References
Prehospital use of the traction splint for suspected mid-shaft femur fractures
Abstract
Introduction:
A retrospective audit of electronic patient care records (ePCRs) highlighted the infrequent use of the traction splint for the management of femur fractures. The aim of this study was to improve the use of the traction splint for patients presenting with a mid-shaft femur fracture in the absence of contraindications, by means of introducing a purpose-designed trauma CPD training course.
Methods:
An intervention consisting of a simulation-based mandatory trauma CPD training session for all operational prehospital care providers was implemented over a 3-month period, supported by a pre- and post-implementation staff survey regarding staff perceptions of using a traction splint. Following the intervention period, a repeat retrospective audit of the ePCR database was conducted to identify any improvement in the use of the traction splint.
Results:
The use of the traction splint for a femur fracture in the pre-intervention stage was found to be underutilised (Median 16%). Following the intervention period, however, traction splint use increased significantly (Median 50%). An improvement was also noted in staff perception and understanding of the management of femur fractures.
Conclusion:
This study found that focused trauma training is an effective means to improve patient care. Training should be ongoing in order to maintain skills and knowledge needed for management of femur fractures.
The force required to fracture an adult's femur represents a significant mechanism of injury. Between October 2016 and December 2017, Qatar's national ambulance service, Hamad Medical Corporation Ambulance Service (HMCAS), treated a total of 192 patients with a femoral fracture. HMCAS attends approximately 900 calls per day which, on average, includes two to three major trauma patients.
During World War One (WW1), it was noted that a fractured femur had an unacceptable high mortality rate. This resulted in the widespread introduction of traction splints into military medicine (Rowlands and Clasper, 2003)—a practice that continues to this day and has resulted in traction splints becoming established within civilian prehospital care (Green et al, 2000; Rowlands and Clasper, 2003; Lee and Porter, 2005). This has led to the development of a range of tractions splints over the years, such as the Thomas, Hare, Trac3, Donway and Sager traction splints. The Trac3 traction splint is the device used by HMCAS and is available in both adult and paediatric sizes.
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