PELVIC BINDERS: a thread.
At @nhsuhcw we receive major trauma patients wearing one of the three commercial pelvic binders shown below, applied by our @OFFICIALWMAS @EMASNHSTrust ambulance service or @WNDLRAirAmb @MAA_Charity @MAGPAS_charity air ambulance colleagues:

Pelvic binders are indicated for a suspected UNSTABLE PELVIC FRACTURE from a HIGH MECHANISM of injury. They reduce venous haemorrhage & keep the fracture still, allowing clots to form. A suggested pre-hospital decision tool from @FPHCEd (2012) is shown below:

Pelvic binders must be applied:

*Direct to skin (not over clothing, including underwear)
*At the level of the greater trochanters
*With the correct tension
*And with no full log-rolling

The most common error is that the binder is applied too high.

If a patient arrives without a binder who needs one (very rare) then we position the splint at the correct level on the ED trolley and lay the scoop stretcher/patient on top. When we remove the scoop stretcher we can then fasten the binder.

With a pelvic binder in situ, anatomical alignment may be restored on the CT leading to false reassurance. If CT = normal, but the pt has symptoms/signs of pelvic # or is unconscious, we routinely perform plain x-ray with the binder open to rule out an occult unstable fracture.