Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Fracture of the bony pelvis usually occurs if there is considerable force applied to the body, such as occurs with a fall or significant crush injury. Because there is a rich blood supply throughout the inner surfaces of the pelvis and many large blood vessels that traverse the muscles and organs housed within this part of the body, bleeding can be severe.

If (gently) pressing inward on the victim’s hips or downward on the pubic bone causes pain, suspect a fracture of the pelvis, and immobilize the victim from his waist on down. In the case of a suspected fracture of the pelvis, walking is prohibited. A pelvic fracture is frequently associated with severe internal injuries and bleeding, so rapid evacuation is a high priority. Be prepared to treat the victim for shock.

In order to keep any fractured bones of the pelvis in alignment, it is useful to wrap, or "bind," the pelvis in such a way as to compress the bones together and minimize their motion. In an improvised fashion, this may be done by wrapping the pelvis (hips and buttocks) very snugly with a sheet(s) or large towels, and tying them off or using adhesive tape to keep them in place. Alternatively, a sleeping pad, jacket or large shirt may be used for the same purpose.

The pelvicbinder™ is a force-controlled circumferential pelvic sling belt for effective reduction and stabilization of pelvic fractures. "Developed by trauma surgeons for trauma surgeons," it is a single-use, disposable "one size fits all" binder that is easily trimmed to fit each patient. Three colors are available - desert camo, yellow, and green camo. It is applied snugly, enough to be able to insert two fingers between the device and the skin of the victim. Another excellent device, which is reusable, is the SAM Pelvic Sling™.

Pelvic immobilization hopefully diminishes instability, internal bleeding, and pain. Before applying any pelvic compression method, be sure to empty the patient’s pockets and remove his belt so that the external pressure doesn’t press any items against the pelvis. For transport, place padding between the victim’s legs and gently tie his legs together to minimize motion and improve comfort. Daily skin checks should be performed to be certain that the pressure is not eroding the skin. This is done by having one health care provider slide his or her fingers under the binder to hold the pelvis stable, while another person briefly loosens the binder in order to inspect the skin.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.