Pelvic injuries, often resulting from high-impact trauma, represent a serious medical emergency. The ring-like structure of the pelvis is situated near major blood vessels, meaning a fracture can lead to rapid, massive internal bleeding that is not visible externally. This internal hemorrhage can quickly cause life-threatening hypovolemic shock. The first aider’s primary responsibility is to minimize further damage and manage the patient’s condition until professional emergency medical services (EMS) arrive.
Recognizing Signs of Pelvic Injury
The initial assessment of a trauma victim must include a high suspicion for a pelvic injury, especially after a high-energy mechanism of injury. The most immediate symptom is often severe pain localized to the groin, hip, or lower back area. This pain is typically exacerbated by any attempt to move or bear weight on the legs. A first aider should observe the victim’s lower extremities for any signs of deformity. One leg may appear noticeably shorter than the other, or the foot on the injured side might be rotated outward (external rotation). While assessment is necessary, avoid aggressively palpating or testing the pelvis, as this movement can dislodge blood clots and worsen internal bleeding. Visible signs like bruising or swelling over the hip bones or groin area can develop rapidly, further indicating underlying trauma and potential vascular damage.
Initial Safety and Emergency Protocol
Before approaching a potential victim, the first aider must ensure the scene is safe to prevent any further danger to themselves or the injured person. Once safety is confirmed, the single most important action is to immediately call for emergency medical services (911 or local equivalent). While waiting for EMS, the first aider must conduct a brief primary survey to check for life-threatening conditions, prioritizing airway, breathing, and severe external circulation problems. If the victim is conscious, keep them calm and continually monitor their level of responsiveness and breathing quality. Any heavy bleeding that is externally visible should be controlled with direct pressure.
Stabilization and Shock Management
The physical treatment provided by a first aider centers on gentle stabilization and managing the onset of shock. The victim must be kept flat on their back on a firm surface to prevent movement of the fractured bone ends. This stable positioning is crucial because movement can disrupt clots and accelerate internal hemorrhage.
If the first aider is trained and appropriate materials are available, a pelvic binder or an improvised circumferential wrap can be applied. An improvised binder, such as a wide sheet or large towel, should be gently slid underneath the victim. The wrap must be positioned over the greater trochanters (the prominent bony knobs on the upper thigh near the hip joint), and then pulled snugly across the front of the pelvis. This gentle compression aims to close the fractured pelvic ring, reducing the potential space for blood loss and providing a degree of internal hemorrhage control.
Signs of shock, such as pale, cool, or clammy skin, a rapid pulse, or altered consciousness, indicate significant blood loss. To manage this developing condition, the victim must be kept warm by covering them with blankets or spare clothing. Maintaining the victim’s body temperature helps to slow down the metabolic demands and supports the body’s ability to clot blood.
Critical Actions to Avoid
Certain actions can significantly worsen a pelvic fracture and increase internal bleeding. The victim should not be moved under any circumstances unless they are in immediate danger, such as a burning vehicle or an unstable structure. Attempting to lift, drag, or reposition the victim without proper spinal immobilization techniques can turn a stable fracture into an unstable one.
Do not attempt to straighten a leg that appears shortened or rotated, as this manipulation can cause further damage to blood vessels or nerves. The first aider must also avoid giving the victim anything to eat or drink, even water, because the injury may require emergency surgery. Excessive pressing or “springing” on the hips to test for instability is also contraindicated, as this maneuver can cause unnecessary pain and increase internal bleeding.