for hoist.
10. When arriving at a facility or in transport, always move the patient off the stretcher/backboard
and on to a bed or well-padded surface as soon as possible.
11. Roll/prop patient differently every 20 minutes to reduce pressure sores when in facility or on
long transport.

Splinting and Orthopedic Issues
1. When using the SAM splint always utilize the C curve or T to create rigidity.
2. Pad bony prominences.
3. Learn the specific configurations for each body site and be able to execute quickly.
4. Use cravats, duct tape, Kerlex, ACE wraps etc., to secure the splint.
5. Check distal pulse-motorsensory before and after applying splints and periodically, and document.
6. If attempting to reduce a fracture prior to immobilization, use procedural sedation if possible,
use gentle continuous traction to attempt to reduce it, and feel it slip into place or feel the step
off reduce.
7. Refer to the SAM Splint Channel on youtube.com to learn how to splint each site. This should be
practiced so it can be done correctly and in the minimum amount of time.

Chapter 13. Packaging and Splinting n 183