Wilderness and Rescue Medicine 8th Edition

Wilderness and Rescue Medicine 108

little reason to prolong pain and disability any lon- ger than necessary. There is clear benefit to early reduction of simple dislocations, and the inci- dence of complication is extremely low. The risks associated with prolonged dislocation include ischemia and infarction of joint structures and the distal extremity. There is also increased risk to the patient and rescuers in the urgent evacuation of a disabled patient in severe pain. 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.

Some techniques used in the hospital employ considerable force, such as two or more people pulling in opposite directions to reduce a shoul- der. The patient is usually sedated enough to tolerate the pain, but unable to give useful feed- back as a result. When viewing this, bear in mind that the practitioner has seen X-rays and knows exactly what they are 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.

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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