# Stabilizing a pelvis. Pelvic Sheet Wrap??



## newEMT (Jan 3, 2009)

So, I just took an online con-ed class on pelvic injuries and they said to stabilize the pelvis with a pelvic sheet wrap. I was taught in EMT class with the MAST trousers, but the current research is stating that they are more harm than good. 

Could someone give me a step by step guide for applying a pelvic sheet wrap? I couldn't tell from the video what they were doing. Thanks!


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## Ridryder911 (Jan 3, 2009)

newEMT said:


> So, I just took an online con-ed class on pelvic injuries and they said to stabilize the pelvis with a pelvic sheet wrap. I was taught in EMT class with the MAST trousers, but the current research is stating that they are more harm than good.
> 
> Could someone give me a step by step guide for applying a pelvic sheet wrap? I couldn't tell from the video what they were doing. Thanks!



Can you provide what research stating that they are more harm than good in pelvic fractures or are you describing them for treatment for shock?

I also suggest looking at SAM pelvic splint.. etc 

R/r 911


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## newEMT (Jan 3, 2009)

It was mentioned in the video that I was watching that the research suggests MAST trousers are more harm than good for traumatic pelvic fractures because they restrict access to the abdomen and lower extremities. I'll look at the references and see if I can find a link to the research they are speaking of.


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## tydek07 (Jan 3, 2009)

Hi newEMT,

Pelvic fractures are tricky to stabilize. I use to work for a service that carried those SAM pelvic splints and we used them on most pelvic fractures. Where I currently work, we do not carry those splints. When we come upon a pelvic fracture (which are very common with all the nursing homes around here) we stabilize using sheets and blankets.

Also, at the company I previously worked for, a medic used the MAST pants to stabilize the pelvis. Did it work? Yah, but I think it was more of a pain to get those darn things on, due to the position the pt was laying. Would I use the MAST pants for most/all pelvic fractures? No

I kind of liked having the SAM pelvic splints around, as they better stabilized the pelvis when the pt was moved. The sheets and blankets work wonders once we have the pt on the scoop board, or the cot, but offer little, to no, stability while moving the pt.

I will look around today and see if I can find a good video or instructions for you about the pelvic sheet wrap.

Take Care,


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## newEMT (Jan 3, 2009)

I can't find a link to the research, but if you're licensed in PA it's the Pelvic Injury online course on Centre Learn. 
Also, I checked youtube.com for a video of someone applying a pelvic sheet wrap, and nothing turned up. Are you just tying a sheet around their pelvis? The video was sort of low quality and I couldn't see how they tied it. Our EMS company only has the MAST trousers. So, my only other option is the pelvic sheet wrap.

It looked like they pulled the knot right over the guy's crotch in the video. I'm a girl and so I don't really know this for sure, but I would think having someone pull the knot tight right over your male parts would HURT!! Correct me if I'm wrong.


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## tydek07 (Jan 3, 2009)

Hi,
I found an article on this. Here is a snip of it:

Advanced Trauma Life Support recommends circumferential application of a pelvic sheet wrap.9 A common hospital draw sheet can be applied quickly at the scene by EMS providers and may meet our goal of temporary stabilization and reduction of a pelvic ring fracture, and, in turn, may reduce severe bleeding. The pelvic sheet wrap can remain in place during transport and emergency department evaluation. 

Following are the recommended steps for applying a pelvic sheet wrap.6 After completing the rapid trauma exam and identifying an unstable pelvis, fold the sheet smoothly (do not roll the sheet); place the sheet under the patient’s pelvis so it is centered over the greater trochanters, where the head of the femur attaches to the pelvis. On exam, you can palpate the bony prominence of the femur. In the supine position, the patient’s greater trochanter is often even with the space between his distal wrist and the base of the thumb. Wrap and twist the two running ends of the sheet around the patient’s pelvis. Once tightened, cross the running ends and tie or clamp them to maintain tension. EMTs need to use their judgment regarding the correct amount of pressure.

Full Article: http://www.emsresponder.com/features/article.jsp?id=1832&siteSection=16

Hope that helps you a little,


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## MSDeltaFlt (Jan 3, 2009)

I love the sheet wrap.  Sometimes "low tech is the best tech".  This would be one of those times.


