The following is paid content sponsored by REEL Splint
We’ve all been there before. You get a call for an orthopedic leg injury, arrive on scene, and find a displaced and/or angulated fracture, dislocated joint, or other out-of-alignment problem, and the patient’s position of comfort and function just isn’t compatible with the splinting equipment given to you by your employer.
Over the years I’ve been in EMS, I’ve often had to resort to the “use your surroundings” ninja mentality when it comes to safely immobilizing these folks, utilizing everything from pillows to (in one case) cardboard boxes taped together in order to try to prevent further disability or loss of function.
Now, let’s face it, most of us have seen pretty much all of the standard options available to us in terms of splinting: board splints, right-angle padded splints, pillow splints, ladder splints, bend-and-form splints, and things of that nature. While we learned to become masters of the cravat in EMT school in order to try to adapt these immutable objects to flexible situations, they really aren’t optimal for immobilizing people for a number of reasons.
First is the obvious concept that people come in all shapes and sizes, so what stabilizes the tibia and fibula of an “average” sized person just isn’t going to cut it for your bariatric patient with a leg fracture, and vice-versa.
Second, in the example of using a board splint for a knee dislocation or fracture close to the joint, is that securing the splint can cause more pressure on the fracture/injury site, even if you’re careful not to tighten too much — and as we all know, sometimes fractures may not be evidently unstable or hazardous to nerves/veins/arteries until the ED takes X-rays.
Third is something which is often overlooked, but pretty critical: if the mechanism of injury is enough to cause deformity or fracture, the surrounding soft tissue has probably sustained significant trauma as well… so if your splinting process puts strain on those areas, concerns such as compartment syndrome and further injury can come into play.
Well, what about technology, hasn’t that made anything better?
Yes, in some sense, technology has made these standard splints better via improvements in the materials used to construct them. Ultimately, however, the same limitations apply in terms of practicality, especially when we’re faced with the guy whose leg is deformed at an unnatural angle, and that’s when we traditionally have had to break out the trauma shears and look for cardboard boxes, or see if the family has a pillow they didn’t want anyway.
As we all know, change can be slow to come in EMS, but when the advancements do happen, they can be significant and really impact how we do things. Recently I found out about one product which I think represents one of those leaps, After getting my hands on a unit to play with, it seems to be something which opens up a lot of options in terms of splinting either exactly in the position found, or in the position most optimal to both the short-term goal of pain relief and the longer-term goal of preventing disability. That product is called the REEL Splint.
To get a sense of what this thing looks like, and how it functions, start with a picture of a standard traction splint in your mind. Then add a bunch of thoughtfully-placed adjustment points along the frame which allow you to shorten, lengthen, rotate, skew, and lock the arms of that device into any position you can think of, including a central pair of hinges at the center which allow for adjustment similar to a woodworker’s angle gauge.
How does it work in real life, though?
Now, I don’t know about you, but I have a pretty vivid memory of the day in EMT school where backboarding was taught, especially the point at which I was the board-ee (scenario: neck pain from a minor MVC, of course) and my instructor “tested” the other student’s work by having a couple of guys pick up the board and flip me upside down over a gymnastics mat. While it scared the dickens out of me, it also taught me an important lesson: unless you’re confident in your immobilization, don’t move your patient.
In the spirit of that lesson, I decided to apply the test splint to a volunteer (my wife — thanks, Ashley) and myself in order to test out how effective the splint could be at a variety of angles and positions, and with people of various sizes. Obviously, I didn’t actually break anything to try it out, but what it allowed me to do was get used to the operation of the device, after which I took it through some imaginary positions for deformed injuries.
My conclusion after splinting not only my entire leg, but also adjusting it to different angles that I’ve personally found with injured patients, as if to immobilize that injury, is that the REEL Splint is pretty remarkable in the sense of being able to conform around a deformity, or to an injured lower extremity, and stabilize it (along with the proximal and distal joints) completely.
Doing these exercises got me especially thinking about some of the folks I’ve dealt with in the past with articulating knee injuries, and how scary it is to try to immobilize them without causing CSM compromise… and wishing that I’d had this splint on-hand for their sake.
The specter of “foot drop” (peroneal nerve damage) and the devastation that can cause for someone in the long term looms large over knee-injury patients, and I’ve seen it happen. Combined with, as I mentioned before, the possibility of compartment syndrome, and just the fact that so many arteries, veins, nerves, and other critical structures pass through such a small space in such an unstable joint, it’s imperative to get the patient’s positioning just right.
In terms of real-life application, the military has apparently had a ton of experience with this device due to the lower-leg injuries prevalent in active combat from such things as IED’s and shrapnel. In fact, a rep from REEL Splint told me that it’s pretty much standard-issue equipment in our theaters of combat for the Army, and is quickly gaining traction (did I mention that the splint also functions as a regular traction splint?) among the other branches as well. While plenty of ambulance services and fire departments are using it here in the US, the simple fact that it’s been adopted in conflict environments speaks volumes to its practicality and versatility.
The Bottom Line
I’d love to have one of these on every truck I work on, in both the pediatric and adult sizes available, if not two of each (we do have two legs, after all… see: motorcycle accidents or pedestrian-struck calls).
Personally, I think that most of us who have been in the business for a while (has it really been 11 years?) know that our role is far more often about preventing long-term disability, and expediting care, than it is about actually saving lives, which certainly does happen, but thankfully for everyone’s sake isn’t the majority of our call volume.
Simply put, the REEL Splint does an admirable job of helping towards that goal with lower-extremity injuries by allowing us to prevent further injury or compromise to those injuries, where having the right immobilization can mean the difference between walking, walking with a cane, not walking, or even losing a leg for that patient. To me, that’s a worthy goal.
Greg Bogosian is the Special Projects Manager for the Praetorian Group, Inc. and is an 11-year field EMT-Basic with significant 911 system experience in urban and suburban patient populations.