# Traction splinting



## flhtci01 (Jan 27, 2009)

Just curious what other patrollers do for traction splinting.

What type of traction splinting do you use? (half-ring, Hare, Sager, etc)

Do you apply it at the scene?

Do you remove the ski boot before applying the splint?

After there are some replies, I'll give my answers.


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## LucidResq (Jan 27, 2009)

I don't do SP, but I do SAR and know some SPers. 

I know out here many guys on SP carry Kendrick traction splints (the fanny-pack-tent-pole kind for those who are unfamiliar) due to portability. 

Because so many of our patients are evacuated by air, in both SAR and SP, many (if not most) use Sager splints. Reason being that Hare splints are almost impossible to fit in a helicopter.


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## karaya (Jan 27, 2009)

flhtci01 said:


> What type of traction splinting do you use? (half-ring, Hare, Sager, etc)


 
Thomas half-rings are still around?!  Brings back memories.


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## BossyCow (Jan 27, 2009)

For us it depends on the pack out time. We are told that the traction and Hare type splints are not to be used if transport is more than an hour due to circulatory issues from the hip side of the splint. In those cases we use the kendrick which Lucid described.


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## flhtci01 (Jan 27, 2009)

karaya said:


> Thomas half-rings are still around?!  Brings back memories.



I know some areas that still have them.  Some patrols work with what they have and don't have the funds to update little used equipment.


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## PNWMedic (Jan 27, 2009)

Hi FLHTC, I'm a patroller, and we have hares, sagers and half rings. Personally I love the KTD's (Kendrick Traction Devices) as mentioned above. They are light weight, small, and work great, though expensive (about $100 ish) One other idea is a few patrollers have setups to convert their ski pole (or trekking pole) into a traction device. Hope that helps!


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## flhtci01 (Jan 28, 2009)

Our main traction splint is the Sager.  As previously mentioned this is to facilitate air-lifting someone, if needed.  We do have Hares, half-rings and a Kendrick available to us.

I have applied them both on scene and after we have removed the person from enviromental exposure.

I have also applied them with the ski boot still on (usually at the scene) and have removed the ski boot.  There seems to be many opinions on this one, especially within our patrol.


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## LucidResq (Jan 28, 2009)

I can imagine, also, that ski patrol is one area where one might be more likely to see bilateral femur fxs as compared to other settings, and the Sager would definitely come in handy in those situations, although rare I'm sure.


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## Summit (Jan 29, 2009)

Around here, KTD. 

Why would you remove the boot in the field with a simple midshaft femur fx?


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## PNWMedic (Jan 30, 2009)

mid shaft femur fx are not unheard of, although i have not run into on on the mountain yet, as for boot, here it is protocol to remove the boot, also for cms


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## Luno (Jan 30, 2009)

Yes, we see midshaft, lower 3rd, and upper 3rd on a regular basis, we had one today...   We have the game, sagers, hares, KTDs, half rings, and an iron duck kicking around somewhere... KTDs are alright but lack the stability for movement that some of the others provide.  Boots are generally off, but entirely dependant on the situation.  This assists in determining distal CMS, but doesn't always provide the complete picture.  That being said, given the volume of calls that we respond to, and the terrain, femurs are a fairly regular occurance.


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## flhtci01 (Jan 30, 2009)

Summit said:


> Why would you remove the boot in the field with a simple mid-shaft femur fx?



The same question has come up here.

From the Outdoor Emergency Care 4th edition textbook:
_It is generally safe to apply traction to a booted foot for up to and hour, but longer periods of time are uncomfortable and introduce the danger of interference with circulation and pressure damage to the tissues of the foot (this is one reason that many patrols are now requiring removal of the boot on the hill before applying traction.  Question the patient periodically about his or her ability to wiggle the toes and whether there is any new numbness or pain in the toes or foot.  If there is any doubt, replace the mechanical traction with manual traction, remove the boot, assess the foot and ankle, and reapply mechanical traction on the unbooted foot._

We average about one femur per year with this year being above average.  One was fall in the middle of a beginner run. 

From my experience pulling traction gives almost instant relief.  I would rather do that than try and wrestle a cold boot off on the hill. As far as distal assessment, I question the patient about sensation and movement and palpate the popliteal pulse.  

