Femur fractures and first aid

[flighty 0]

We've been having a discussion in incidents about femur fractures and first aid.Bad landing, reported apparent both femurs

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I've been wondering about this type of injury. In my EMT class we were taught that femur breaks are some of the most dangerous and fatal injuries due to thigh muscles moving the bones and cutting the arteries. Femur fractures, like spinal injuries are cases where what you do or don't do to treat the person can mean life or death.

I've never really heard femur fractures discussed during safety day type discussions, even though it sounds like they are fairly common in landing injuries.

Anyone who knows something about it have practical advice about what to do for someone with an obvious break? My knowledge is just classroom.

~Cindy~
Quantum materiae materietur marmota monax si marmota monax materiam possit materiari?
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[mr2mk1g 10]

From what I have been taught and have experianced of first aid, you shouldn't be trying to give aid to a broken femour unless it is absolutly nessasery to move the injured (unlikly on a DZ) or if there is a large amount of blood being lost (ie their gonna die anyway unless you do something).

I think DZ's really ought to let the EMT teams handle complicated injuries like this. Femour breaks fall into that class of injury where a little bit of knowledge on the part of the rescuer is far more dangerous than non as they will seek to employ it.

[flighty 0]

propilot wrote:

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I am an EMT. I dont think having a traction device at the DZ would be helpfull unless there was an EMT/nurse on staff to use it properly. What if joe blow used it on some guy and by moving the leg while trying to get the device on, he moved the bone off of the artery and essentailly allowed an otherwise relativly promising situation turn into fatal blood loss.

All im saying is that people should not mess with people unless they are trained. You could hurt them.


Also, do the bigger DZ's like Deland have onstaff EMT or nurses? Just wondering.

There is a very high proportion of medical professionals in the sport. So many EMTs, Nurses, Doctors are skydivers that there is a high chance that someone trained would be there. A femur fracture is one injury where a $100 piece of equipment can mean the difference between deadly bloodloss and only massive bloodloss. Training on any specific variation of the device would be essential (great safety day class.)

Good judgment must be used in any injury. You don't see skydivers putting people on long backboards and running injured people to a pickup truck even though the equipment is there.

This is a device that brought the fatality rate from femur fractures in WWI from 80% to 20%.

I do think that there would be issues with the ambulance service using equipment that was already in place, but maybe this is something to bring up with them. Any dz worth it's salt should have a good working relationship with the first responders in the area.

At my old DZ the head EMT muckety muck guy for the town was delighted to be asked by us to give a safety day briefing to the dz about first aid for a critical injury. We learned a lot about what info to give and how to get the resources there as fast as possible. He learned a lot about skydiving gear and mechanisms of injury.

I'm mostly referring to the DZs where help wouldn't arrive for 30 minutes or more. It just seems like a long time for that thigh muscle to be spasming and moving those bones around.

~Cindy~
Quantum materiae materietur marmota monax si marmota monax materiam possit materiari?
Spelling and grammar errors are left as an exercise for the reader.

[councilman24 36]

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A femur fracture is one injury where a $100 piece of equipment can mean the difference between deadly bloodloss and only massive bloodloss. Training on any specific variation of the device would be essential (great safety day class.)

IMHO A traction splint is NOT a topic for a safety day class. This is a piece of equipment that while available to the public should only be use with specific training that is part of an overall certification in pre hospital treatment. As a MFR licensed in MI I DO recommend that medical personel trained in its use that hang out at the DZ have one. I suggested it in my first aid for the DZ seminar at the PIA symposium last year.

