APPLICATION OF BASIC SPLINTS AND SLINGS

COURSE OVERVIEW

Application of Basic Splints and Slings is a practical, simulation-based clinical skills course designed to equip undergraduate MBBS students with the knowledge, clinical judgment, and psychomotor skills required for the safe temporary immobilization of injured limbs.

Splinting and sling application are important first-aid and trauma-care skills. Correct immobilization can reduce pain, limit movement, protect injured tissues, and help prevent further neurovascular or soft-tissue injury while the patient is being evaluated and transferred for definitive management.

This course takes students beyond simply learning how to apply a splint. It emphasizes a structured clinical approach:

ASSESS → SUPPORT → IMMOBILIZE → REASSESS → REFER

Learners are trained to assess the injury, establish a baseline distal neurovascular status, select appropriate equipment, support the injured limb, apply adequate padding, immobilize safely without unnecessary or forceful manipulation, and reassess circulation, sensation, and movement after application.

LEARNING OUTCOMES

By the end of the course, the learner will be able to:

Knowledge

• Define splints and slings and describe their clinical purposes.
• Explain the principles of temporary immobilization following trauma.
• Identify common indications for splint and sling application.
• Describe commonly used basic upper- and lower-limb splints.
• Explain the importance of padding and appropriate securing.
• Describe the importance of pre- and post-immobilization neurovascular assessment.
• Recognize complications associated with inappropriate or excessively tight splinting.
• Identify clinical situations requiring urgent referral or escalation.

Clinical Skills

The learner will be able to:

• Perform a focused assessment of an injured limb.
• Assess distal circulation, sensation, and motor function.
• Select an appropriate splint or sling for a simulated injury.
• Support an injured limb safely.
• Apply appropriate padding, particularly over bony prominences.
• Apply a basic forearm/upper-limb splint.
• Apply a triangular-bandage arm sling.
• Apply a basic lower-limb splint in a simulation environment.
• Secure immobilization without excessive pressure.
• Keep appropriate distal areas visible for ongoing assessment.
• Perform and compare neurovascular assessment before and after immobilization.
• Provide appropriate aftercare and referral advice.

Professional Skills

Learners will also practise:

• Patient identification
• Introduction and explanation
• Consent
• Respectful communication
• Maintenance of dignity
• Infection prevention
• Teamwork and assistance-seeking
• Clear clinical documentation

COURSE CONTENT

MODULE 1 — INTRODUCTION TO SPLINTS AND SLINGS

Students are introduced to the role of splints and slings in acute trauma care.

Topics include:

• Definition of a splint
• Definition of a sling
• Purposes of immobilization
• Pain reduction
• Protection from further injury
• Temporary stabilization
• Safe patient transport
• Relationship between splinting and definitive fracture management

A key concept emphasized throughout the course is:

Splinting is temporary protection — not definitive fracture treatment.

MODULE 2 — INITIAL ASSESSMENT BEFORE SPLINTING

Before applying any immobilization device, students learn to perform a focused assessment of the injured limb.

The assessment includes:

• Mechanism of injury
• Pain
• Swelling
• Deformity
• Bruising
• Skin integrity
• Open wounds
• Bleeding
• Distal circulation
• Sensory function
• Motor function

Students are taught to establish a neurovascular baseline before splint application.

MODULE 3 — NEUROVASCULAR ASSESSMENT

Neurovascular assessment is one of the most important safety components of the course.

Students practise assessment of:

Circulation

• Distal pulse
• Capillary refill
• Skin colour
• Skin temperature

Sensation

Assessment of appropriate distal sensory areas.

Motor Function

Assessment of appropriate distal movement when clinically safe.

Learners are taught to document findings and compare the examination before and after immobilization.

Core Message

CHECK BEFORE — CHECK AFTER

MODULE 4 — SPLINTING EQUIPMENT

Students become familiar with common equipment used for temporary immobilization.

