If the mechanism of injury raises the suspicion of a pelvic injury (IEDs, blasts, motor vehicle accidents (MVAs), etc.) and/or the five major signs and symptoms we just reviewed are present, then a PCD should be applied.

CoTCCC has evaluated several commercially available PCDs and recommended three of them:

- PelvicBinder®
- T-POD™ Pelvic Stabilization Device
- SAM® Pelvic Sling II

Of note, two of the junctional hemorrhage control devices also provide pelvic stability and could be considered: the SAM Junctional Tourniquet (SJT) and the Junctional Emergency Treatment Tool (JETT™).

Whichever PCD is used, it should be placed at the level of greater trochanters, NOT the iliac crests. In one study, 40% of the pelvic binders were placed too high, resulting in inadequate reduction of the pelvic fracture and possibly increased bleeding.

Also, external rotation of the lower extremities is commonly seen in casualties with displaced pelvic fractures, which may increase the dislocation of pelvic fragments. Secure the knees and/or feet together to prevent external rotation and improve the effect of the PCD.

If you must move the PCD to access the groin or pelvic area for other critical casualty management purposes, temporarily move it to the upper thighs and replace it as soon as possible.

### Contraindication for Pelvic Compression Device

- Open Pelvic Fractures
- Perineal Lacerations
- Intraabdominal injuries requiring surgery
- Burns
- Severe associated pelvic soft tissue injuries may necessitate external fixation of the pelvis instead of a pelvic binder

Open fracture to the pelvis may lacerate the rectum, perineum, or vagina, and an obvious source of external blood loss may not be readily apparent.