Lower Extremity Fractures (081-831-1034)
Figures 4-17 through 4-22
show how to apply splints to immobilize fractures of the lower extremities. Although
padding is not visible in some of the figures, it is preferable to apply padding
along the injured part for the length of the splint and especially where it touches
any bony parts of the body.
Jaw, Collarbone, and Shoulder Fractures
a. Apply a cravat to immobilize
a fractured jaw as illustrated in Figure 4-23. Direct all bandaging support to
the top of the casualty’s head, not to the back of his neck. If incorrectly placed,
the bandage will pull the casualty’s jaw back and interfere with his breathing.
with lower jaw (mandible) fractures cannot be laid flat on their backs because
facial muscles will relax and may cause an airway obstruction.
two belts, a sling, and a cravat to immobilize a fractured collarbone, as illustrated
in Figure 4-24.
Apply a sling and a cravat to immobilize a fractured or dislocated shoulder, using
the technique illustrated in Figure 4-25
Spinal Column Fractures (081-831-1000)
It is often impossible to
be sure a casualty has a fractured spinal column. Be suspicious of any back injury,
especially if the casualty has fallen or if his back has been sharply struck or
bent. If a casualty has received such an injury and does not have feeling in his
legs or cannot move them, you can be reasonably sure that he has a severe back
injury which should be treated as a fracture. Remember, if the spine is fractured,
bending it can cause the sharp bone fragments to bruise or cut the spinal cord
and result in permanent paralysis (Figure 4-26A). The spinal column must maintain
a swayback position to remove pressure from the spinal cord.
a. If the Casualty
Is Not to Be Transported (081-831-1000) Until Medical Personnel Arrive—
Caution him not to move. Ask him if he is in pain or if he is unable to move any
part of his body.
Leave him in the position in which he is found. DO
NOT move any part of his body.
Slip a blanket, if he is lying face up,
or material of similar size, under the arch of his back to support the spinal
column in a swayback position (Figure 4-26 B). If he is lying face down, DO NOT
put anything under any part of his body.
If the Casualty Must Be Transported to A Safe Location
Before Medical Personnel
And if the casualty is in a face-up position, transport
him by litter or use a firm substitute, such as a wide board or a flat door longer
than his height. Loosely tie the casualty’s wrists together over his waistline,
using a cravat or a strip of cloth. Tie his feet together to prevent the accidental
dropping or shifting of his legs. Lay a folded blanket across the litter where
the arch of his back is to be placed. Using a four-man team (Figure 4-27), place
the casualty on the litter without bending his spinal column or his neck.
The number two, three, and four men position themselves on one side
of the casualty; all kneel on one knee along the side of the casualty. The number
one man positions himself to the opposite side of the casualty. The number two,
three, and four men gently place their hands under the casualty. The
number one man on the opposite side places his hands under the injured part to
o When all four men are in position to lift, the number two man commands,
“PREPARE TO LIFT” and then, “LIFT.” All men, in unison, gently lift the casualty
about 8 inches. Once the casualty is lifted, the number one man recovers
and slides the litter under the casualty, ensuring that the blanket is
in proper position. The number one man then returns to his original lift
position (Figure 4-27).
o When the number two man commands, “LOWER CASUALTY,”
all men, in unison, gently lower the casualty onto the litter.
the casualty is in a face-down position, he must be transported in this same position.
The four-man team lifts him onto a regular or improvised litter, keeping the spinal
column in a swayback position. If a regular litter is used, first place a folded
blanket on the litter at the point where the chest will be placed.
Neck Fractures (081-831-1000)
A fractured neck is extremely dangerous.
Bone fragments may bruise or cut the spinal cord just as they might in a fractured
a. If the Casualty Is Not to Be Transported (081-831-1000) Until Medical
Caution him not to move. Moving may cause death.
Leave the casualty in the position in which he is found. If his neck/head is in
an abnormal position, immediately immobilize the neck/head. Use the procedure
o Keep the casualty‘s head still, if he is lying face up, raise
his shoulders slightly, and slip a roll of cloth that has the bulk of a bath towel
under his neck (Figure 4-28). The roll should be thick enough to arch his neck
only slightly, leaving the back of his head on the ground. DO NOT bend his neck
or head forward. DO NOT raise or twist his head. Immobilize the casualty’s head
(Figure 4-29). Do this by padding heavy objects such as rocks or his boots and
placing them on each side of his head. If it is necessary to use boots, first
fill them with stones, gravel, sand, or dirt and tie them tightly at the top.
If necessary, stuff pieces of material in the top of the boots to secure the contents.
o DO NOT move the casualty if he is lying face down. Immobilize the head/neck
by padding heavy objects and placing them on each side of his head. DO NOT put
a roll of cloth under the neck. DO NOT bend the neck or head, nor roll the casualty
onto his back.
b. If the Casualty Must be Prepared for Transportation Before
Medical Personnel Arrive—
And he has a fractured neck, at least
two persons are needed because the casualty’s head and trunk must be moved in
unison. The two persons must work in close coordination (Figure 4-30) to avoid
bending the neck.
Place a wide board lengthwise beside the casualty.
It should extend at least 4 inches beyond the casualty‘s head and feet (Figure
If the casualty is lying face up, the number one
man steadies the casualty’s head and neck between his hands. At the same time
the number two man positions one foot and one knee against the board to
prevent it from slipping, grasps the casualty underneath his shoulder and hip,
and gently slides him onto the board (Figure 4-30 B).
If the casualty
is lying face down, the number one man steadies the casualty’s head
and neck between his hands, while the number two man gently rolls the casualty
over onto the board (Figure 4-30 C).
The number one man continues
to steady the casualty’s head and neck. The number two man simultaneously
raises the casualty’s shoulders slightly, places padding under his neck, and immobilizes
the casualty’s head (Figures 4-30 D, and E). The head may be immobilized with
the casualty’s boots, with stones rolled in pieces of blanket, or with other material.
Secure any improvised supports in position with a cravat or strip of cloth extended
across the casualty’s forehead and under the board (Figure 4-30 D).
Lift the board onto a litter or blanket in order to transport the casualty (Figure