Not really overthinking it, as much as trying to apply the advice given by Hmac for civilian care to a military setting. And as he pointed out, it doesn't.
And I am aware of the treatment protocols, and like I said previously I won't usually bother with fractures unless I am caring for the pt over an extended period of time.
It's not about surviving, it's about winning!
I think it's always worth remembering that as medics we should always be governed by calculated risks.
"Do no harm" means you don't attempt anything without a reasonable expectation of improving survivability/outcome.
Femur fractures suck and are extremely painful. Reducing a fracture/dislocation sucks and are both extremely painful.
What are you gaining by causing that much pain without the appropriate equipment/capability?
An MCI/Battlefield conditions will profoundly impact that calculus, as does having a stocked ambulance with a trauma center within 10-15 miles.
1. In general I see no virtue of even thinking of reducing a compound fracture without a lack of distal pulse.
2. Once you've made the decision that it might make sense, you have to consider whether conditions preclude taking such a risk.
Even if conditions 1. and 2. were satisfied, I'd have a hard time justifying taking the time to do it if a trauma center/OR were within the hour.
A lot more other things I'd be working on first if I was on a battlefield or in the midst of an MCI.
Just because you CAN do something, doesn't mean you SHOULD do something.
I'd also say that reducing any kind of fracture or dislocation can result in significantly worse outcome if you don't know what precisely you're doing. I would really only consider a traction splint for a closed femur fracture.
Completely agree.A lot more other things I'd be working on first if I was on a battlefield or in the midst of an MCI.
It's not about surviving, it's about winning!
I had a proximal femur fracture (jagged break in half). Medics attempted to set it/splint it, talking about it being a hip dislocation. A few hours later, the real docs stated something to the effect of them causing more damage than good with their nonsense. Not sure how much that helps, but that was my painful experience.
I was an EMT back in the late 80's, Two times in the field before transport came I set , or stretched a leg back . No one wants to be the one putting the leg back. With out pain meds. in and working there are some very tense moments , but pain is less with the leg is in traction and stretched back. Not out in the woods stuff. Every Bear in miles will hear the screams and smell a hot lunch. Be ready !
We all did stupid stuff back in the 80's. Thank god we know better now.
I disagree; civilian care is essentially the same as military. I'd lean towards civilian EMS as "better" for this, since most medics/corpsmen don't see many fractures . Nothing I said directly contradicts HMAC. The only difference between most military care and civilian is evac times (excluding, of course, MCI, active firefight, etc).
Last edited by Caduceus; 10-07-13 at 12:06.
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