This includes:

• Padded rigid splints
• Forearm splints
• Posterior lower-leg splints
• Thomas splint where available
• Triangular bandages
• Roller/crepe bandages
• Gauze
• Cotton/padding
• Adhesive tape
• Scissors
• Gloves
• Arm slings

Students learn how to select equipment based on:

• Injury location
• Limb size
• Clinical condition
• Swelling
• Soft-tissue injury
• Neurovascular findings
• Availability of equipment
• Local clinical protocols

MODULE 5 — PRINCIPLES OF SAFE SPLINTING

The course introduces four essential principles:

1. ASSESS

Understand the injury and establish neurovascular status.

2. SUPPORT

Support the injured limb and minimize unnecessary movement.

3. IMMOBILIZE

Apply the appropriate padded splint and secure it safely.

4. REASSESS

Repeat the neurovascular examination after application.

The complete clinical sequence is:

ASSESS → SUPPORT → IMMOBILIZE → REASSESS → REFER

MODULE 6 — BASIC FOREARM SPLINT APPLICATION

Through instructor demonstration and supervised practice, learners perform a basic forearm splint application.

Students practise:

1. Introducing themselves and explaining the procedure.
2. Obtaining consent.
3. Performing hand hygiene and using appropriate PPE.
4. Assessing the injury.
5. Performing a pre-splint neurovascular assessment.
6. Supporting the injured limb.
7. Selecting an appropriately sized splint.
8. Applying adequate padding.
9. Positioning the splint appropriately.
10. Securing the splint safely.
11. Avoiding excessive pressure.
12. Keeping appropriate digits visible.
13. Performing post-splint neurovascular reassessment.
14. Providing aftercare and referral advice.

A major safety principle is reinforced:

Do not forcefully straighten or manipulate a deformed limb simply to facilitate splint application.

MODULE 7 — ARM SLING APPLICATION

Students learn the correct use of a triangular-bandage arm sling for upper-limb support.

The session covers:

• Positioning the injured arm
• Supporting the forearm and wrist
• Correct placement of the triangular bandage
• Securing the sling
• Avoiding excessive pressure around the neck
• Maintaining comfort
• Checking distal circulation and sensation
• Recognizing when a sling alone is insufficient

Students understand that a sling is primarily a support device and does not necessarily provide adequate immobilization for every fracture or traumatic injury.

MODULE 8 — BASIC LOWER-LIMB SPLINTING

Students practise safe temporary immobilization of a simulated lower-limb injury.

The sequence includes:

Assess → Support → Pad → Position → Splint → Secure → Reassess

Learners practise:

• Inspection of the limb
• Distal neurovascular assessment
• Safe limb support
• Appropriate padding
• Splint positioning
• Secure fixation
• Avoidance of excessive pressure
• Keeping toes visible where appropriate
• Post-application reassessment
• Safe transport and referral principles

MODULE 9 — COMPLICATIONS AND SAFETY

Students learn to recognize complications that can occur following inappropriate immobilization.

Important warning signs include:

• Increasing pain
• New or worsening numbness
• Tingling
• Pale fingers or toes
• Bluish discoloration
• Cold distal extremity
• Reduced movement
• Increasing swelling
• Reduced or absent distal pulse

Learners are taught that these findings require prompt reassessment and appropriate escalation.

Particular emphasis is placed on avoiding:

• Excessively tight bandaging
• Inadequate padding
• Unnecessary manipulation
• Failure to assess neurovascular status
• Failure to reassess after splint application

MODULE 10 — CLINICAL SIMULATION AND CASE-BASED PRACTICE

The course uses realistic simulation scenarios to help students transfer the skill from the laboratory into clinical decision-making.

Example scenarios include:

Scenario 1 — Suspected Forearm Fracture

A patient presents with pain, swelling and deformity following a fall.

Students must:

• Assess the injury.
• Perform neurovascular examination.
• Support the limb.
• Apply an appropriate splint.
• Reassess.
• Arrange appropriate referral.

Scenario 2 — Neurovascular Compromise

A simulated patient develops:

Increasing pain, numbness and cold fingers after splint application.

Students must recognize the warning signs and respond appropriately.

Scenario 3 — Lower-Limb Trauma

Students assess, support and immobilize a simulated lower-limb injury before arranging further management.