By A Manly Guest Contributor
Editor's note: This is a guest post from former Army medic Bruce A. West.
You're miles from any civilization at a lookout point on a large boulder with a friend, taking in the beautiful fall scenery, when your buddy slips and falls to the ground. They're holding their leg and screaming in pain; their tibia (shin bone) is sticking out of the skin, and blood is quickly escaping the wound. You run to their aid and put an improvised tourniquet on them to stop the bleeding. Now you need to get them out of the woods quickly, but you've got to do something about that fractured leg before you move them. What do you do? When you're in the wilderness you don't always have all the gear you need to save lives — let's face it, few of us are strong enough to carry an entire ambulance's worth of supplies on our backs. You don't have pre-made braces, crutches, or cast-making material on hand, and you probably don't have the tools to properly set a broken bone. What you do have is a first aid kit (maybe), a pocket knife, the clothes on your back, and the woods around you. These are all the tools you need for a makeshift splint that could mean the difference between life and death. Never mind all the rules you've learned about first aid, or all the technical gear you wish you had. You simply need to improvise. These techniques aren't pre-made, and they certainly aren't pretty. They're passed down through years of combat medics' experiences, and they're proven to save lives. Knowing how to treat a broken limb is one of the easiest and most important improvised first aid skills you can learn. Different kinds of fractures are treated differently, so today we will just focus on those in the lower leg (tibia and/or fibula). In future articles, I will explain how to handle other kinds of fractures (upper leg and arm). Lower leg fractures are common, and severe breaks can even be life threatening. I'll provide all the steps you need to know to perform this potentially lifesaving technique. Your Lower-Leg-Splinting Battle Plan If there are other people with you, have them call 911. If you're alone with the victim, make sure they're breathing, their heart is beating, and they have no major bleeding, and then call 911 yourself. Assuming you're in the middle of nowhere with no phone signal, you're probably going to have to move your patient to get reception – and you may need to travel just to be in a place where rescue workers can find you. But you can't move someone with an unsplinted, severely fractured limb. Follow these steps to brace their broken leg: Step 1: Scene Safety and Body Substance Isolation In military medicine, civilian medicine, and basic first aid the most important consideration is safety of the rescuer. Don't treat anyone if you're in harm's way. Now, you're not worried about guns and bombs, such as in military medicine, but you should consider other threats: your patient broke their leg from a fall…are you in a position to fall yourself? If you're at risk, address your threat first, and then care for the patient. In this case, you may need to drag your patient to level ground (despite their fracture or bleeding) before you can safely treat them. Then, before you do anything, protect yourself from disease by wearing gloves (or even plastic bags). Step 2: Expose the Wound & Assess the Patient Before you treat a patient you have to assess them in order of most important functions to least — and treat them as you encounter problems. It's always important to make sure your patient is breathing and that their heart is beating. You may have taken first aid and learned to remember your ABCs: Airway, Breathing, and Circulation. This is a great mnemonic device in a medical situation, but in major trauma this order of procedures can cost a life. In the Army we taught an acronym called MARCH, which stands for: - Major Hemorrhaging
- Airway
- Respirations
- Circulation
- Head Injuries, Minor Hemorrhaging, Hypothermia/Shock
ALWAYS address major bleeding first — if they're losing a lot of blood and you're worried about doing CPR, you've already lost them. In this case of open fractures (broken bones protruding through skin), blood loss is a major concern. You'll need to apply a tourniquet. So, assess and treat any major bleeding, then do your ABCs, or "-ARCH." The best and only way to know where your victim's wounds are is to expose them. In major trauma, do NOT focus only on the spots you know are hurt — there could be other injuries you're not seeing because they're masked by clothing. There's an old saying in medicine, "A happy trauma patient is a naked trauma patient." You can't fix anything you're unaware of. I advise undressing your patient entirely (you can always redress them later — as long as you don't cover any wounds). Step 3: Manually Stabilize the Fracture You're not a doctor (unless you are), and this isn't the movies, so you won't be setting your victim's broken bone. You need to leave it in the position you found it in, and you need to keep it still (so the broken bone doesn't cause more internal damage, i.e.: severed arteries; torn muscles, ligaments, tendons, etc.). You're going to splint it, but before you do, it's good practice to manually stabilize the broken limb while you prepare your homemade splint. If you aren't alone with the victim, have someone hold the broken limb in place. Manual stabilization is that simple; complicated name, easy execution. They're in pain, and they may be moving around; have someone hold their limb still to prevent further aggravation of the injury. This can really only be done if you have help; if it's just you and the victim, limb immobilization will have to wait until you've applied your splint. Step 4: Check for PMS Before you splint the limb, you need to assess their PMS. This means you check below the fracture for: - Pulse
- Motor Control
- Sensory Feeling
Check for tibial pulses (on the inside of the ankle, just behind the bump commonly referred to as the "ankle bone"), or for a dorsal pedal pulse (on top of the foot); have them wiggle their toes, and make sure they feel you touching their feet (pinch their pinky toe, ask them which toe you're touching). Here’s a short video on how to locate these pulses:
If there was an exposed fracture and you used a tourniquet, you won't find a pulse below the injury, and there may be little motor control or feeling. In less extreme cases, checking for PMS is important. If they had circulation, movement, and feeling to the hand/foot before you installed the splint, you want them to have the same sensations afterwards. Thus, you'll repeat this step later. Step 5: Select Your Splint  If you fracture your leg during a bartitsu fight with another distinguished gentleman, have your friend splint it with your umbrella. Here is your opportunity to get creative. You need to improvise a splint. Grab some thick sticks, a hiking pole or walking stick, the frame from inside a backpack, an axe handle — anything rigid will do. You simply need two objects, preferably the length of the limb (or at least the length of the affected half) to splint each side – for even more support, extend a longer outer splint up to the victim's armpit. Next you need something to tie your braces to the limb with. Again, get creative. You can use belts, shirt sleeves/torn strips from t-shirt, bandanas/handkerchiefs (just another one of their many uses!), a shemagh/scarf, rope from a survival bracelet, even a tie! It matters not what you use, but how you use it. Step 6: Apply the Splint 
Get everything into place before you tighten it down. Start by laying your ties in place under the limb — for a leg, you can carefully slide the tying devices through the void below the knee and ease them back and forth until you've slid them into place. Place one by the ankle, one below the fracture, one below the knee, one above the knee, and so on. Don't place one directly on the knee — and definitely don't place one around the wound! Once you have your ties in position, place your splints on either side of the limb on top of the tying devices. Starting at the bottom and working your way toward their body, tie the splint to their leg. For more support, if you have time and a long enough strap, you may wrap the ankle strap around their foot; this immobilizes the foot, preventing the victim from creating unnecessary pain by bending their ankle, which causes the leg muscles and tendons to place stress upon the tibia and fibula. You may also place padding between the splint and the patient's body for comfort (this can be in the form of torn cloth, acrylic sleeping bag stuffing, spare socks, etc.) But if your top priority is getting someone out of the woods as quickly as possible, you don't need to waste time on it; their leg is already uncomfortable. In the end, you want the ties to be snug, but not too tight. The idea is to hold the braces to the leg, but not to cut off circulation. Remember this rule of thumb: you should be able to easily slide two fingers side by side between the ties and their limb. Step 7: Assess and Treat Remaining Injuries Great! The victim's fractured limb is splinted! But, they're far from lying in a warm and comfortable hospital bed awaiting powdered eggs. Aside from simply getting them to a hospital, there are other things to consider before they're truly safe. First, check their affected limb again, and make sure they have PMS. If they did before and they don't now, you likely need to readjust your splint (again, unless