EMS Pelvic Binders

Excerpt

Pelvic fractures are encountered in approximately 10% of patients who experience blunt trauma. These are most often young patients with high overall injury severity scores. Life-threatening bleeding occurs in 1% to 4% of all pelvic trauma cases, while present mortality rates are as high as 60%. Bleeding from a pelvic injury occurs from several sources, including fractured bone ends, arteries, veins, and pelvic viscera. These fractures are often compounded by the loss of the natural tamponade effect within the pelvis as a result of pelvic ring instability and disruption of the pelvic floor. One of the key strategies employed in the early management of pelvic fractures is the application of a pelvic circumferential compression device, more commonly referred to as a pelvic binder. This device recreates the tamponade effect by reducing pelvic volume and increasing intrapelvic pressure to facilitate clot formation. When used early in managing pelvic fractures, pelvic binders have been demonstrated to reduce transfusion requirements.

The use of pelvic binders has been incorporated into teaching prehospital and emergency room management of trauma and is integral to Advanced Trauma Life Support (ATLS). The rate of detection of pelvic fractures by clinical examination is often poor. Therefore, the ATLS guidelines adopt a low threshold for their use where potential pelvic injury may be encountered. Educating practitioners about the correct application of pelvic binders is challenging because evidence from major trauma centers frequently demonstrates improper application.