I'm old for my age.
Terry Urban
D-8631
FAA DPRE

[CanuckInUSA 0]

Obviously a doctor or a EMT would be more qualified than someone like myself. But as a former ski patroller (I used to patrol up in Lake Louise Alberta from '89-'92) I have had to deal with several femur accidents (the worst femur accident being some guy who wrapped himself around a snow making hydrant and broke his femur in two places). And I was trained to put the victim on a backboard, monitor their condition (shock and all that other fun stuff ... NOT) and call for either an ambulance or a chopper depending on the victims condition. Placing the victim on a backboard properly is not a trivial task to teach people in the field during an incident. So I would say that unless the DZ is properly equiped with the appropriate first aid equipment and trained personnel, the best thing to do is call for an EMT monitor the victims condition and be prepared for the worst (every adult should know CPR).

Try not to worry about the things you have no control over

[frenchyflyer 0]

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... and be prepared for the worst (every adult should know CPR).

Well, except that CPR might not help much if there's no blood left to pump to the brain (in case of a sectionned femural artery)

The scariest part is that because the femur is broken, I wouldn't know how to stop the blood flow; in fact I might not even see that the arteria is sectionned so I'll do CPR anyway...
Scary situation, I hope I'll never run into that situation....

[BikerBabe 0]

I was told (as a femur-patient myself) that the danger isn't so much the femoral artery, but all the other blood vessels that run through and around the bone. Enough of them can be severed that the loss of blood would be substantial enough for the person to bleed out.

Of course, this was never told to me until months after my accident! I think I owuld have been much more panicked waiting for the ambulance if I had known about this in advance!

Never meddle in the affairs of dragons, for you are crunchy and taste good with ketchup!

[boxingrrl 0]

So, in the absence of specialized training and a traction device just administer first aid/CPR until EMT's arrive, correct?

In the event of a compound fracture and your victim is stable, would it still be worthwhile to attempt to slow the blood flow by applying pressure or, with femur, it might cause more harm than good?

A little clarification, please?

[CanuckInUSA 0]

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In the event of a compound fracture and your victim is stable, would it still be worthwhile to attempt to slow the blood flow by applying pressure or, with femur, it might cause more harm than good?

A little clarification, please?

Absolutely ...

Here are the six priorities of first aid:

1) Prevention of further injury

This applies to the victim as well as the rescuers. Get the victim out of harms way, but only after the rescuers are not in harms way (no point having new victims).

2) Airway

Make sure the victim's airway is not blocked.

3) Breathing

Make sure the victim is breathing.

4) Circulation

Make sure the victim's blood is circulating and apply pressure to any open wounds.

5) Fractures

Immobilize any bone fractures the victim may have.

6) Everything else

Address all the other injuries the victim may have (including recognizing and monitoring the victim going into shock).

Try not to worry about the things you have no control over

[CanuckInUSA 0]

I would like to add another point here. If the victim has suffered a head, neck, back or femur injury. Please do NOT move the victim unless their immediate life is at risk (remembering the first priority of first aid). The head, neck, back and femur injuries, the victim needs to be placed on a backboard and the proceedure for doing this is not all that obvious to the untrained eye.

Try not to worry about the things you have no control over

[tombuch 0]

At my DZ we have been told clearly and unequivocally by the local rescue squad that we may NOT use or maintain a traction splint, or even oxygen, on the DZ unless it is under the direct control of a physician who is then the only person that can use it. The rescue squad position is that an EMT (in New York state) is licensed only under the direction of a physician, and the EMT license is not valid without medical control or a physician on site. In the absence of medical control an EMT is simply a member of the general public and is not authorized to use any advanced first aid skill or equipment for which he is trained. Thus, according to our rescue squad, using a traction splint represents practicing medicine without a license and is illegal. That’s a crappy position, I know, but it is supported by NY State EMS policy, and must be the policy of our drop zone. Check with your local rescue squad prior to stocking any EMT level equipment, and prior to authorizing any EMT to perform service.

The other thing worth of note, is that in NYS a responding volunteer CFR (certified first responder, the lowest level of certification) has control and authority, but a trained EMT or paramedic who works full time in the profession has no authority unless he/she is directly affiliated with the local rescue squad.

