Tales of the Traction Splint

by Ron on Thursday, August 19, 2010

Last night I almost failed EMT-B class because I did my traction splint incorrectly. Twice. I’ll talk more about it on the podcast next week, but I thought I’d do a post now about the traction splint. After I tweeted last night that I’d failed it the first time, Greg Friese replied


I’ve heard this before. The traction splint is so rarely used that medics forget how to use it when they do need it.

So here’s my request of you – Tell us about a time you did use the traction splint.

Either in the comments, or via trackback to your own blog.

Since I obviously don’t have such a story, I’ll tell you one one of our paramedic lab instructors told.

Man was working on the roof of his house. Near the edge. And took one step too far. Falls and lands so his thigh hits a rock, causing an isolated femur fracture. The guy is alone at home and ends up dragging himself into the house, across the living room into the kitchen to the phone and calls 911. When the medics arrive they just follow the trail of blood to the patient, who is sitting up in the kitchen. Other than minor cuts and abrasions, the only injury is the femur. So they use a traction splint.*

What’s your story?

* I don’t believe the fracture was open, and I realize MOI says you need to do more (C-collar, spinal immobilization etc), but that’s the story I was told by the paramedic.

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  • OrdoPM

    While Greg has a bit of a point, I disagree with him. I have used a traction splint a handful of times in my nearly 20 year career.

    The first time that I did was a few years into my career (about 6) for a fall in a grocery store. My assessment, as concurred with my EMT-I partner, was that the patient was a prime candidate for a traction splint. In my mind, I was worried; I had never put one on in the field before. We explained to the patient’s mother that we were going to get a special piece of equipment from the ambulance and would be back in a moment. As my partner and I walked out to the ambulance, he turned to me and asked, “Have you done this before?” “No,” I replied and we simultaneously responded to each other, “But, I have tested it a million times.” We both chuckled as we thought back to the many times that we had worked together as skills examiners for various EMT classes in the region. After retrieving the traction splint, we talked ourselves through the skills sheet for traction splint and, if I don’t say so myself, applied it perfectly. Up to this point, I had always thought that what we were taught about traction splints was a load of bollocks; pain-free, whatever. In preparation for this, I had also gathered Morphine from the truck. Lo and behold, the thing worked as described. The patient experienced relief and actually remained pain-free until the device was removed in preparation for surgery.

    While it may not be an often used skill, it is one that can and will be used in the field. Learning ti now and correctly might make the difference to a patient later; and maybe a paramedic. Being as you are new to the field, your paramedic may defer to your knowledge of the device as there is a good chance that its application is fresher in your mind. There is a lot to be said for EMTs saving Paramedics.

  • OrdoPM

    While Greg has a bit of a point, I disagree with him. I have used a traction splint a handful of times in my nearly 20 year career.

    The first time that I did was a few years into my career (about 6) for a fall in a grocery store. My assessment, as concurred with my EMT-I partner, was that the patient was a prime candidate for a traction splint. In my mind, I was worried; I had never put one on in the field before. We explained to the patient’s mother that we were going to get a special piece of equipment from the ambulance and would be back in a moment. As my partner and I walked out to the ambulance, he turned to me and asked, “Have you done this before?” “No,” I replied and we simultaneously responded to each other, “But, I have tested it a million times.” We both chuckled as we thought back to the many times that we had worked together as skills examiners for various EMT classes in the region. After retrieving the traction splint, we talked ourselves through the skills sheet for traction splint and, if I don’t say so myself, applied it perfectly. Up to this point, I had always thought that what we were taught about traction splints was a load of bollocks; pain-free, whatever. In preparation for this, I had also gathered Morphine from the truck. Lo and behold, the thing worked as described. The patient experienced relief and actually remained pain-free until the device was removed in preparation for surgery.

    While it may not be an often used skill, it is one that can and will be used in the field. Learning ti now and correctly might make the difference to a patient later; and maybe a paramedic. Being as you are new to the field, your paramedic may defer to your knowledge of the device as there is a good chance that its application is fresher in your mind. There is a lot to be said for EMTs saving Paramedics.

  • WEMT

    I remember the large traction splint.. For wilderness we had to also be familiar with the collapsable TS that most ski patrol people might carry (not sure if that one is used at all in urban settings). The real fun one was that in addition to those two, we had to know how to fashion one out of triangle bandages, medical tape, rope and ski or hiking poles.. Getting the hang of that one took a little while.

  • WEMT

    I remember the large traction splint.. For wilderness we had to also be familiar with the collapsable TS that most ski patrol people might carry (not sure if that one is used at all in urban settings). The real fun one was that in addition to those two, we had to know how to fashion one out of triangle bandages, medical tape, rope and ski or hiking poles.. Getting the hang of that one took a little while.

  • http://coyoteunderground.blogspot.com Cynthia

    I’m an EMT-Basic working in a MT rural fire department. It takes the ambulance service at least 30 minutes to get to us providing the weather is nice and no one gets lost. We used a traction splint on a kid who rolled his ATV and ended up with a closed femur fracture. When the ambulance arrived, the paramedic added morphine to the mix. His partner whispered to my partner that he’d never seen the splint deployed in real life. Search and Rescue then dragged the kid four miles in a basket stretcher back to the ambulance. The splint helped that kid. The drugs didn’t hurt. ;)

    It’s kinda like your White Cloud effect and Kelly’s “shoulda been here yesterday” as soon as you think you’ll NEVER need this skill, you’ll use it three times in a row.

