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Tue Mar 10 19:00:31 GMT 2009

Let's be clear what we're talking about here.  Are we talking about
pelvic belts in general or the T-POD binder?

Pelvic belts are an ideal prehospital device.  They provide fracture
splintage during the phases where there is the most movement (and
potential clot disruption). They should be placed to protect &
stabilize a suspected pelvic injury, just like any splint - and as a
protective device just like the C-collar.  Like any splint they will
reduce bleeding from bone ends and some venous bleeding.  (They will
never control significant arterial bleeding).   (Tim - following your
logic about exposure then cervical spine collars should not be placed
pre-hospital).

The belts are there to stablize - not to "close-down" a pelvis.  As
such they can be placed on any pelvic fracture (before the fracture
pattern is known). They should not be applied by two gorillas leaning
on the pelvis, but just snugly over the greater trochanters.

I personally don't see any reason for placing them over clothes.
These should be cut off and then the belt placed.  BUT if they are on
over clothes then take it off, cut the clothes off and then put it
back on!!

I've never liked the T-POD.  It's too big, too over-engineered, too
inflexible and doesn't allow easy access for laparotomy/angio.  Like
Tim says a simple belt like the Pelvigrip or SAM sling is ideal.

As for no data - it's true there is little specific data related to
the belts (but about as much as there is for any type of splintage).
BUT there is data recently from protocolised care of bleeding pelvic
fractures that includes using the pelvic belt as part of the
management algorithm.

Karim

2009/3/10 Dr Timothy Hardcastle <dr.tchardcastle at absamail.co.za>:
> Johan
>
> Good reason to change practice - they should NOT be used pre-hospital: The
> pelvic binder is only useful for open-book fractures (AP compression
> type), more for patient support than anything else (I agree with Norman's
> comments).
>
> Good practice of ATLS is to do an EXPOSURE with ENVIRONMENTAL control -
> neither is possible with the binder. If they want to use something, the
> Pelvigrip type device, with velcro straps for easy removal/adjustment is a
> better option. Also re-usable (made of neoprene)
>
> How fast do you get your trauma-CT. If less than 30 minutes - fine,
> otherwise get the pelvic mobile film in the ER.
>
> Regards
> Tim
>
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer University of KwaZulu-Natal Dept Surgery
> Deputy Director - IALCH Trauma Service
> Durban - South Africa
>>
>> Hello!
>> I have a question to all of you regarding the use of prehospital pelvic
>> binders. I work at a small hospital where we dont have access to x-ray of
>> the pelvis in the traumaroom. Currently the prehospital personel applies
>> the TPOD (pelvic binder) in the prehospital setting whenever they suspects
>> a pelvic fracture. The TPOD is often placed before removing the patients
>> cloths. This approach interferes the examination of the patient in the
>> traumaroom because when the pelvic divice is applied prehospital every one
>> is afraid of removing it with the fear of bleeding. Since we dont have
>> acces to plain x-ray in the traumaroom we often leave the TPOD until the
>> trauma-ct is done and we have  pictures. The tpod also makes it difficult
>> to remove the patients clothes and sometimes makes it impossible to make a
>> good examination of the lower back, perineum/rectum. How would yo approach
>> this matter?
>>
>> Johan
>>
>>
>>
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Prehospital pelvic compression