you've applied a tourniquet). Next, assess them again: Do they have an open airway, and are they breathing? Do they have a pulse? Are they bleeding? Any exposed wounds? In this case, yes! There are exposed wounds. The victim has an open fracture, meaning open flesh and exposed bone, which can lead to severe infection. You've already stopped the bleeding with the tourniquet; now its time to protect the wound from the elements. If you have sterile gauze in your first aid kit, now is the time to use it — if you don't have gauze, use soft cloth from a shirt. Cover the wound entirely, and secure it in place with another handmade tie (making sure not to tie it too tightly so as not to cause pain). Now would also be the time to assess for shock. In the event of such a severe fracture, shock is very likely. Look for: - Cool, clammy skin (moist, cool, and pale)
- Cyanosis (blueing of skin)
- Weakness
- Confusion
- Rapid Breathing
- Unconsciousness
To treat the victim for shock, lay them on their back and keep them warm. Cover them with clothes, coats, blankets, a sleeping bag, or even a pile of leaves or pine needles — whatever you have available, just get them warm. Step 8: Get Help! If 911 hasn't been called yet, do so now. If you still can't call 911, it's time to move. Never leave your patient behind. If they can hop on one foot as you aid them, do it — but this may not be possible. In such a case, it's time to summon your inner fireman — carry that person, and go find help. _________________________ Bruce A. West served as an Army medic in the Iraq war. He taught over 500 soldiers how to save lives in a class called Combat Lifesaver, and will be sharing his knowledge here on AoM in a series on important first aid/first responder skills every man should have. Bruce also recently started Geared Magazine, an outdoor gear and instructional site with a focus on survival and preparation.
Related posts: - Save Lives Like a Combat Medic: How to Use a Tourniquet to Control Major Bleeding
- How to Perform the Heimlich Maneuver in 6 Different Situations
- Beyond Toilet Paper: How to Treat Shaving Nicks and Cuts
- The Art of Manliness Guide To Snakes Part 2: How To Avoid & Treat A Snakebite
- Underestimating a Hike
By Brett & Kate McKay
You might not know it since promoting the heck out of stuff isn’t our style, but over the years, we’ve created several products inspired by the site. All of them would make great gifts for an AoM reader that you know (or for yourself!). Giving the Art of Manliness this year will not only make some lucky man’s holiday manlier, but it will also help us to continue to grow the site and create new ways to help you reach your potential as a man. Show your support by giving the Art of Manliness for the holidays! 1. The Art of Manliness Manvotionals: Timeless Wisdom & Advice on Living the 7 Manly Virtues. The Art of Manliness Manvotionals is a collection of the best advice ever written down for men. From the philosophy of Aristotle to the success books of the late 19th and early 20th centuries to the speeches and essays of leaders like Theodore Roosevelt and Winston Churchill, the book contains the manly wisdom of the ages — a myriad of poems, quotes, and essays designed to inspire men to live life to the fullest and realize their complete potential as men. We divided the book into seven chapters, one for each of the seven manly virtues: manliness, courage, industry, resolution, self-reliance, discipline, and honor. Manvotionals will provide you hours upon hours of manful pondering and will inspire you to become the best man you can be. $11.55 2. The Art of Manliness: Classic Skills & Manners for the Modern Man. While Manvotionals is more about developing the mindset and philosophy of a truly manly man, The Art of Manliness: Classic Skills & Manners for the Modern Man focuses on the practical how-tos of being a man. Within this book you’ll learn how to tie a tie, how to start a fire without matches, how to give a dynamic speech, and how to be a well-mannered gentleman. It’s a great book for a young man about to head out on his own, but an older, more established gent will enjoy it too. The Art of Manliness has sold over 60,000 copies since publication in 2009 and continues to get rave reviews on Amazon.com. $11.55 3. The Art of Manliness Collection Box Set. Get both of our books in a handsome vintage-inspired cigar box along with six manly coasters for just $19.79. That’s less than what it would cost to buy both books separately, plus you’re getting a cool cigar box and some nice looking coasters. It’s an incredible deal! What man wouldn’t want to find this awesomely manly book collection under the Christmas tree? The cigar box the books come in is even accented with festive red and green. All the more reason to give it for Christmas. $19.79 (Price could change. Amazon is always tweaking prices based on some mysterious algorithm.) 