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. Every effort should be made to control bleeding coming from an open pelvic fracture or associated injuries

### Contraindication for Pelvic Compression Device

- Open Pelvic Fractures
- Perineal Lacerations
- Intra-abdominal injuries requiring surgery
- Burns
- Severe associated pelvic soft tissue injuries may necessitate external fixation of the pelvis instead of 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.

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.9

There are several commercially available PCDs that could be considered, and although the Committee on Tactical Combat Casualty Care (CoTCCC) previously evaluated and recommended some of them, others have since become available and there is no longer a COTCCC-recommended pelvic compression device list. Commercial PCD examples include the PelvicBinder®, the T-POD™ Pelvic Stabilization Device, and the 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™).

There is no evidence that any one commercial compression device is better than another.10, 11, 12

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.13, 14

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.15

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.

The evidence supporting the stabilization of pelvic fractures and reduced need for blood transfusions, when PCDs are properly applied, comes from nonrandomized studies, but the evidence supporting improved survival is lacking.