My response to a femur fracture with deformity is to apply manual traction, treat for shock, and await a local ambulance squad responder who is under medical control. At that point we can use the ambulance equipment.

For additional discussion, please see http://ranchskydive.com/safety/tb_article10.htm

Tom Buchanan
EMT-B
S&TA
Author JUMP! Skydiving Made Fun and Easy

Tom Buchanan
Instructor Emeritus
Comm Pilot MSEL,G
Author: JUMP! Skydiving Made Fun and Easy

[AggieDave 6]

Remember something, having equipment like traction boards, etc on the DZ and having people that are not certified medical personal will open folks up to severe lawsuits.

I've been around some seriously bad accidents on DZs, I've also seen folks that claimed they were EMTs that were there do some VERY stupid things (like try to get a severely injured person to stand up and take his rig off).

End the end, it really comes down to getting an ambulance there FAST and only doing basic life saving things. Such as keeping the injured from moving, not trying to move the injured in any way, calling 911, if need by, adminstering CPR and such.

--"When I die, may I be surrounded by scattered chrome and burning gasoline."

[jahk 0]

For additional discussion, please see http://ranchskydive.com/safety/tb_article10.htm

Tom Buchanan
EMT-B
S&TA
Author JUMP! Skydiving Made Fun and Easy

[Squeak 17]

OK I read all the posts so far in this thread and Speaking as a former Military Mdic, and current !st Aide Instructor, what Canuck posted is the most approoriate method of dealing with a suspected femorial injury.
I would also add:
If there is obvious massive bleeding, either externally or internally (you know if you see it) I would also apply direct presure to the inner groin area where the leg and pelvis meet. this will help limit the blood flow to the leg below.
If there is massive external bleeding and applied presure does not limit the flow enough, I would consider a tornequette. but only if I knew how to apply it. (and I do).

You are not now, nor will you ever be, good enough to not die in this sport (Sparky)
My Life ROCKS!
How's yours doing?

[flighty 0]

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IMHO A traction splint is NOT a topic for a safety day class. This is a piece of equipment that while available to the public should only be use with specific training that is part of an overall certification in pre hospital treatment. As a MFR licensed in MI I DO recommend that medical personel trained in its use that hang out at the DZ have one. I suggested it in my first aid for the DZ seminar at the PIA symposium last year.

I wholeheartedly agree. By saying safety day class, I meant familiarizing skydiving medical professionals with the specific model at the dz, as there are several different types. I just couldn't imagine holding manual traction for any extended period of time.

Anyone want to give an opinion on whether it is better to do manual traction or wait for the ambulance.(lets say we're talking about a trained EMT, plenty of help, isolated femur fracture with deformity and swelling)

People have brought up some great points about legal issues. I am so glad to see that a few dzs have policies about first response. I fear that that isn't true of most dzs though.

~Cindy~
Quantum materiae materietur marmota monax si marmota monax materiam possit materiari?
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[WeakMindedFool 0]

Dude...that sucks!!! In CA an EMT at any level can carry ALL EMT-1 gear and use it at their discretion. In my county (Sacramento) the paramedics can operate at their full scope of practice (including invasive procedures, Rx, Advanced Airway, Electrical therapy) up to Base MD order only shit (ie.Dopemine) We can carry what we require or scavange, we can carry partial equipment...or not (as in my case...why would I want to carry all that stuff around? Oh yeah, I do have a Laryngescope and some McGills) My DZ has ALS gear and more MD's and MICN's then you can shake a stick at. The FD is on the airport and we can launch a bird direct (It may be an auto dispatch). We have two birds within 10 min from wind up to scene...I love my DZ. As for dealing with a Femur...The Idea behind traction is mostly comfort, yes you can save muscle damage and in the highly unlikely event of major artery disection traction or no traction will make no difference, I have found pressure points to be of marginal effectiveness. Torniquet or death in this situation is about it untill a surgen happens by. If you think it's an ISOLATED mid-shaft fracture, knock yourself out. Pull traction till they stop screaming, if they don't, your either doing it wrong or it wasn't isolated. In any event DON'T MOVE ANYONE & DON"T TAKE THEIR SHIT OFF PLEASE!!!!!!!! Oh yeah...everyone learn to hold c-spine!