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## Grady_emt (Jan 3, 2009)

I've also used a KED before as a pelvic stabilizer


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## Markhk (Jan 3, 2009)

Morrison Med also sells a pelvic stabilizer (albeit not as fancy as the SAM Pelvic Sling or the TPOD), which looks suspiciously like a part of a KED...

http://www.morrisonmed.com/hiphugger.html


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## Lin57EMT (Jan 3, 2009)

*Unstable pelvic fracture*

In our region in NY the MAST pants are still protocol, unless contraindicated.

A couple of years ago we had a woman who was standing upright in a roadside ditch, pinned by a fully loaded dumptruck that had lost it's brakes and came back down the hill, into the ditch where she was.  While the truck had her pinned, she was alive and talking to the road crew and our EMTs.  Once the truck was pulled off her, she collapsed and essentially bled out.  

We worked her all the way to the hospital (25 minutes or so).  Once in the ER, they took over (I stayed at her head and bagged - got to see a lot from that angle).  One of the docs called for the MAST pants, which I thought was pretty interesting, since the most recent scuttle on them was that they were fast falling out of favor everywhere. In fact, I had heard that some squads had removed them completely from their rigs.  It was one of those moments when you say to yourself "should I have considered doing that"?

As it turned out, they couldn't get her into the MAST pants due to the massive degloving of her buttocks and right leg - couldn't get the skin and muscle back up where it needed to be for the pants to fit and be inflated.   Due to the long down-time, I was surprised that the ER docs weren't just going to call it a day after a short effort.  They worked her for about 45 minutes, I think.

Anyway, what she had was more than just an unstable pelvic fx, but I'm always interested to hear on whom and under what circumstances the MAST pants are used.


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## jochi1543 (Jan 3, 2009)

The extra-wide velcro belt from the Sager works well, too. I think stuff like MAST/PASG would cause too much unnecessary motion when you're trying to get it in - I bet, more than if you just scooped the pt onto the board with a few blankets.


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## Ridryder911 (Jan 4, 2009)

You don't "get in" PASG. They should be opened up and placed upon the LSB or carrier. The patient is placed upon them and then the legs and abd is wrapped up. So in reality the patient is never moved to place them inside. 

In regards to too much pressure, one can and should regulate the pressure by the patients tolerance. How silly and stupid if someone was to place pressure to activate velcro or pop off valves. Again, splinting and treatment for shock are too opposite things. 

R/r 911


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## MSDeltaFlt (Jan 4, 2009)

Ridryder911 said:


> You don't "get in" PASG. They should be opened up and placed upon the LSB or carrier. The patient is placed upon them and then the legs and abd is wrapped up. So in reality the patient is never moved to place them inside.
> 
> In regards to too much pressure, one can and should regulate the pressure by the patients tolerance. How silly and stupid if someone was to place pressure to activate velcro or pop off valves. Again, *splinting and treatment for shock are too opposite things*.
> 
> R/r 911



Like comparing apples to oranges.


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## Airwaygoddess (Jan 4, 2009)

*Great link!*

Thanks Tyler for the link, this will be a good update for skills!


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## Lin57EMT (Jan 4, 2009)

Ridryder911 said:


> You don't "get in" PASG.
> R/r 911



Well you've got me on THAT one!  

While the end result is that the patient looks like he's wearing a pair of pants, you are correct that he doesn't magically slip his feet into the leg-holes and pull them up around his waist.

Whew - good catch.  

Annnnywhooo...the patient I was speaking of never was able to have the MAST pants "properly applied".


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## jochi1543 (Jan 4, 2009)

Lin57EMT said:


> Well you've got me on THAT one!
> 
> While the end result is that the patient looks like he's wearing a pair of pants, you are correct that he doesn't magically slip his feet into the leg-holes and pull them up around his waist.
> 
> ...



Yes, I know they don't slip their legs into actual "pants," I was thinking more along the lines of how you'd have to get the bottom layer under their bum and legs when you can't roll them b/c they have a pelvic fracture. For whatever reason, the thought of using a scoop to move them onto the pants didn't even cross my mind at the time I was posting.


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## WiFi_Cowgirl (Jan 20, 2009)

We use the Sam Sling device. Works great.


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