Why was splinting removed from First Aid at Work?

The above is bit of a misleading statement. At Marlin splinting never was removed from First Aid at Work training, but it seems that for many other organisations splinting protocols simply aren't being taught. "Call the ambulance" has become the 'First Aid Protocol'.

The Health and Safety (First-Aid) Regulations 1981 (amended 2018) state in "what should be in a First Aid at Work Course:

  • administer first aid to a casualty with:
    – injuries to bones, muscles and joints, including suspected spinal injuries; – chest injuries;
    – burns and scalds;
    – eye injuries;
    – sudden poisoning;
    – anaphylactic shock;
  • recognise the presence of major illness (including heart attack, stroke, epilepsy, asthma, diabetes) and provide appropriate first aid.

It should be noted that it states "administer first aid...to....injuries to bones, muscles and joints. Further this is detailed in the section with other first aid treatments, such as treating burns with water or washing something out of an eye. 

The European Resuscitation Council also give advice on splinting: European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid

"Do not straighten an angulated long bone fracture: Protect the injured limb by splinting the fracture. Realignment of fractures should only be undertaken by those specifically trained to perform this procedure."

This is clear advice to splint fractures, but not to straighten angulated fractures in a first aid setting. This is what we teach on our courses.

 The NHS also give advice on when to call an ambulance. It is clear that these should be reserved for "life threatening emergencies" and a simple fracture is NOT one of these. The NHS advice on broken bones states, "go to your nearest A&E for a broken arm or leg. Call 999 for an ambulance if the injury seems severe". It certainly does not state "just call an ambulance if you think someone has broken a bone', as seems to be advocated on so many First Aid at Work courses.

So, at Marlin we teach a pragmatic approach to broken bones and splinting:  “Do as little as you need to do, not as much as can be done”.

1.       Assessment

2.       Pain Management

3.       Treatment

Not to splint:

Let's take the example of a simple closed fracture of a forearm or ankle. It isn't bleeding externally and isn't life threatening. The patient may be in considerable pain, not want to move and be content to sit and hold it in place until an ambulance arrives. That's fine, however as a first aider it is sensible to let them know that it isn't a life threatening emergency and they might be waiting hours for an ambulance to arrive! The author's own 90 yr old step-mum spent 7 hours waiting for an ambulance to take her to hospital with a broken hip only a few months ago.

 Splinting:

Alternatively the patient may consent to splinting the fracture:

A splint prevents further movement, stops the fracture becoming worse (or the bone popping out turning a closed fracture to an open one). It also dramatically reduces pain by preventing motion. A simple splint for a forearm or ankle can be made using a rolled up newspaper or cardboard box, both found easily in most workplaces. Once the pain has been lessened the patient may then consent to being taken in a car or taxi to the local A&E department.

In a recent scenario one of our students treated a suspected broken ankle by immobilising it with tape and pieces of a cardboard box. The patient attended A&E and staff complimented the first aider on the job they had done (using the skill taught on our FAW training).

Summary

Unfortunately despite the clear advice, many still will not teach any splinting in first aid. In some case this advice comes from large organisations themselves, whereas in other cases it is under-qualified instructors not having the confidence to teach splinting.

We are proud to be an organisation that teaches splinting routinely to our students:

 They are easy to improvises and can reduce pain dramatically. They save unnecessary 999 calls. First aiders shouldn't be frightened of them.

At Marlin we constantly look at what we teach and why we teach it.

In the last few years we have changed our protocols in many areas to offer our customers, and their staff, the most up to date and evidence based training possible. This means that at times what we teach will 'fly in the face' of what some other organisations are teaching. However, we would rather lead the way with effective evidence based training and let the others follow our lead.