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
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[Erroll 49]

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So, in the absence of specialized training and a traction device just administer first aid/CPR until EMT's arrive, correct?

In the event of a compound fracture and your victim is stable, would it still be worthwhile to attempt to slow the blood flow by applying pressure or, with femur, it might cause more harm than good?

A little clarification, please?

I seem to recall an incident several years ago where a (military?) parachutist died in Bloemfontein, South Africa, after suffering a compound fracture. Reported cause of death was 'Bone marrow entering the bloodstream'. Does this sound probable?

[skymedic 0]

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Reported cause of death was 'Bone marrow entering the bloodstream'.

possibly...but more likely caused by numerous other issues with a broken open femur fracture.

my advice for displaced CLOSED femur's is wait for an ambulance. I could hold manual traction...but you have no idea how stron the muscles are in the thigh, on top of a screaming hurting person, they will tense up and have more resistance for you to hold. remember most DZ's are way out of the way....and your nearest ambulance most likely will be an extended time(10-20mins or more) so if you apply traction and then let up an any point as those VERY sharp ends of bone go penetrating back into that jumpes leg you could lacerate nerves, or worse major vessels...letting an already very bad injury into a fatal injury.

please dont be a hero....I dont treat at the DZ....other than rapid assessment and ABC's...let the ambulance do it.

Marc
otherwise known as Mr.Fallinwoman....

[mr2mk1g 10]

I can only really comment on one possible aspect of this... the possibility of litigation arising out of well-intended medical intervention. I know "real skydivers don't sue" but you might not know at the time if you are working on someone familiar with that ethos.

My concern is that in many jurisdictions the moment you start trying to perform procedures that require specialist training or start using equipment that is normally the preserve of a specially trained profession, your litigation risk instantaneously shoots through the roof. The reason is that many jurisdictions sensibly say that if you are going to perform a specialist procedure or use specialist tools then you must do so with the skill of a reasonable person who is trained in that procedure / with that equipment.

eg: if you perform CPR you may only have to live up to the standard of a reasonable person who is trained in CPR... not too hard to do as that probably means someone just like you. If try to use a backboard in order to immobilise a person you may find yourself having to live up to the standard of a reasonable EMT for example... that may be significantly harder… you’re probably not an EMT nor are you trained to know what they know. If you start trying to do things like use a traction splint, depending on what the local rules are and how complicated things get, you [I]could[/I] find yourself having to live up to the standard of a Doctor… if you fail to meet that standard then you open yourself up to the possibility of litigation – and they’ll probably win.

If you’re an individual skydiver, do you have medical malpractice insurance? Well if you don’t your unlikely to be a tempting target for a lawsuit, but if they want to sue and you’re the only one out there… If you’re an employee of the DZ then the DZ can be liable for anything you do – even negligently provided medical care in the right circumstances.

The crux of the matter is, if a DZ is going to have a backboard or traction splint, they better have a procedure for who can and cannot use it, a documented training scheme for those who can, and a documented system for keeping their knowledge current and well practiced. They should also check out the local rules on who in the medical community can use that equipment and what look standard they are going to be judged against should the worst come to the worst.

These comments are only intended to reflect the generality of the common law system and those basic principals that are shared with many legal systems in the English-speaking world. I have little direct knowledge of US law and can only fully comment on the law of England and Wales. Please check your local jurisdiction for the applicability of my comments before relying upon any of them.

