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The prehospital management of pelvic fractures: initial consensus statement
  1. I Scott1,
  2. K Porter2,
  3. C Laird3,
  4. I Greaves4,
  5. M Bloch1
  1. 1Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
  2. 2Department of Trauma, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  3. 3Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh
  4. 4Department of Emergency Medicine, James Cook University Hospital, Middlesborough, UK
  1. Correspondence to Professor Keith Porter, Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen B15 2WB, UK; keith.porter{at}uhb.nhs.uk

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Introduction

Serious pelvic injuries are associated with a high mortality rate,1 ,2 which has remained persistently high even with advances in hospital care. Hypovolaemia is often a significant contributing factor to these deaths1 ,3 If haemorrhage from pelvic injuries could be controlled or reduced in the prehospital environment, then survival rates might increase.

Improved mortality has been seen with catastrophic haemorrhage from limb injuries after the introduction of the battlefield tourniquet and topical haemostatic dressings.4 However, compared with bleeding from pelvic injuries, external haemorrhage is simple to recognise and the success of intervention easier to observe.

Pelvic binding devices provide a simple alternative to surgical fixators. These devices can be applied in the prehospital environment, potentially allowing control of unseen major haemorrhage.2

This article reports the finding of a consensus meeting on the prehospital management of pelvic injuries held in March 2012 and examines the evidence associated with pelvic binding devices and their application.

Method of literature search

A review of the literature was undertaken prior to the consensus meeting. The Medline Database was searched using PubMed and Google Scholar was also used. The search terms were Pre-hospital management of pelvic injuries, Pelvic circumferential compression devices, pelvic binders, SAM pelvic sling, T-POD, PelvicBinder, Geneva belt and London pelvic sling. Further articles were identified from the references of retrieved articles. Manufacturers’ websites were reviewed for further information regarding specific products.

Consensus outcomes:

  • A pelvic binder is a treatment intervention rather than a packaging intervention and should be applied early

The initial management of any patient with a suspected pelvic injury must include the usual safety precautions. During scene assessment, visual clues to the mechanism of injury will help determine the likelihood of a pelvic injury.

The primary survey should deal with external catastrophic haemorrhage then any significant airway …

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