Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section IV: Trauma

Protocols for field reduction are now common in wilderness medical training and approved by many medical control authorities. It is still incum- bent on the medical officer, however, to be aware of local statutes and medical control policies regarding the use of these procedures, particu- larly when working in a duty-to-act situation like emergency medical service (EMS). The example techniques detailed in this chap- ter all use gentle manipulation on an awake and cooperative patient. Some increase in pain with manipulation is normal; severe pain is not. If the patient cannot tolerate the procedure, you need to stop and try something else or evacuate to medi- cal care.

Dislocations Wilderness Perspective

General Principles

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High-Risk Problem: • Persistent impaired CSM • Failed reduction • Critical System Injury • Hip or elbow • Dislocation from direct force • Compartment syndrome

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Some techniques used in the hospital employ considerable force, such as two or more people pulling in opposite directions to reduce a shoulder. The patient is usually sedated enough to toler- ate the pain, but unable to give useful feedback as a result. When viewing this, bear in mind that the practitioner has seen X-rays and knows exactly what he or she is dealing with, and there are skilled staff available to minimize the risks associated with sedation. The same technique in the field setting would carry much greater risk. Fortunately, considerable force is rarely necessary in any setting.