In a simulated adult trauma patient, can pelvic binders be applied accurately by paramedics and HEMS paramedics? A pilot observational study.

Abstract

Background\nPre-hospital treatment of suspected haemorrhagic pelvic fractures includes application of a purpose-made pelvic binder. Recent hospital studies identified poor accuracy of pelvic binder application, but there is little pre-hospital research to date.\n\n\nMethods\nA pilot observational study was conducted in an NHS ambulance service to examine the accuracy of landmark identification and pelvic binder application. Paramedics and Helicopter Emergency Medical Service (HEMS) paramedics were recruited via an internal advert. Participants were asked to name and identify the landmarks (greater trochanters) on a simulated patient and apply the Prometheus pelvic splint. Participants read two clinical scenarios and indicated if they would apply a pelvic binder. Descriptive and inferential statistics were used in the analysis of results to compare performance between the two groups.\n\n\nResults\nTwenty-six paramedics were recruited. A total of 92.3% (n = 12) paramedics and 100% (n = 13) HEMS paramedics verbalised the correct landmarks. A total of 23.1% (n = 3) paramedics and 61.5% (n = 8) HEMS paramedics identified the correct landmarks on both sides of the pelvis. A total of 15.4% (n = 2) paramedics and 61.5% (n = 8) HEMS paramedics applied the pelvic binder centrally over both greater trochanters. Clinical decision-making to apply a pelvic binder was largely in accordance with a local standard operating procedure.\n\n\nConclusion\nThis study supports existing research highlighting cases of inaccurate pelvic binder placement. HEMS paramedics were more accurate than paramedics, but only 39% of all binders placed in the study were applied correctly. Frequent exposure to major trauma and familiarity with pelvic binders may have resulted in greater accuracy among HEMS paramedics. Further education and training around clinical assessment of the pelvis may improve the accuracy of pelvic binder application by all paramedics. This would subsequently improve the quality of patient care and ensure adequate haemorrhage control is maintained.