Ideally, every suspected pelvic fracture will be managed with a commercial PCD. But there are often only a handful of them available locally, and sometimes an improvised PCD must be considered.

In several studies evaluating the sheeting technique, where a sheet is wrapped circumferentially around the pelvis and tightened,17 the ability to stabilize pelvic fractures was nearly equivalent to commercial PCDs when properly applied.18,19,20

A common approach to improvisation is to use the casualty’s uniform pants as the binding materials by cutting them open from the ankles to the level of the greater trochanters, spreading them out to the sides like wings, and then drawing them tightly across the pelvis and tying them in a square knot to secure them and maintain pressure.21

But if the pants are torn or cannot be used, compression can be exerted by using any materials that can go around the circumference of the pelvis (for example, sheets, blankets, tourniquets linked together, elastic wraps, etc.). They would be placed, encircling the pelvis at the level of the trochanters, and then tightened and secured in place.

As with a commercial PCD, you would still want to prevent external rotation of the lower extremities by tying the casualty’s knees and/or feet together.