A recent edition of an urban EMT magazine has an article on splinting that opens with a tale of a patient being transported with an un-splinted ankle fracture, and a reference to a study where only 25% of patients with extremity fractures had their injuries splinted before arrival at the ER, and fewer had RICE therapy applied in the field to help manage pain.  I’m not sure how representative the sample population of this study may be (it didn’t clearly separate isolated injuries from urgent multiple trauma patients), but it is consistent with my experience that splinting does not receive the same attention in urban EMS that we give it in wilderness medicine.

One of the comments on the web version of this article said that most ambulance patients are on backboards, which serve as a splint.   I disagree.  Just the other day I took over care of a patient with an un-splinted open tib-fib fracture.  This first response crew also thought the backboard was plenty of splint, and were focused on applying the gadgetry of modern EMS; electrodes, pulse ox, automatic BP cuff, IV.  I splinted the leg. 

Because we can care for patients for hours or days, and transport patients in difficult conditions, wilderness medicine providers know the value of a sound splint: padded, but not bulky or heavy; rigid; adjustable; with fingers/toes accessible for assessment; with the joints above and below long bone injuries and the bones above and below a joint injury immobilized. We know a splint can stabilize an injury and prevent further damage, and that combined with RICE, can be helpful in pain management.

This is basic first aid.  It’s an important skill that is much appreciated in the wilderness but sadly sometimes a lost art in the urban world.