Are Pelvic Binders an Effective Prehospital Intervention?

Area of Science:

• Trauma care
• Emergency medical services
• Orthopedic emergencies

Background:

• Prehospital application of pelvic circumferential compression devices (PCCDs) by emergency medical services (EMS) has seen slow and inconsistent adoption across the United States.
• There is a need to understand the current frequency of PCCD use in the prehospital setting and its impact on early patient outcomes.

Purpose of the Study:

• To determine the frequency of prehospital PCCD use by EMS providers.
• To investigate factors associated with prehospital PCCD application.
• To evaluate the association between prehospital PCCD use and early hemorrhagic shock outcomes.

Main Methods:

• A single-center retrospective cohort study was conducted involving 162 patients with unstable pelvic ring injuries transported by EMS between 2011 and 2020.
• Data on prehospital treatment, including PCCD application, were extracted from EMS medical records.
• Outcomes assessed included the proportion of patients receiving a prehospital PCCD, factors influencing its use, changes in vital signs, blood transfusion requirements, and mortality.

Main Results:

• Only 32.2% of patients received a prehospital PCCD, with significant variation based on patient characteristics, geographic location, and EMS provider level.
• Helicopter paramedics applied PCCDs more frequently (46%) compared to local EMS (≤5%).
• No significant improvements in clinical outcomes, such as vital signs, 24-hour blood transfusions, or mortality, were associated with prehospital PCCD use.

Conclusions:

• Significant practice variation exists in the prehospital application of PCCDs among EMS providers.
• This study did not find evidence of clinical benefits associated with the routine prehospital use of PCCDs.
• Potential benefits of prehospital PCCDs may be confined to patients with the most severe pelvic fractures and hemodynamic instability.