Dr. Janet Hurley

My family was recently celebrating a family birthday at an indoor facility, which included trampolines. Sadly, a girl fell and hurt her arm. My son appropriately alerted me to see if I could help.

The child’s arm was obviously broken, with a visible bend in her arm between her wrist and her elbow. She was lying on the trampoline crying in pain. She had no other visible injuries, was awake and alert and was not bleeding. She had fallen while on the trampoline, not from a great height. Her mom and the manager were already at her side by the time I arrived. We now had to determine what to do next. There are two key take-home points to learn from this experience.

First, a simple splint makes transport much easier. Splints help to stabilize the fracture and provide comfort while the patient is being moved. Splints can be made from any stiff object, such as cardboard, plastic, thin wood or anything else stiff and small lying around. Preferably it will be about as long as the bone you are trying to splint. This object can be laid along the edge of the bone, and gently attached around it with an ace-wrap, tape, a belt, a scarf or anything else that can be wrapped around it to hold it in place. This only needs to last a short time to get the patient to a medical facility, so it does not need to be beautiful or perfect. In this situation, I used cheap paper plates and shaped them into a tube around her arm, then stretched a sock around it to hold it together. Once we got this child splinted, she stopped screaming in pain with simple movements. She was still in a lot of discomfort, yet she was able to be moved out of the facility in a wheelchair without crying.

Second, the medico-legal circumstances may prevent the local facility management from providing medical care. The manager offered to call an ambulance or to get a wheelchair, yet otherwise we were on our own to get her up, splint her and make transport arrangements. If we could not do it on our own, he would call an ambulance, which really was not necessary. I understand why he had this approach, as this is probably an industry policy. They are not as protected by the Good Samaritan Law as are other patrons in the facility at that time. The manager said he could not provide materials for splinting. I helped her mom move her from the trampoline to a bench, and I was on my own to find splinting supplies, which I did.

Some may worry that the splint can get too tight as the broken body part swells, yet if the patient is going directly to a care facility for advanced care this won’t likely be a problem. A good rule of thumb is that a splint should make the injured part feel the same or better, never worse. An awake patient will alert you to worsening discomfort. If the injured part starts to hurt worse, the splint should be loosened or removed. If advanced care takes more than an hour, the splint should be checked every hour to be sure it is not getting too tight. If the fingers get pale or purple, or if the patient is having much more pain, the splint is probably too tight. If the patient has other injuries, is not coherent, has neck or back pain or fell from a height, then an ambulance should be called.

An isolated injury to an arm with a visible deformity and no other obvious injuries might feel much better during transport with a rudimentary splint made from basic, household objects found in proximity. If the injury occurs in an activity park, don’t assume the management will be able to provide much medical advice. If you have medical training, you could provide some appreciated support by assisting with a splint or providing other basic first aid that the management might not legally be able to provide. Providing help to sweet little girls like this is certainly worth it.