In today’s installment of Improvised Splints, we’ll go over how to make an impromptu brace for wrist, hand, and forearm injuries.
This is the second article of a three-part series. Check out Improvised Splints – Part I: Basic Principles.
The Sling and Swath
The sling and swath is used for all upper extremities. The sling supports the injured extremity and immobilizes the lower arm, while the swath functionally immobilizes the shoulder and keeps the arm from “chicken winging” outward.
Step 1: The inner splint
- Pad and size.
An inner splint (a semi-rigid sheet under the forearm) helps, but isn’t strictly necessary. Use a SAM splint (a commercial splint that comes in many outdoor first aid kits), or cut out a section of foam and fold it in half. It’s a good idea to measure your splints against the uninjured extremity before applying them. Make sure you put a layer of padding between the splint and the arm, and wrap a layer of clothing around the arm before applying the splint to the forearm. - Apply the splint to the arm.
Secure it by tying cravats or by wrapping fabric, gauze, Ace bandage, strips of cloth, etc., from the back of the hand all the way to the elbow. Make sure the splint supports the hand, and there is something for your injured friend to hold: a rolled up bit of cloth works well, or the end of the splint. **TIP: make sure you wrap your cravat, gauze, etc., over the back of the hand, then between the thumb and first finger, then back under the split. This helps secure the hand to the splint and prevents the patient’s wrist from flopping around.
Secure the inner splint to the arm with wide cravats, strips of fabric, or an ace bandage.
Step 2: The sling
- Take a cravat and tie an overhand knot a few inches from the apex of the triangle. This creates a pocket for the elbow to sit in. Have the patient put his hand over his heart, as if he were saying the pledge of allegiance. Pass the sling around his elbow, tying the two swath ends together around the shoulder. Pad under the knot.
The sling. Note the position of the arm.
Step 3: The swath
- Tie a cravat (or wrap strips of fabric, etc) around the injured arm and secure it to the other side of the body. The swath should be fairly low (covering the injured person’s elbow), and the wider the better. No chicken winging should be possible. Pad under any knots, as these will become uncomfortable pressure points during a long evacuation.
The sling with a hoody used as a swath.
Variations
- For a humerus fracture (upper arm injury) A fractured humerus hurts like hell. The humerus is a long bone, and the tricep and bicep are fairly large muscles (especially if you’ve got guns like mine). When a humerus breaks, the tricep and bicep pull the broken ends together, which is extremely painful. You can counteract this by creating gentle traction. Place the splint on the upper arm, and secure it with either an Ace bandage, gauze, or a few cravats. If you’re using cravats, make sure to tie one below and one above the injury, not on the injury itself (this could be very painful). Now make a sling, but do not support the patient’s elbow. The goal here is to comfortably support the forearm, but let gravity pull on the upper arm a bit, providing a bit of gentle traction. Finish off the splint with double swaths, which should immobilize the shoulder.
A sling and swath for an upper arm injury. The sling does not support the end of the elbow, and the shoulder is immobilized with 2 swaths.
- For a collarbone injury Just make a sling and swath, no inner splint required.
- For a elbow injury The only difference here is that you’ll have to make sure that there is no pressure on the elbow and that the entire elbow area is extremely well padded. A good technique for this is to create an upper arm splint (like in the humerus example) but slide the splint down the arm so that it sticks out below the elbow. Pad the elbow area well, then apply a sling and swath like normal.
The inner splint positioned for an elbow dislocation or fracture.
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Tags: backpacking, do-it-yourself, outdoor survival, safety, wilderness survival
[...] out Part I: Basic Principles of Splints if you don’t know what a cravats does, or check out Part II if you broke an [...]
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Great article. I agree 100%. Something important I have learned is that no matter who you are being able to survive in the wilderness or the end of the world is a must. I recomend http://www.survivalguide4pros.com to anyone who hasn’t seen it yet. Keep up the great work and god bless – DC
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The photo of the “splinted humerus” is amazingly horrible. That wouldn’t do ANYTHING for the patient – let alone, stabilize the injury! A T-Shirt with a small slab of sleeping pad foam is NOT sufficient to create enough rigidity (or padding) to the injury, and would honestly be a complete waste of materials, as well as valuable time for all involved.
A much better recommendation would be to use a rigid splint; or even to create an anatomic splint to the person’s torso. Padding is a great idea, as there is nothing that can be done for this patient in the field with the exception of making them comfortable until they have been evacuated to definitive care.
Just my humble thoughts.
Regards,
John Holman, WEMT
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[...] more information, you can visit First Aider or Backcountry Beacon. Image source: First Aid Manual Irish Edition. 9th Revised edition ed. Dorling Kindersley, 2009. [...]
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