Traction splints - tips of the trade?

[fm_emt]

We're going to be tested on both the Sager & Hare traction splints in class. I got the chance to try out both of them last night, and I wanted to know if any of you had any tips or things to keep in mind.
One of the reasons I'm asking is because they both seem fairly straight forward to operate and my brain keeps saying "You're missing something.."

[emtff376]

Ahhh, traction splinting. We use the sager, hare, thomas and the KED brand of traction. Love them all for different reasons.

Big thing to remember is that sager can be used for bilateral femurs and the hare isn't designed for it. Disadvantage of the sager is you have to know the person's approximate weight to apply appropriate traction (although every protocol here says "mech. traction equal to manual traction")

Here's my mental check list for traction (for the hare)

bsi/ss/etc.
determine it is mid-shaft
check CMS distal to the injury
have someone take c-spine
have someone manually stabilize above and below the injury
apply ankle hitch
apply manual traction until pt feels relief
measure splint against good leg and adjust to fit
lift injured leg and slide splint under leg
apply ischial strap
apply mechanical traction
apply straps
check CMS distal
backboard them
check CMS again
transport

that sounds right to me... (I did one friday, but using a different splint).

[FFEMT1764]

and dont forget that it must be a midshaft femur fx to use the hare...if its a femur head fx the hare is useless...i go with the inverted ked trck for femur heads and hips.

[Ridryder911]

Tips for testing..

maintain traction at all times... be sure to place ankle hitch prior to traction..(other wise positioning hands can be tricky

be sure you have PLENTY of padding on the ischial bar...

thigh strap is secure

invert the straps so you can undo them more rapid and won't stick on carpet...


After you are through.. don't forget to check stability of splint as well as PMS...

God luck,
R/R 911

[TTLWHKR]

I have often used it to immobilize the tib/fib fractures, with out the use of traction.

[ffemt8978]

The Sager is good, especially for bilateral femur fx's. The Hare is good for long transport time. But nothing beats the KTD for field work. Simple to use, fast to apply, and traction does not have to be maintained while applying (although it does make the patient feel better).

[IVgal]

"the disadvantage of the Sager is knowing the spprox. weight of the patient"

What about the 'awe' factor? Or no more than 15 lbs? The thing about Sager too is that you don't have to maintain manual traction throughout transportation - and it fits within the bodies silouhette, better for boarding. Not to mention it doesn't cut off the feeling to your legs like a Hare (the SI nerve under the back of the leg gets piched in a Hare) - Nor does the Sager act as a turnicate like the KTD if applied too tight.

There's a new Sager too - the Sx405, that's the total fraction response system. It can be converted into a regular splint too, not just a traction splint.

Did you know that KTD shows you how to apply traction to the arm...??? I thought traction was only ever applied to the femur???

[ffemt8978]

The KTD was originally designed for wilderness EMS, where it may be several hours/days before you can get your patient out. Traction can be applied to any limb if required, but is generally (and by protocols) only done to the femurs.

[IVgal]

So KTD is designed for wilderness, where removal might take hours/days... and if they KTD restricts flow of the femoral artery and acts as a turnicate... bye-bye leg?

I just attended a conference for the western division ski patrol association and the general consensus was KTD for immediate extrication - simple, light-weight etc etc... most of the patrolmen there didn't seem to care that they could possibly damaging the femur further by cutting off circulation, or possibly causing more damage by moving the broken femur (soft tissue/nerve/artery damage) if the top strap is too tight... I do understand that time is of the essance, but what about the patient?

Sorry, I'm just trying to understand why they wouldn't go with a superior product that might take an extra minute to apply if it means he gets to keep his leg...

[Ridryder911]

If any device causes circulatory obstruction, it was usually because it was placed improperly by the rescuer. The thigh/inguinal strap is only supposed to be taught enough to prevent slippage and placement for traction to occur. It is no different in design than the first original Thomas half-ring splint , then the Hare, Sager, etc.. Proper padding is the key on any splint.

Basically all tractions splints are equal in how they operate, rather it is just the mechanics and materials that makes the difference.

When properly splinting, any extremity in-line traction's is supposed to occur, (for long bones) to prevent ends from lacerating nerves, muscle, tissue and of course artery and venous vessels. As well, in by doing so, reduces muscular spasms and prevention of nerve damage, especially in large muscle groups such as the quadriceps.

R/r 911