Complete Guide To Splinting

When you're first on scene facing a patient with a suspected fracture, proper splinting can significantly reduce pain, prevent further tissue damage, and make transport safer and more comfortable. This guide explores practical splinting principles that every first responder should master, whether you're working in a remote bushland setting, on a busy roadway, or in a tactical operation.

The Purpose of Emergency Splinting

Effective splinting serves several crucial functions:

• Prevents further tissue damage by immobilising bone fragments
• Reduces pain by limiting movement at the fracture site
• Controls bleeding by stabilising bone ends that might damage vessels
  
• Facilitates safer transport by converting an unstable injury into a temporarily stable one
• Minimises the chance of bone fragments penetrating through skin by limiting their movement

“When a Musculoskeletal injury is identified, the treatment goal of the EMS providers is to restore and maintain bone and joint alignment. By doing this, EMS providers control pain, reduce motion, prevent further soft tissue injury, and promote the tamponade effect of muscles on any injured blood vessels.” (Powell & Weir, 2023)

Fracture Management in the Field

Primary Assessment Always Comes First

Inspect Neurovascular Status

Perform a thorough assessment before and after splinting:

• Distal pulses: Check strength and compare to uninjured side to detect vascular compromise that could lead to tissue death
• Capillary refill: Should be under 2 seconds in a warm environment; delayed refill may indicate reduced perfusion or developing compartment syndrome
• Sensation: Test in all dermatomes distal to the injury to identify nerve damage or compression that could cause permanent deficit if missed
• Motor function: Assess specific muscle groups to detect nerve injuries and establish if compartment syndrome is developing

These checks are critical because fractures can damage or compress nearby blood vessels and nerves, and proper splinting should not worsen circulation or neurological function. Without this baseline assessment, you won't be able to determine if the patient's condition is deteriorating during transport.

Immobilise the Injury

• Begin with manual stabilisation and maintain it throughout the process. Per ANZCOR, "tell the victim to remain still but do not physically restrain if uncooperative."
• Think of a long bone like the femur or humerus as a lever. When one end moves (like at the knee or shoulder), that movement transfers force along the bone to the fracture site. By immobilising the joints at both ends of the fractured bone, you prevent this transfer of force.
• When possible, work with a partner—one maintains manual stabilisation while the other applies the splint.

Cover Any Wounds

"Open fractures have a high risk of developing osteomyelitis, an infection of the bone itself. This type of infection typically requires intravenous antibiotics and surgical debridement. When left untreated, can be limb or life-threatening." (Powell & Weir, 2023)

• Use sterile dressings on open fractures to create a barrier against contamination
• Gently irrigate visible debris with sterile saline if available
• Do NOT manipulate or realign protruding bone ends
• Ensure you can still check pulse, sensation, and movement without removing splint

Next Steps

• Monitor your patient closely for shock and keep them warm
• Call emergency services and seek urgent transport to hospital

Shoulder and Proximal Humerus Fractures

1. Test sensation over lateral deltoid muscle
2. Check the ability to slightly abduct the arm
3. Assess for any muscle weakness in the shoulder area

Warning Signs:

• Inability to Move Fingers

• • Indicates potential nerve damage or severe compression
  • Suggests disruption of the brachial plexus or peripheral nerves
  • Do not attempt to force movement, prioritise evacuation

• Severe Pain with Minimal Movement

• • May indicate soft tissue damage
  • Could suggest nerve root compression or a complete fracture
  • Provide pain relief and monitor closely

• Pale or Bluish Skin Tone
  • Indicates potential vascular compromise
  • Suggests reduced blood circulation to the extremity
  • Consider loosening the splint to ensure no constriction and keep your patient warm. Seek urgent extrication.

What to Use:

• SAM Splint or Aero Splint
• Conforming Bandage
• Triangular Bandage
• Slishman Pressure Wrap

Technique:

Forearm, Elbow and Wrist Fractures

Critical Assessments:

1. Test sensation & grip strength in all fingers
2. Check finger movement capabilities

Warning Signs:

• Numbness or Tingling in Fingers
  • Indicates potential nerve compression or damage
  • Could suggest median, ulnar, or radial nerve involvement
  • Adjust the splint to reduce pressure and monitor
• Discolouration of Hand or Fingers
  • Suggests significant vascular compromise
  • May indicate arterial blockage or severe tissue damage
  • Ensure the splint or bandaging is not too tight, keep the hand warm and elevate slightly
• Inability to Move Fingers Independently
  • Indicates potential nerve or muscle damage
  • Could suggest a complete fracture or severe soft tissue injury
  • Do not force movement and monitor for signs of increasing pain or swelling

What to Use:

• SAM Splint or Aero Splint
  
• Conforming Bandage
• Triangular Bandage 

Technique:

Pelvic Fractures

Critical Assessments:

1. Check for pain with gentle palpation of the pelvis
2. Assess lower extremity pulses and sensation
3. Evaluate for signs of external bleeding or bruising
4. Monitor vital signs closely for indications of shock

Warning Signs:

