CG17 | VERSION 1.1 1/4
trust clinical guideline
Guideline ID
CG17
Version
1.1
Title
Pelvic Injury
Approved by
Clinical Effectiveness Group
Date Issued
01/10/2014
Review Date
31/09/2017
Directorate
Medical
Authorised Staff
Clinical
Publication
Category
Ambulance Care Assistant
Emergency Care Assistant
Student Paramedic
Advanced Technician
Paramedic (non-ECP)
Nurse (non-ECP)
ECP
Doctor
Guidance (Green) - Deviation permissible;
Apply clinical judgement
1.Scope
1.1
This guideline details the assessment and management of actual and potential
pelvic injuries.
2.
Background and Definitions
2.1
Pelvic fractures represent 3-6% of all fractures in adults and occur in up to 20%
of all multiple trauma cases. Patients aged between 15-30 and those over 60
years old are most at risk, with 75% of cases occurring in men. Major pelvic
injuries are predominantly caused by high levels of energy being transfer to the
patient, such as following a road traffic collision, pedestrian accident, fall from
a height or a crush injury. However, less serious pelvic injuries may also occur
following low-energy transfer events, particularly in the elderly. It is estimated
that up to 20% of pelvic fractures are unstable.
responsive
committed
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© South Western Ambulance Service NHS Foundation Trust 2014
CG17 | VERSION 1.1 2/4
trust clinical guideline
3.Guidance
3.1
When to Suspect Pelvic Injury
3.1.1 Whenever a patient has been subjected to significant blunt trauma, the
possibility of pelvic fracture should be considered. Such patients complaining
of pain in the pelvis, lower back, or hips should be considered as having an
unstable pelvic injury. On examination of the patient, do not attempt to ‘spring
the pelvis’ to assess stability, as this is unreliable and may cause additional
haemorrhage or injury. A thorough assessment for associated wounds and other
injuries is also essential.
3.2 Indications for Pelvic Splinting
3.2.1 A pelvic binder is a treatment intervention rather than a packaging device, and
should be applied early to provide stability and allow clot formation. This may
prevent ongoing haemorrhage and reduce trauma induced coagulopathy.
3.2.2 To determine whether a patient requires a pelvic binder the mechanism of injury
must be suggestive of a pelvic fracture AND be accompanied by one or more of
the following:
▲▲ Haemodynamically unstable;
▲▲ Pulse >100 and systolic blood pressure <90;
▲▲ GCS <13;
▲▲ Distracting injuries present;
▲▲ Patient complaining of pelvic pain.
3.2.3 Any patient with a significant mechanism who is haemodynamically unstable
due to unknown cause should be managed as a time critical pelvic injury.
3.3
Application of a Pelvic Splint
3.3.1 In patients with a suspected pelvic injury, moving and rolling the patient should
be kept to an absolute minimum. The pelvic splint should be applied to bare skin
unless exceptional circumstances exist (hostile environment, patient refusal).
3.3.2 Where possible apply the pelvic splint prior to extrication, as early placement
controls haemorrhage and movement of an unstable fracture, which could
potentially disrupt clot formation.
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committed
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3.3.3 Prior to application bind the patients legs together at the knees and apply a
figure of eight around the ankles and feet, unless the patient has an associated
fractured fermur(s).
© South Western Ambulance Service NHS Foundation Trust 2014
CG17 | VERSION 1.1 3/4
trust clinical guideline
3.3.4 Ensure the pelvic splint is applied evenly over the patient’s greater Trochanters
and symphysis pubis, in the position indicated below:
3.3.5 Please refer to the relevant Trust SOP detailing the correct application technique
of the pelvic splint in current use for further information.
3.3.6 Once the pelvic sling is applied, immobilise according to Clinical Guideline
(CG30) Spinal Care and Immobilisation. Log rolling patients with significant
pelvic fracture can cause clot disruption and further haemodynamic compromise,
therefore log rolling should be avoided.
3.3.7 Unstable pelvic fractures require specialist treatment and should be transported
to a Major Trauma Centre where they fulfil the other requirements detailed in
Clinical Guideline CG24 - Trauma Care: Accessing Trauma Services.
3.4
Associated Femoral Fractures
3.4.1 Patients that have clinically obvious femoral fractures should have these
stabilised.
3.4.2 If the patient is haemodynamically compromised, to prevent unnecessary delay
consideration should be given to:
▲▲ Pulling the legs out to one length (with appropriate analgesia as required).
▲▲ Apply a pelvic binder.
▲▲ Bind the legs together at the knees and a figure of eight around the ankles
and feet.
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3.4.3 If applying traction increases pain or further haemodynamic instability, then strap
the legs together in the position found.
3.4.4 Donway and sagar traction splints are not recommended for use in pelvic
fractures. The Kendrick traction device, if available, may be considered.
© South Western Ambulance Service NHS Foundation Trust 2014
CG17 | VERSION 1.1 4/4
trust clinical guideline
3.5
Cleaning and Decontamination
3.5.1 The pelvic splint is a treatment intervention rather than a packaging device and
should remain on the patient.
3.5.2 If a pelvic splint is passed back to the ambulance service after use, it can be
cleaned using sanitising wipes. If the splint is contaminated dispose within the
clinical waste stream and replace with a new pelvic splint.
4.
Episode Closure
4.1
All patients with a suspected pelvic injury must be admitted to hospital. Clinical
Guideline CG24 - Trauma Care: Accessing Trauma services covers the selection
of the most appropriate destination hospital for patients experiencing trauma.
5.Documentation
5.1
In line with Trust Policy, a Patient Clinical Record must be completed and
annotated appropriately. Any deviation from this guideline must be recorded,
with any potential or actual adverse event reported through the incident
reporting system.
5.2
A trauma checklist must also be completed to identify and support clinical
decision making around triage and selection of the most appropriate destination
hospital for patients experiencing actual or potential pelvic injury.
responsive
committed
effective
© South Western Ambulance Service NHS Foundation Trust 2014