    Good luck.

    Cynthia

    I had to take the backboarding station twice. I almost had a nervous breakdown. The first time they gave me a practice patient the size of a small whale.

  • Cath

    Almost did last winter. But we’d have to be doing it outside because of the way our ambulance is designed (!), so our patient would have been seriously hypothermic by the time we finished. I’d never done it before, and when we checked protocol, there were so many “ifs” and “buts” that we decided against it anyway. We’d also have to give her enough drugs to knock out a whale, which means she might have had to go by helicopter and that’s a bit over the top for a broken leg (had a good pulse and all)

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  • Ctroberts01

    On one of the first few calls I had ever been on, we used it. I was doing a visiting ride-along ( I was 16 maybe) A teenage had been racing dirtbike and came up short on a landing. He was in lots of pain, with closed mid femur fx, but stable otherwise. I was just an IV pole at the time so I didnt know how rare this was. But since then, i have not seen one used, but like everyone, have practiced a lot.

  • Slichten01

    I have used one on a 16 year old that fell off the trail at the local ski area. I was working the clinic and heard over the radio that ski patrol had a patient stuck in a ravine with a fractured femur. Once I heard the pts age, I called for ambulance transport (min 30 minutes to arrive) with ALS for pain management. I also asked for a helicopter on standby. The patient arrived off the hill about 40 minutes after the initial call from ski patrol. The kid was stuck in a ravine about 20 feet below the ski trail. They had to drag him uphill to get him on the sled. Extrication took a long time. The patient arrived at the same time as the paramedic and the only traction splint I could find was pediatric. We grabbed the one off the ambulance. The ski patroler had put a flat splint on the leg for the ride down hill. We took that off and cut the kids ski pants to see the injury. Seeing that leg shortened and twisted was something I knew to be classic signs of a femur fracture. I started pulling traction while the medic started attaching the splint. Even though we told the kid it would hurt, all he could say was stop pulling on my leg. Once we got the traction set properly, it was very apparent the kid was in much less pain. His whole body just seemed to relax. Morphine was administered for the 20 minute ride to the hospital. Like many things in your jump bag, this is one you truly don’t use very often. The one time you need it though, it is the only tool that will solve the problem.

  • Dalee1002000

    I’ve used a Peds Hare traction once. 8yr old playing tackle football in the living room with his siblings. They said they actually heard the “snap” of the bone. When I lightly felt the thigh I could feel the muscles were totally bunched up and the child was screaming in pain.

    We retrieved the splint and applied traction with it and the child instantly stopped screaming and crying. Simply amazing.

  • Rescue53

    I have used a traction splint exactly once in the last 8 years.

    I was working medical standby at a motocross. A 13 year old boy with more guts than skills took a jump at about 15 mph too fast, caught some seriously impressive air, and came down hard on his left leg. Fortunately, the bike missed him on it’s way down. Unfortunately, his left foot sank into the ground as he fell and twisted, and it was bad. BAD. By the time we made it over to him via our trusty gator, he was in pain like no other. We got him unstuck from the mud and into the stokes so we could get him off the track (since the race was still in progress), and got him into the back of the truck.

    Cut off his pants leg, and you could see the obvious lateral displacement, mid-shaft, with classic muscle cramping around the fracture site. The pt had a good pedal pulse though. And like some of the other commenters, I turned to my partner and asked him if he’d ever applied a traction splint to a real patient, and he gave me the best blank stare I’ve ever seen.

    We got the splint, dusted it off, and applied it without administering narcotics first in hopes that it would be enough relief that we could reevaulate him before we got morphine onboard.

    Sure enough, it was like magic. As soon as that traction got the fracture site aligned again, he was in total relief. The end of tears, crying, screaming, the whole 9 yards. One of the few magic fixes I’ve ever applied.

    I heard from his parents a couple of months later (at the track where his brother was racing) that he was able to have a closed reduction, and was doing fine.

  • NYEMT

    Used a traction splint ONCE in sixteen years as an EMT-D. It was on a lady of some size, who was in her early sixties and complaining of severe pain in her thigh after a fall inside the house. Looking at the ergonomics of the fall, I was perplexed as to how she could’ve broken a long bone, but her pain corresponded to a femur fracture on palpation, so we gave the Sager a shot (I never liked the mechanics of the Hare or ring splint).

    We set the Sager up as per protocol, secured the ankle hitch, and began to apply a bit of traction. Immediately, the patient howled in pain and clutched wildly at her knee. As I had suspected, her “femur fracture” was actually a strained or dislocated knee. That was my sole experience with a traction splint, aside from practical exams.

  • Metrgorulno13

    I almost failed the traction spliting as well. I kept on forgetting how to adjust the length . I was so nervous as well because the guy watching us was like crazy. I mean he wasnt crazy but he was tough. I think if I ever got called to a femur fracture I would hold traction even though it hurts my back and shoulders. lol

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