Emergency Stabilization of Pelvic Fractures: An Evaluation of Virginia EMS Training Protocols

Background: Pelvic fractures are typically a result of high energy collisions, such as motor vehicle accidents (MVAs). For this reason, pelvic trauma is usually accompanied by a myriad of other injuries. Due to the potentially fatal nature of pelvic trauma, Emergency Medical Service (EMS) providers are often the first to administer treatment to patients with suspected pelvic fractures. While difficult to make a proper diagnosis in the field, it is essential to properly stabilize the pelvis whenever a fracture is suspected.

Hypothesis: 1) There will be a lack of emphasis on formal pelvic immobilization training among prehospital providers, especially in EMT-Basics. However, we believe some providers will feel confident in this skill simply due to the deceiving simplicity of pelvic binder application. 2) EMS providers with extensive experience, training beyond a basic EMT course, or those that practice in more rural localities will have had greater training and exposure to proper pelvic binding technique.

Methods: A survey was sent to prehospital providers throughout Virginia via their regional EMS district. This study included 258 EMS providers. Questions addressed sociodemographic characteristics, EMS experience, EMS locality, and the level of training exposure to pelvic binding.

Results: Of the EMS providers surveyed in this study, one quarter (25.2%) have never been trained in pelvic binding. A majority (70.5%) of providers in this study believed that not enough emphasis is currently placed on prehospital pelvic binding training. A majority (64.8%) of the providers trained in pelvic immobilization were certified at the paramedic level or above. Less than a quarter of respondents (19.2%) that were trained in pelvic binding had less than 7 years of experience in EMS. There was a significant correlation between geographic area and having been trained in pelvic binding, with only 10.9% of respondents that were trained in pelvic binding having a rural EMS background. There was a noticeable lack of racial diversity within the sample. The sample consisted of mainly white respondents (78.7%). Additionally, only 4.7% of respondents identified as African American.

Conclusions: Findings suggest a lack of emphasis in pelvic binding training for prehospital providers as well as a training deficit between rural and EMS providers. Further, there is a lack of racial representation within their workforce. Additional studies with a larger sample size must be conducted to evaluate the strength of these trends.