How to Administer First Aid for a Fractured Bone

A fractured bone, commonly referred to as a broken bone, is a significant injury that necessitates medical attention. However, receiving prompt first aid from trained medical professionals may not always be feasible in certain situations — some circumstances could result in a delay in medical care lasting several hours or days. Even in developed countries, the average person experiences two broken bones during their lifetime, making them relatively common occurrences. Therefore, understanding how to administer first aid for fractured bones is crucial for assisting oneself, family members, or others in emergency scenarios.

Evaluate the injured area. In an emergency situation where trained medical personnel are unavailable, it's essential to quickly assess the severity of the injury. While trauma from a fall or accident accompanied by severe pain doesn't necessarily indicate a broken bone, it often serves as a reliable indicator. Fractures involving the head, spine, or pelvis are challenging to identify without an x-ray; if you suspect a break in one of these areas, refrain from moving the individual. Conversely, bones in the arms, legs, fingers, toes, and nose typically appear crooked, misshapen, or visibly out of place when fractured. Severe fractures may protrude through the skin (open fracture), leading to significant bleeding.

• Other common symptoms of fractured bones include limited use of the injured area (reduced mobility or inability to bear weight), immediate localized swelling and bruising, numbness or tingling beyond the fracture site, shortness of breath, and nausea.
• Exercise extreme caution during the assessment to minimize movement. Moving an individual with an injured spine, neck, pelvis, or skull poses significant risks without proper medical training and should be avoided.

Contact Emergency Services Immediately for Severe Injuries: If you determine that the injury is severe and suspect a broken bone, call 9-1-1 to request an ambulance and ensure that professional medical assistance is en route as quickly as possible. While providing basic first aid and support can be beneficial, it does not replace the need for trained medical attention. If a hospital or emergency clinic is nearby, and the injury is not life-threatening and involves only a limb, consider transporting the injured individual to the facility.

• Even if the fracture seems non-life-threatening, refrain from driving yourself to the hospital. You may be unable to operate the vehicle effectively or may lose consciousness due to pain, posing a hazard on the road.
• If the injury appears severe, stay on the line with the 9-1-1 dispatcher to receive helpful instructions and emotional support in case the situation deteriorates.
• Contact emergency services if you observe the following: the individual is unresponsive, not breathing, or not moving; there is excessive bleeding; gentle pressure or movement causes pain; the limb or joint appears deformed; the bone has penetrated the skin; the extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip; you suspect a broken bone in the neck, head, or back.

Perform CPR if Necessary

: If the injured individual is not breathing and you cannot detect a pulse on their wrists or neck, initiate cardiopulmonary resuscitation (CPR) until the ambulance arrives. CPR involves clearing the airways, providing artificial respiration, and attempting to restore heart function by applying rhythmic pressure to the chest.

• Prolonged lack of oxygen for more than five to seven minutes can result in some level of brain damage, emphasizing the importance of timely intervention.
• If you are not trained in CPR, administer hands-only CPR by delivering uninterrupted chest compressions at a rate of approximately 100 per minute until paramedics arrive.
• If you are proficient in CPR, begin with chest compressions immediately (about 20 – 30) and then assess the airway for obstructions, followed by initiating rescue breathing after gently tilting the head back.
• In cases of spinal, neck, or head injuries, refrain from using the head-tilt-chin-lift technique. Instead, utilize the jaw-thrust method to open the airway, provided you have received proper training. This method involves kneeling behind the individual, placing hands on either side of their face, and pushing their jaw forward until it protrudes.

Control Bleeding: If the injury is bleeding significantly (more than a few drops), take immediate steps to stop it, regardless of whether a fracture is present. Profuse bleeding from a major artery can lead to death within minutes, making bleeding control a top priority over addressing a broken bone. Apply firm pressure to the wound using a sterile, absorbent bandage, or if unavailable, a clean towel or piece of clothing. Maintain pressure for several minutes to facilitate clotting at the injury site. Secure the bandage around the wound using an elastic bandage or cloth if possible.

• If bleeding persists from a limb injury, consider applying a tight tourniquet above the wound to temporarily restrict circulation until medical assistance arrives. A tourniquet can be fashioned from various materials that can be securely fastened, such as string, rope, cord, rubber tubing, a leather belt, necktie, scarf, or tee-shirt.
• If a foreign object is lodged in the skin, avoid removing it, as it may be aiding in clotting. Removing it could result in severe bleeding.

Stabilize the Fractured Bone: Once the injured individual is stabilized, immobilize the broken bone if you anticipate a wait of an hour or more for emergency medical assistance. Immobilization can alleviate pain and prevent further injury due to inadvertent movement. Avoid attempting to realign the bone without proper training, as improper alignment can damage blood vessels and nerves, potentially leading to bleeding and paralysis. Splinting is effective for limb bones but not for pelvic or torso bones.

• To immobilize the bone, create a simple splint using stiff cardboard, a branch, metal rod, or rolled-up newspaper/magazine placed on either side of the injury to provide support. Secure these supports together with tape, string, rope, cord, rubber tubing, belt, scarf, etc.
• When splinting, allow movement in adjacent joints and avoid excessive tightness to promote adequate blood circulation.
• Splinting may not be necessary if emergency services are imminent, as improper splinting can exacerbate the injury without appropriate training.

Apply Cold Therapy: After immobilizing the broken bone, apply cold therapy, preferably ice, to the injury while awaiting medical assistance. Cold therapy helps numb the pain, reduce inflammation and swelling, and minimize bleeding by constricting arteries. If ice is unavailable, use frozen gel packs or bags of vegetables wrapped in a thin cloth to prevent ice burn or frostbite.

• Apply ice for approximately 20 minutes or until the area becomes numb before removing it. Applying compression may further reduce swelling, provided it does not exacerbate the pain.

Maintain Calmness and Monitor for Shock: Breaking a bone is a distressing and painful experience that can induce fear, panic, and shock. It's crucial to remain calm and reassure the injured individual while awaiting assistance. Keep the person warm, offer hydration if thirsty, and engage in conversation to distract from the injury.

• Signs of shock include dizziness, pale complexion, cold sweats, rapid breathing, increased heart rate, confusion, and irrational panic.
• If signs of shock are present, lay the individual down with head support and elevate the legs. Cover with a blanket or jacket to maintain warmth and comfort.
• Shock diverts blood and oxygen from vital organs, posing a risk of organ damage if left untreated.

Consider Pain Relief: If the wait for emergency assistance exceeds an hour or is expected to be lengthy, consider administering pain medication, if available, to alleviate discomfort. Acetaminophen (Tylenol) is suitable for managing pain associated with broken bones and internal injuries as it does not affect blood clotting.

• Over-the-counter anti-inflammatories like aspirin and ibuprofen (Advil) relieve pain and inflammation but should be avoided for internal injuries like broken bones due to their blood-thinning effects.
• Avoid giving aspirin and ibuprofen to young children to prevent potential adverse effects.