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Orthopedic surgeon discusses importance of EMS care

Decisions made in the prehospital setting can significantly improve outcomes for patients with orthopedic trauma


Gladden speaking on the cavity created by a bullet, using pictures originally created by Norman McSwain.

Photo by Catherine R. Counts

The McSwain EMS Trauma Conference is a one-day symposium covering the treatment prehospital providers render to a range of traumatic injuries. It is held every year in New Orleans and named for Dr. Norman McSwain, the pioneering trauma surgeon and lifelong advocate for EMS.

NEW ORLEANS — Paul Gladden, MD, an orthopedic surgeon who serves as an Associate Professor within Tulane’s Orthopedic Surgery program, gave the first clinically oriented talk at the fourth annual McSwain EMS Trauma Conference. Gladden was able to cover the treatment process for a variety of orthopedic trauma patients from the time EMS arrives to the patient’s discharge from the hospital while applying his experience working in the prehospital, air medical and tactical settings.

Gladden kept his talk lighthearted as he covered a number of topics including pelvic fractures, open fractures, dislocations and gunshot wounds. Here are some memorable quotes, key takeaways and additional resources from the session.

Memorable quotes on orthopedic trauma

Gladden when discussing the challenges of trauma assessment and splinting shared these memorable quotes.

“It’s what we do, we take care of really bad problems really quietly and we don’t get any credit for it.”

“If your belly is bigger than mine, I’m not operating on you.”
Gladden regarding the feasibility of operating on a morbidly obese man with a pelvic fracture.

“They are going to bleed, and they are going to bleed like crazy.”
Gladden regarding open pelvic fractures

“Never splint in the position found.”
Gladden explaining the importance of improving blood flow and patient comfort

“Most follow up for bad, bad trauma patients keeps occurring in the trauma center when you see them back with another traumatic injury”

Key takeaways on splinting

Gladden’s presentation on orthopedic injuries and splinting had many important lessons for EMS providers. Here are my top takeaways.

  • Binding the pelvis of a patient with a pelvic trauma saves lives. It can be done with anything from a specialty device, to a bed sheet or even a waist belt from the patient, a bystander, or even the provider so long as it isn’t so tight that a secondary crush injury is created.
  • Any pelvic wrap or binding should be checked regularly to ensure placement is maintained, this is particularly true for patients that are overweight.
  • The survival curve for traumatic injuries means that half the patients die prior to their arrival to the hospital. But appropriate care and transport decisions can change the curve. Prehospital administration of antibiotics may not affect the first few days of survival, but it can change outcome in the weeks that follow an injury.
  • If possible, providers should always reduce, reposition or realign an open fracture or dislocation since blood flow is likely compromised. If not done in the prehospital setting, it’s usually the first thing orthopedic surgeons will do upon arrival to the hospital. Any concerns about further injury are minimal, since if the initial trauma didn’t break it, it’s unlikely anything else will.
  • Mangled extremities are straightforward, figure out a way to stop the bleeding since the life must take priority over the limb.

Additional resources on splinting

Learn more about orthopedic trauma and splinting.

This article was originally posted Nov. 15, 2016. It has been updated.

Catherine R. Counts, PHD, MHA, is a health services researcher with Seattle Medic One in the Division of Emergency Medicine at the University of Washington School of Medicine. She received both her PhD and MHA from Tulane University School of Public Health and Tropical Medicine.

Dr. Counts has research interests in domestic healthcare policy, quality, patient safety, organizational theory and culture, and pre-hospital emergency medicine. She is a member of the National Association of EMS Physicians and AcademyHealth. In her free time she trains Bruno, her USAR canine.

Connect with her on Twitter, Facebook, or her website, or reach out via email at