References

UK Ambulance Services. Clinical practice guidelines.Bridgwater, Somerset: Class Professional Publishing; 2016

Clinical practice supplementary guidelines.Bridgwater, Somerset: Class Professional Publishing; 2017

Balogh Z, King KL, Mackay P The epidemiology of pelvic ring fractures: a population-based study. J Trauma. 2007; 63:(5)1066-73 https://doi.org/10.1097/TA.0b013e3181589fa4

Banerjee S, Barry MJ, Paterson JM. Paediatric pelvic fractures: 10 years experience in a trauma centre. Injury. 2009; 40:(4)410-3 https://doi.org/10.1016/j.injury.2008.10.019

Pelvic injury. Assessment, management, and discussion of cases. University of Cambridge Pre-hospital Care Programme. 2017. https//tinyurl.com/yarolfvr (accessed 28 October 2018)

Cordts Filho Rde M, Parreira JG, Perlingeiro JA, Soldá SC, Campos Td, Assef JC. Pelvic fractures as a marker of injury severity in trauma patients. Rev Col Bras Cir.. 2011; 38:(5)310-6

Dong JL, Zhou DS. Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury. 2011; 42:(10)1003-7 https://doi.org/10.1016/j.injury.2011.01.032

Fink AG. Conducting research literature reviews: from the internet to paper.Thousand Oaks, CA [AQ — ok?]: Sage; 2014

Fleiter N, Reimertz C, Lustenberger T Importance of the correct placement of the pelvic binder for stabilisation of haemodynamically compromised patients. Z Orthop Unfall.. 2012; 150:(6)627-9 https://doi.org/10.1055/s-0032-1327796

Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA. Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury. 2011; 42:(10)985-91 https://doi.org/10.1016/j.injury.2011.06.003

Critical management of deadly pelvic injuries. 2014. http//tinyurl.com/y9xowocm (accessed 22 October 2018)

Giannoudis PV, Grotz MR, Tzioupis C Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007; 63:(4)875-83 https://doi.org/10.1097/01.ta.0000242259.67486.15

Helm M, Faul M, Unger T, Lampl L. [Reliability of emergency medical field triage : Exemplified by traffic accident victims.] [Article in German.]. Anaesthesist. 2013; 62:(12)973-80 https://doi.org/10.1007/s00101-013-2255-x

Kirves H, Handolin L, Niemelä M, Pitkäniemi J, Randell T. Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study. Scand J Trauma Resusc Emerg Med.. 2010; 18 https://doi.org/10.1186/1757-7241-18-60

Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005; 59:(3)659-64

Lee C, Porter K. The prehospital management of pelvic fractures. Emerg Med J.. 2007; 24:(2)130-3 https://doi.org/10.1136/emj.2006.041384

Lustenberger T, Walcher F, Lefering R The reliability of the pre-hospital physical examination of the pelvis: a retrospective, multicenter study. World J Surg.. 2016; 40:(12)3073-9 https://doi.org/10.1007/s00268-016-3647-2

Moss R, Porter K, Greaves I Minimal patient handling: a faculty of prehospital care consensus statement. Emerg Med J.. 2013; 30:(12)1065-6 https://doi.org/10.1136/emermed-2013-203205

PHTLS: Prehospital Trauma Life Support, 7th edn. Burlington MA: Jones & Bartlett Learning; 2010

Papadopoulos IN, Kanakaris N, Bonovas S Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care. J Am Coll Surg.. 2006; 203:(1)30-43 https://doi.org/10.1016/j.jamcollsurg.2006.03.017

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 2009. https//tinyurl.com/zsj86r9 (accessed 28 October 2018)

Scott I, Porter K, Laird C, Greaves I, Bloch M. The prehospital management of pelvic fractures: initial consensus statement. Emerg Med J.. 2013; 30:(12)1070-2 https://doi.org/10.1136/emermed-2013-203211

Williams-Johnson J, Williams E, Watson H. Management and treatment of pelvic and hip injuries. Emerg Med Clin North Am.. 2010; 28:(4)841-59 https://doi.org/10.1016/j.emc.2010.07.002

Yong E, Vasireddy A, Pavitt A, Davies GE, Lockey DJ. Pre-hospital pelvic girdle injury: Improving diagnostic accuracy in a physician-led trauma service. Injury. 2016; 47:(2)383-8 https://doi.org/10.1016/j.injury.2015.08.023

attitudes
paramedic
injury
haemorrhage
clinical skills

Paramedics' perceptions and experiences of pelvic injuries in prehospital situations

02 November 2018
Features
02 November 2018
Volume 10 · Issue 11

Abstract

Mortality rates remain high in patients with pelvic injuries despite improvements in trauma care in recent years. Pelvic injuries are associated with patients with a high Injury Severity Score (ISS); it can therefore be difficult to distinguish whether the pelvic injury was a primary causative factor of mortality. ‘Open book’ fractures carry a mortality rate as high as 50% and clinicians should therefore have a low threshold for suspecting a pelvic injury. Paramedics should follow the latest guidance found in the UK Ambulance Service Clinical Practice Guidelines (Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2016; 2017). Additionally, log rolling and/or ‘springing’ the pelvis of a patient with a pelvic injury will cause pain, disrupt clots and distort a potential fracture. Furthermore, pelvic binders/splints can reduce the area into which a patient can haemorrhage, if they are placed correctly. Lastly, triage of these patients can be difficult and major trauma centres should be considered for definitive care.

Pelvic injuries have increased in recent years because road traffic collisions (RTCs) have risen (Chesters, 2017). Two-thirds of pelvic injuries are sustained in RTCs, with the remainder caused by motorcycle accidents and falls from heights. Patients with fatal pelvic injuries more than likely die of exsanguination and/or associated severe injuries (Chesters, 2017).

Lee and Porter (2007) undertook a literature review to analyse the assessment and management of pelvic injuries in prehospital situations. They found that mortality rates of patients with pelvic fractures are estimated at between 7% and 19% upon their arrival at hospital, and that mortality rates of patients with ‘open book’ fractures can be as high as 50%. An open book fracture can be defined as any serious fracture that causes the pelvic ring to open like a book. This is commonly seen in anterior injuries because damage to the pubic symphysis can cause the pelvis to open (Gerecht et al, 2014).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Pelvis
Pelvic
Fracture
Splint
Assessment
Management