Paramedics' perceptions and experiences of pelvic injuries in prehospital situations

Abstract

Mortality rates remain high in patients with pelvic injuries despite improvements in trauma care in recent years. Pelvic injuries are associated with patients with a high Injury Severity Score (ISS); it can therefore be difficult to distinguish whether the pelvic injury was a primary causative factor of mortality. ‘Open book’ fractures carry a mortality rate as high as 50% and clinicians should therefore have a low threshold for suspecting a pelvic injury. Paramedics should follow the latest guidance found in the UK Ambulance Service Clinical Practice Guidelines ( Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2016 ; 2017 ). Additionally, log rolling and/or ‘springing’ the pelvis of a patient with a pelvic injury will cause pain, disrupt clots and distort a potential fracture. Furthermore, pelvic binders/splints can reduce the area into which a patient can haemorrhage, if they are placed correctly. Lastly, triage of these patients can be difficult and major trauma centres should be considered for definitive care.

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

“…In addition to rapid transport, specialist HEMS paramedics and physicians provide pharmacological and surgical interventions to patients with traumatic injuries beyond the scope of practice of most UK paramedics. Pelvic injuries occur in patients who have suffered a high energy impact mechanism of injury ( Ward et al, 2018 ). Road traffic collisions account for two thirds of pelvic injuries, followed by motorcycle incidents and falls from height ( Ward et al, 2018 ).…”

“…Pelvic injuries occur in patients who have suffered a high energy impact mechanism of injury ( Ward et al, 2018 ). Road traffic collisions account for two thirds of pelvic injuries, followed by motorcycle incidents and falls from height ( Ward et al, 2018 ). Considering the relationship between pelvic fractures and other traumatic injuries, HEMS paramedics are frequently exposed to patients with these injury patterns.…”