SPLINT MANAGEMENT

Any splint placed in TCCC must be periodically reassessed for complications, such as pressure points, irritation, excessive tightening, and missed underlying wounds. Additionally, all extremities and palpable bony structures must be thoroughly assessed for any unrecognized fractures that may have been missed during the initial TCCC treatments.

Non-medical Responders

If a splint was placed in TCCC, ensure that it is still in place and not causing additional pain beyond the fracture it is stabilizing. Refer any issues with the splint to the medical responder immediately.

Medical Responders

Any suspected fractures or significant extremity injuries identified but not previously treated will be managed IAW the TCCC Guidelines. Injured and splinted extremities will tend to initially have increased swelling for 2-5 days after a significant injury. Continual reassessment is mandatory for all applied splints. Basic steps for evaluating previously applied splints include:

- If the casualty is verbal, ask if the splint (and not the fracture) is causing pain.
- Recheck pulses distal to any splint at least every 6 hours when the casualty is conscious, more frequently if there are any complaints of pain due to the splint. If the casualty is unconscious, pulses distal to the splint must be checked every 2 hours.
- Ensure that the splints are fitted properly and have not shifted. Readjust or replace the splint as needed.
- Ensure that the splints are adequately stabilizing the fracture, ideally immobilizing one joint above and below the injury. Improve or replace the splint as needed.
- Check for pressure injuries by examining the skin around the splint. Skin should blanch within 2-3 seconds. If there is non-blanchable erythema, changes in sensation, or the skin feels warmer to the touch, the casualty could have a stage 1 pressure injury.
- Look for possible hypersensitivity or allergic reactions to tape applied directly to the skin by checking for developing erythema, excessive dryness, cracking, or breakdown.
- Assess for any signs of compartment syndrome. If present, adjust or loosen the splint and reassess. If the symptoms are still present, remove the splint and contact your higher medical authority.

*NOTE: The first and most important symptom of compartment syndrome is pain, particularly when worsening, pain with passive motion or pain out of proportion to the injury. If the casualty is non-verbal, then it is critical to continually reassess any splinted extremity for other signs indicative of developing compartment syndrome and address the problem immediately.