Wilderness Medicine, First Aid, and Outdoor Skills
Splinting

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
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Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

Splinting is the technique to secure the part of the body that is injured to decrease further damage or injury to that part of the body, and to make the individual more comfortable until treatment can be initiated. There are many forms of splinting. Many outdoorsmen have been very creative in the past. Many items can be used, from sticks to ski poles to dismantled barrels of shotguns, to dismantled arrows, bark of trees, anything that is stable and can be used to wrap around an extremity or an injured part of the body. For the most part, splinting has very few drawbacks. One of the most common is putting the extremity in a splint and wrapping it too tightly, thereby cutting off circulation. Other than that, it is very difficult to cause more harm with splinting. With any injury, one should assume that the injured party has a fracture, and go ahead and splint until one can be transported to a healthcare provider. All dislocations, sprains, strains, and assumed fractures should be splinted. It is important to assess color of the skin farthest from the injured area, as well as feeling farthest from the injured area. This will give you some indication of the possible seriousness of the injury, which will help when reporting this to a healthcare provider. All injured extremities should be elevated to decrease swelling.

When using sticks in the outdoors for splinting fingers, arms, ankles, it is important to use fresh green limbs as opposed to dead dry ones for the obvious reason of the dry limbs breaking (A). It is important to remember that when using any bark or limbs, to make sure there are no insects under the bark, for example ants and termites. It has not been uncommon for individual in a rush to splint an injured party member on a camping expedition and after a few minutes to an hour, the ants then start to come out and numerous bites are inflicted on that part of the extremity. As you can see in the picture to the right, these are willow branches that are used to splint a finger, which work very well when using duct tape to make a hammock, if you will, for the finger to lie in. (B, C, D)

One of the most useful inventions, developed by Sam Scheinberg, M.D., is the SAM splint. This splint has been around for a while and has been used on Mt. Everest expeditions, as well as on the space shuttle. It is extremely lightweight, very malleable, as well as very durable. As you will see in the photos, these splints can be put into position to splint a variety of joints, as well as appendages. This splint can also be cut with a pair of scissors to shorten or mold along certain area of the body. These splints can be reused over and over again, and are invaluable when on any outdoor expedition. In sustaining any falls, for example out of a tree stand when deer hunting, or when rock climbing, head injuries are not uncommon. Subsequently, one has to worry about a cervical fracture, which would be a fracture of the neck. The SAM splint can easily be used for a cervical collar, which can immobilize the neck and prevent further problems. Please see photo to the right. (E)

The ankle is also very frequently injured in the outdoors, whether from running, camping or rock climbing. Severe sprains and fractures are not uncommon. There are two technique used when employing the SAM splint with a sprained or fractured ankle. One is the Ice Tong Technique, where the SAM splint is used to go under the bottom of the foot and up onto each side of the ankle and then wrapped (F, G, H, I), as well as the Forward and Back Wrap, which is also a very secure method of splinting an ankle. All of these SAM splints should be secured with either an Ace wrap (which can be carried in your backpack), a belt can be used or even a torn shirt, to secure the SAM splint to the appendage. Dislocations and fractures of the wrist as well as the elbow also commonly occur. The SAM splint can be placed on the palm side of the arm as seen in the picture to the right, and wrapped with Ace wrap to secure the wrist or the elbow. (J, K)

When an individual needs to have a more secure splint, or it will not move, it is important to take the SAM splint and bevel it before you apply it, by bending it with a ridge on the bottom of the splint. This splint will be in the shape of an I-beam for example, which makes the splint almost impossible to bend after it is molded. (L, M)

This is especially useful when transporting on long distances, with concerns that the extremity is fractured, and you do not want any movement with that extremity. Again, it is important to mention to keep the injured extremity elevated if possible, to decrease any swelling to the injured area. Splinting remains one of the quickest and easiest mechanisms of first line treatment in the outdoors which, when used effectively, can actually save limbs from further injury, as well as preserve function of the limbs for years to come.

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