• Severe Pain with Minimal Movement
  • Indicates significant bone or soft tissue injury
  • Could suggest an unstable fracture pattern
  • Minimise all movement, provide pain management, and prioritise rapid evacuation
• Signs of Shock Despite No Visible Blood Loss
  • Indicates potential massive internal bleeding
  • Suggests a life-threatening haemorrhage into the pelvic space
  • Apply pelvic binder/compression device, keep patient warm, and slightly elevate legs if no spine injury
• Urinary Problems or Blood in Urine
  • Suggests potential urinary tract or bladder involvement
  • Could indicate complicated pelvic trauma
  • Do not catheterise in the field, document findings, and prioritise urgent transport

What to Use:

• Commercial pelvic binder
• Improvised pelvic wrap (sheet, blanket)
• Emergency blanket for warmth
• Multiple padding materials
• Slishman Pressure Wrap (for improvised binding)

Technique:

Femur Fractures

"Traction splints are used to immobilise femur fractures... This is done to reduce pain, realign the limb, and decrease vascular and neurologic complications to the affected lower extremity." (Powell & Weir, 2023)

Critical Assessments:

1. Test hip and knee movement
2. Check sensation along the entire leg
3. Assess foot and ankle responsiveness

Warning Signs:

• Severe Pain and Inability to Move Leg
  • Indicates complete fracture or significant soft tissue damage
  • Suggests potential multiple trauma
  • Minimise all movement of the leg, provide pain management, monitor for shock and prioritise rapid evacuation
• Visible Deformity or Shortening of Leg
  • Suggests a complete fracture with significant displacement
  • Could indicate multiple fracture sites
  • Do NOT attempt to realign the leg, apply a traction splint carefully and prepare your patient for advanced medical care.
• Signs of Shock
  • Indicates potential massive internal bleeding
  • Could suggest a life-threatening condition
  • Keep your patient warm, elevate legs slightly (if no spine injury), monitor closely and prioritise urgent transport to hospital

What to Use:

• Traction Splint - STS Gen2 or STS Compact
• Multiple padding materials
• Wide straps or bandages – Slishman Pressure Wrap
• Emergency Blanket to keep your patient warm

Technique:

Tibia and Fibula Fractures

Critical Assessments:

1. Test ankle movement
2. Check sensation in the foot and toes
3. Assess the ability to wiggle toes

Warning Signs:

• Increasing Pain
  • May indicate developing compartment syndrome
  • Suggests progressive soft tissue damage
  • Carefully loosen the splint and reassess
• Tight, Shiny Skin Around Injury
  • Strong indicator of compartment syndrome
  • Suggests dangerous increase in tissue pressure
  • Loosen the splint immediately and elevate the leg slightly, prepare for urgent medical evacuation and monitor your patient closely.
• Numbness or Tingling in the Foot
  • Indicates potential nerve compression
  • Could suggest severe soft tissue damage
  • Carefully adjust the splint position and recheck circulation, prioritise rapid medical evacuation

What to Use:

• Rigid Padded Splint – SAM Splint or Aero Splint
• Multiple Padding Materials – towels, clothing, blanket
• Conforming Bandage
• Wide straps or bandages – Slishman Pressure Wrap
• Emergency Blanket to keep your patient warm

Technique:

Ankle and Foot Fractures

Critical Assessments:

1. Test toe movement
2. Check sensation across the entire foot
3. Assess arch and ankle stability

Warning Signs:

• Severe Swelling
  • Indicates significant soft tissue damage
  • Could suggest a complete fracture or multiple injury sites
  • Apply a cold compress and elevate the foot, monitor for progression of swelling
• Discolouration of the Foot
  • Suggests vascular compromise
  • May indicate arterial or venous damage
  • Ensure the splint is not too tight, keep the foot warm and elevate slightly
• Complete Loss of Foot Mobility
  • Indicates a potential complete fracture
  • Could suggest severe nerve or muscle damage
  • Do not attempt to force movement, monitor closely, prioritise rapid transport to hospital

What to Use:

• Rigid Padded Splint – SAM Splint or Aero Splint
• Conforming Bandage
• Slishman Pressure Wrap
• Soft Padding - towels, blankets, clothing, empty backpack

Technique:

Universal Splinting Guidelines

1. Always prioritise airway management & bleeding control
2. Avoid putting direct pressure on fragmented bones
3. Maintain manual stabilisation during the splinting process
4. Check neurovascular status before and after splinting 
5. Be prepared to adjust the splint if needed, but minimise all movement during patient transport
6. Seek professional medical help as soon as possible
7. Monitor neurological status continuously
8. Keep the patient warm and calm

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Need advice on selecting the right splinting equipment for your role? Reach out to us via phone 1300-862-633 or email info@tacmedaustralia.com.au.

 

Stay Safe,

Team TacMed

 

References:
ANZCOR, 2025, Guideline 2.1 – Managing an Emergency, Priorities in an emergency, accessed 11 April 2025, https://www.anzcor.org/home/basic-life-support/guideline-2-managing-an-emergency/

ANZCOR, 2025, Guideline 9.1.6 - Management of Suspected Spinal Injury, accessed 11 April 2025, https://www.anzcor.org/home/first-aid-management-of-injuries/guideline-9-1-6-management-of-suspected-spinal-injury/

Powell RA, Weir AJ. EMS Bone Immobilization. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29939555. https://www.ncbi.nlm.nih.gov/books/NBK507778/#article-31742.s2