4. Art of Manliness T-shirts. Show off your Art of Manliness pride with one of our 19 AoM T-shirts. We've teamed up with TankFarm Clothing to create some of the manliest t-shirts around. Our most popular seller is the “Gentleman & Scholar” tee. My personal favorite is the Flying Eagle design. $19.50 5. Art of Manliness Letterpress Coasters. We teamed up with Page Stationery to create these handsome letterpress coasters. Made from sturdy cardboard and letterpressed with vintage, manly motifs, these coasters make a great addition to your poker night, a bachelor party, or your annual holiday party. $32.40 for a pack of 25 (With a 10% AoM discount that will automatically be applied when you checkout) 6. Rudyard Kipling “If” Poster. A poster that depicts Rudyard Kipling’s famous poem “If.” In the background you’ll find Casper David Friedrich’s famous painting “The Wanderer Above the Sea Clouds.” We thought this was a fitting image for such a manly poem. Look how the man looks out upon the majesty below as he contemplates that word with endless possibility, danger, and excitement…. if. Over that image, we took the eternal words of Kipling’s poem and situated them so they form the word “If.” This poster will be a constant reminder to you on what it means to be a man. It makes a great gift for a young man to hang in his bedroom or dorm room. 18 x 24 inches. $9.99 7. Art of Manliness Calling Cards. The calling card has a long and distinguished history. For centuries, young gentlemen would leave their personal calling cards at homes they visited. Officers in the military have carried personal calling cards since the 19th century. Carry on this gentlemanly tradition with our Art of Manliness-inspired calling cards. The ultimate networking tool, they're perfect for handing to new friends, potential dates, and business contacts. Pick from 9 different designs and customize them with the personal information you want to share with new social acquaintances. $27 for a pack of 100 8. Theodore Roosevelt “Man in the Arena” Poster. A poster of Teddy Roosevelt, smiling at death itself while waving his hat to his admirers. Next to him you’ll find inscribed his most popular quote, “The Man in the Arena.” Whenever dejection and defeat come knocking at your door, simply glance at TR’s toothy grin and hear his voice reminding you that “the credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood.” In an instant your manly resolve will be rejuvenated and you’ll have the vim and vigor to overcome any challenge that besets you. 18×24 inches. $9.99 9. Official Art of Manliness Sticker. A great stocking stuffer for an Art of Manliness man. This 4×4 inch custom die sticker features famed bare knuckle pugilist and AoM icon, John L. Sullivan, striking his famously virile fisticuffer pose. Slap one on your laptop, guitar case, or the rear window of your car and spread the good word of manliness. 10. Art of Manliness Pocket Notebook. Far from being a modern fad, the pocket notebook has a long, important, and manly history. Pocket notebooks were part of the daily arsenal of a long list of great men from Thomas Jefferson to Thomas Edison. The repositories of eminent men's personal effects nearly always includes a pocket notebook full of their ideas and musings. Follow in their footsteps by carrying your own official AoM pocket notebook where you can write down all your manly ponderings and ideas. The cover has John L. Sullivan with the words “Semper Virilis” (Always Manly) circling his head. $12 for a packet of 3 11. Art of Manliness Stationery. A gentleman understands the power of a handwritten note. Unfortunately, quality stationery designed specifically for men is hard to find. That's why Art of Manliness has teamed up with Page Stationery to create a line of manly correspondence cards, perfect for jotting off a quick note. Cards measure 4.25″ x 5.5″ and you can choose from 25 different manly motifs. Also check out our holiday cards — where the motifs have been festive-ized for the season. A box is a great stocking stuffer and the recipient won’t have any excuse not to write a thank you note. You gave them the materials to do just that! $18 for a box 15 (With a 10% AoM discount that will automatically be applied when you checkout) Related posts: - Introducing Art of Manliness Stationery (Win a Box!)
- Winner of the AoM Collection Boxed Set & An Update on Your Amazon Order
- Announcing the Official Manvotionals Book Site
- The Art of Manliness Collection Boxed Set [Giveaway]
- Signed Copies of Manvotionals Now Available for Purchase
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