Our transport time is under an hour to the ER so that is usually not an issue. 

I have also ridden in the rig to the hospital and after they assessed and sedated the patient, they asked me to remove the boot because they did not know how to do it.  I think the last boot we sent in was a victim of a cast saw.:sad:

I have also heard of patient spending a couple of days in traction with a boot on at the hospital.


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## MRE (Jan 30, 2009)

We have adult and pedi Hare traction splints, but we just got a Kendrick and have been playing with it.  I expect that it will be used for S+R and not normal ambulance calls.


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## Summit (Jan 30, 2009)

flhtci01 said:


> From my experience pulling traction gives almost instant relief.  I would rather do that than try and wrestle a cold boot off on the hill. As far as distal assessment, I question the patient about sensation and movement and palpate the popliteal pulse.



See, I figure for a short transport, leave the boot on for exactly this reason and assess thusly. In addition to not causing trauma removing the cold stiff boot singlehanded on the hill, it goes to reason traction splint is LESS likely to _cause_ impaired CSM in the foot with a supportive boot on to spread the force. The boot must be removed, it can be done so in the ED with lots of hands, heat, and tools.

At the other extreme (after reviewing WMS's opinions on the matter), in a REALLY long transport (12 hours or a day), I'd consider asking (if possible) med control if they really want to apply the traction splint or would prefer an extremely supportive and padded non-traction splint.


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## Sasha (Jan 30, 2009)

> Why would you remove the boot in the field with a simple midshaft femur fx?



Forgive me, I'm not WEMT or ski patrol or anything. But wouldn't removal of the boot be necessary for assesment of PMS? I was always taught to check pulses before and after splinting.


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## Summit (Jan 30, 2009)

Sasha said:


> Forgive me, I'm not WEMT or ski patrol or anything. But wouldn't removal of the boot be necessary for assesment of PMS? I was always taught to check pulses before and after splinting.



Ah yes, but a ski boot is a different beast than a hiking boot or a shoe. Especially when it's a 4 buckle race boot and it's 0F and blowing. This can make the boot extremely hard to get off singlehanded, even harder than when it's at room temp in an easy position, even with massive manipulation of the patient's leg and may make pedal CSM compromise secondary to the fx unjudgable due to cold. But if the protocols say to take it off, take it off.

If leaving the boot on, open the buckles and straps up.


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## Sasha (Jan 31, 2009)

Wow! I'm gonna stay in Florida, where all we have to worry about removing are flip flops


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## task (Jun 30, 2010)

who would you want to take your ski boot off. A Ski Patroller who takes ski boots off on a regular basis or an ER nurse who has never seen a ski boot in her life.


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## jjesusfreak01 (Jul 1, 2010)

PNWMedic said:


> Hi FLHTC, I'm a patroller, and we have hares, sagers and half rings. Personally I love the KTD's (Kendrick Traction Devices) as mentioned above. They are light weight, small, and work great, though expensive (about $100 ish) One other idea is a few patrollers have setups to convert their ski pole (or trekking pole) into a traction device. Hope that helps!



Hares run $170+, Sagers $250+, and KTDs $85+ on Froogle. Not to mention any of the others is more expensive to replace if it gets left on a patient at the hospital. Considering the prices of a lot of the equipment that EMS in my area carries (eg ResQPods $100), that's not a bad price for something that you would likely only need to buy once or twice.


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## zmedic (Jul 2, 2010)

We use KTDs. Our protocol is to attempt a boot removal on the hill, if it's super tight and we can't remove it on one attempt we leave the boot on and use a boot hitch. 

While yes, the ski boot does technically protect the foot, a tight boot might actually put the foot at more risk of frostbite because it is restricting blood flow. I think it'd rather have my foot in a sock covered with a blanket then squeezed into a racer boot for an hour. 

As has been mentioned, patrol has more experience taking boots off than most hospitals. Though if this is at a major ski area (Jackson, Vail etc) the hospitals nearby are probably full of docs who are also skiers and have probably delt with ski boots on patients almost daily. 

Lastly, one consideration is that if you pull traction over the boot you are going to have to undo traction to get the boot off in the hospital, which is less than ideal.


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