Assessment of proprietary and improvised pelvic binders: time to application and displacement during casualty evacuation.

Abstract

Introduction: Pelvic injuries resulting from high-energy trauma have an approximately 10% mortality rate. Suspected pelvic injuries are treated with pelvic binders to stabilise fractured bones and promote tamponade until surgical treatment. The effectiveness of pelvic binders in reducing mortality risk depends on accurate positioning of the binder. This study quantifies the ability of proprietary and improvised pelvic binders to maintain their positioning during a simulated casualty evacuation.

Methods: One improvised and three proprietary pelvic binders were tested in their ability to maintain their initial placement. Combat Medical Technicians applied binders to healthy subjects and then performed a simulated casualty evacuation. The time taken to apply each binder was measured. The evacuation consisted of: 20 m casualty drag, transfer onto a soft stretcher, 100 m evacuation on a soft stretcher, transfer onto a rigid stretcher and transfer into a field ambulance. Binder placement was measured using bony landmarks after the initial positioning and after each phase of the simulated casualty evacuation.

Results: The field-expedient pelvic splint (FEPS), SAM Pelvic Sling II (SAM) and T-POD Pelvic Stabilisation Device (TPOD) all remained within 45 mm of vertical displacement from their initial placement, which is considered an acceptable range for optimal binder functionality. The Prometheus Pelvic Splint (PROM) fell within this range in 83% of trials. The SAM was the fastest binder to apply, followed by the TPOD, and then the FEPS and PROM which took similar times to apply.

Conclusions: Binders were mostly able to maintain their positioning during the simulated casualty evacuations carried out in this study but differed in their application times. The improvised binder (FEPS) performed comparably to the proprietary binders tested, and its low cost and weight make it a good alternative to proprietary binders in the austere environment.