[skymedic 0]

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My concern is that in many jurisdictions the moment you start trying to perform procedures that require specialist training or start using equipment that is normally the preserve of a specially trained profession, your litigation risk instantaneously shoots through the roof. The reason is that many jurisdictions sensibly say that if you are going to perform a specialist procedure or use specialist tools then you must do so with the skill of a reasonable person who is trained in that procedure / with that equipment.

exactly the problem we face....hence the reason why I never stop at car accidents and only do the bare minimum at the DZ if someone is injured...I know due to our good sam laws they can't really touch me...but that doesn't mean they can't sue anyway and try to beat the good sam law's. I am in no need or want of a lawsuit for something I did or did not do...

Marc
otherwise known as Mr.Fallinwoman....

[firediver 0]

I understand that anytime someone gets injured, it seems to take forever for an ambulance to get there and everyone wants to do whatver they can to help. However, (you knew there was a however didn't ya??) if someone broke their femur, it's a result of a major traumatic event. This triggers a whole lot of protocols which really don't need discussion here. The point is that the only thing non-professionals can do is to keep the jumpers head/neck still, and (assuming they're breathing and not externally bleeding out), support the busted leg however it ended up. Applying traction to it is great, unless you let it up for even a second and shred something important with the splintered bone ends. I've been in Fire/EMS full time for 20 years, JMHO.

Skydiving isn't scary;...but clowns...CLOWNS are scary!

[WeakMindedFool 0]

That's why I said, "If you think it's an ISOLATED mid-shaft fracture, knock yourself out. Pull traction till they stop screaming, if they don't, your either doing it wrong or it wasn't isolated. In any event DON'T MOVE ANYONE & DON"T TAKE THEIR SHIT OFF PLEASE!!!!!!!! Oh yeah...everyone learn to hold c-spine! "
I think there is enough major trauma in this sport to warrent a greater level of understanding of EMS then first aid...Where I jump that is the case (blind dumb luck on my part) I've been in EMS a bit as well and the fact is it's the first responders and bystanders that save peoples asses more times then not. Mabey it's an east coast thing that you all don't teach the public to do things, out here you can buy a traction splint with no training, KED makes one especially for climbers. If people are interested in learning more to help their buddies when they slam in, we should be teaching them. Hell, you can't throw a rock without hitting medical professional on my DZ, it can't be that different everywhere else. Lets teach and organize, it might save my ass, and I'm all for that!

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
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[WeakMindedFool 0]

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...I know due to our good sam laws they can't really touch me...but that doesn't mean they can't sue anyway and try to beat the good sam law's. I am in no need or want of a lawsuit for something I did or did not do...

Not in CA. Good Sam laws DO NOT cover you. You are held to standard of care. So act within it and you are covered...anyways if you are known as a Paramedic at your DZ you have a duty to act and are liable. Omission is as bad as commission here. So if you had gear...your buddy was down, you would do nothing beyond ABC's & c-spine?

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
Check out these Videos

[skymedic 0]

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you would do nothing beyond ABC's & c-spine?

Yep...and I dont have gear and my DZ doesn't have gear...just to avoid the issue. we have life flight closer than we have a ground ambulance where I jump. also standard of care for good sam laws apply if you are on duty here in IL where I practice. as far as duty to act if I am not at work I do not have a duty to anyone.

Marc
otherwise known as Mr.Fallinwoman....

[WeakMindedFool 0]

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Yep...and I dont have gear and my DZ doesn't have gear...just to avoid the issue. we have life flight closer than we have a ground ambulance where I jump. also standard of care for good sam laws apply if you are on duty here in IL where I practice.

Wow! the laws are very different there?!?

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as far as duty to act if I am not at work I do not have a duty to anyone.

Again, here "Duty to act" is a legal distinction, not a moral one. If you are Identified in any way as a Paramedic/Emt you have to act. This is why you rarely see old medics walking around with stickers on there cars or t-shirts that say "Paragod".
But that's all beside the point, I'd help my buddies regardless of the consequences, fuck the law.

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
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