Joint Immobilization

Joint Immobilization is included in this California-based EMT program as it is required for National NREMT registration. It is not yet required for skills verification for California Registration.

Radius/Ulna Immobilization (board splint)  Manual stabilization initially done by manually holding the area above and below the injury site (maintained until splinting is complete)  CMS checked in both upper extremities at the same time  A small padded board is used. The board placed underneath the forearm (padded side toward patients arm). The person holding manual stabilization is now also holding the board against the arm.  Hand placed in position of function. Can be done by placing roller gauze underneath the fingers. The goal is to leave the hand/fingers in a curved position. Hand must be positioned on board, cannot hang over the edge of the board.  Cravats tied to secure the padded board to the arm. One cravat above the injury site and one below. The wrist also will need to be secured to the board. An additional cravat can be used for this. If they choose, instead of using a third cravat, they can use the cravat from below the injury site. This cravat will need to be initially secured below the injury site, but it can wrap around, extend over the hand, come across the knuckles, and tie underneath.  It is optional for the thumb to be included when securing the hand 30  The cravats should not be placed directly over the injury site  When tying a knot with the cravat, the knot cannot be tied over the skin. It needs to be tied over a void space or against the board.  Another option is to use roller gauze instead of cravats. With this, students will just roll the gauze from the elbow down to the hand.  Once the board is secured to the forearm, a sling and swathe needs to be applied  Recheck CMS on both extremities once splinting is complete

Wrist Immobilization  Manual stabilization is initially done by manually holding the area above and below the wrist (maintained until splinting is complete)  CMS checked in both upper extremities at the same time  A small padded board is used. The board placed underneath the forearm (padded side toward patients arm). The person holding manual stabilization is now also holding the board against the arm.  Hand placed in position of function. Can be accomplished by placing roll gauze underneath the fingers. The goal is to leave the hand/fingers in a curved position. Hand must be positioned on board, cannot hang over the edge of the board.  Cravats tied to secure the padded board to the arm. Two cravats are used to secure the forearm to the board. The hand also is secured to the board. An additional cravat can be used for this. If they choose, instead of using a third cravat, they can use the cravat closest to the wrist that is secured to the forearm. This cravat will need to be initially secured close to the wrist, but it can wrap around and extend over the hand and come across the knuckles and tie underneath.  It is optional for the thumb to be included when securing the hand  The cravats are not be placed over the wrist  When tying a knot with the cravat, the knot cannot be tied over the skin. It needs to be tied over a void space or against the board.  Another option is to use roller gauze instead of cravats. With this, students will just roll the gauze from distal to proximal on extremity.  Recheck CMS on both extremities once splinting is complete 31  A sling and swathe is not required due to hand and forearm being immobilized, which meets the requirements of securing the bone above and below an injured joint

Sling and Swathe Application  Check CMS in both upper extremities at the same time  Cravat positioned across patient’s chest. The point of the triangular bandage (cravat) will be towards the patients elbow.  A knot can be tied in this corner, allowing a pocket to “catch” the elbow.  Form the sling by lifting the ends of cravat and cradling the arm  The ends of the cravat are brought around the neck. The ends need to be pulled tight enough so that the arm cannot drop, and the patient feels that their arm is being supported. Once this is established, the ends are to be tied in a knot against the neck, with padding placed for comfort.  A swathe is formed by folding a cravat so that it is about 2-3” wide  The swathe is then placed across the arm in the sling, with the broad surface of swathe going around the injured arm’s humerus. The two ends of the swathe should then be tied with padding underneath the knot. Neither the swathe nor the knot should be tied over an injured area.  The swathe must encompass the forearm. It cannot be placed across the chest and only include the cravat.  CMS rechecked in both upper extremities at the same time