What to do if someone breaks a bone?

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I was wondering today about what someone should do immediately after either they or someone else had a fractured / broken bone.

What first aid / steps should be taken after this happens?

Is this something you'd call 911 for immediately and need an ambulance for?

Or could you get someone with a broken leg or arm to hobble over into a car and take them to an emergency room?

On that note - When someone has a broken bone, do you take them to an urgent care or an emergency room? How do you decide?

schizoid04

Posted 2017-11-12T20:05:05.560

Reputation: 208

What do you mean by broken bone? I have had broken foot, ankle and arm. In none of these cases it was obvious to me or the bystanders. Twice I got my plaster after 2-3 days when visited doctor because the pain didn't lessen. But the ankle fracture was only discovered 2 weeks later when I visited doctor because the foot was badly burnt in sun after trying to soothe the pain with ketoprofem gel. – Džuris – 2017-11-12T23:22:47.163

@Džuris You’re experience is rather unlikely. Most (complete) fractures come with pain and swelling of the area where the fracture is. I think it is safe to assume from the question context that this is talking about apparent fractures, if no one recognises the fracture there‘s no one worrying about first aid. The ankle fracture could have been discovered earlier (you yourself noted the pain). – Narusan – 2017-11-12T23:40:38.050

NOT urgent care. – Carey Gregory – 2017-11-12T23:59:13.597

@Narusan-sedated I had pain and swelling in every case, that's how I ended up with x-rays and discovered the fractures. But I think that the difference is that I had no displacement except the arm case when there was a small displaced something at a hand-end of ulna. But I could still drive car to doctor's. – Džuris – 2017-11-13T00:22:44.670

@CareyGregory Why not urgent care? I've never been in one that doesn't offer XRays and splinting, and at least in the US the wait is often a fraction of the time of an ER. Different of course if they hit their head, which may warrant a CT, but extremity fractures? – DoctorWhom – 2017-11-13T06:52:50.160

1People with broken collarbones classically drive themselves to a doctor. Fingers and toes the same, in fact toes are rarely treated. Ribs even. But arms or legs are different. Not sure you can say "a bone". – Kate Gregory – 2017-11-13T16:48:02.510

@KateGregory drive themselves? As in they’re behind the wheel? Certainly wouldn’t recommend that. – Narusan – 2017-11-13T20:17:23.123

@Narusan-sedated nor would I but I know two people who have done it, and a mother who waited a week or more to take her child to the doctor after a broken collarbone – Kate Gregory – 2017-11-13T20:27:34.020

@DoctorWhom I don't know of any urgent care center in this area with x-ray capabilities. Maybe it's a regional thing. – Carey Gregory – 2017-11-14T01:30:47.630

@CareyGregory Every urgent care I've been to has had X-Rays; I've heard generally they have access to most services that a hospital might, with exception to very serious emergency services. I've heard conflicting information about whether you should go to an urgent care or emergency for an emergency room, and was interested to know what the consensus really was on that. Also as someone else mentioned, the wait is usually pretty small - I've had urgent care visits before where I waited less than 10 minutes. – schizoid04 – 2017-11-14T03:36:42.437

1@schizoid04 I'm not saying urgent care centers are to be avoided. I just think that suspected fractures deserve a higher level of care. – Carey Gregory – 2017-11-14T05:26:25.997

Answers

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You as an untrained bystander can do little to nothing.

Professionally trained paramedics could (as an example) pull the leg and thus remove tension between two bone membranes (periostei) and in a best case scenario alleviate all pain. The bone itself has hardly any nerve endings, it is only the periosteum that causes pain. This only works in a few cases. Other options include administration of pain killers.

A few “guidelines” what to do when:

  1. If the patient is in pain, call an ambulance.
  2. If the patient can not walk/stand up, call an ambulance.
  3. If the fracture is open (ruptured skin / blood), call an ambulance.
  4. If the patient was or still is unconscious, call an ambulance, check for vital functions (breathing, airways).
  5. If the patient wants an ambulance, call the ambulance.

Bottom line: To be on the safe side, call an ambulance.


What can you do?

During my very first first-help training, my trainer said something that stuck with me: “We humans have two fundamental fears: To die, and to die alone”. While it is sometimes impossible to save someone’s life, we can always, always be with them and comfort them. So, never leave a patient alone unless there is absolute need, and if so, communicate clearly that you will return very shortly and e.g. just need to grab an AED.

Secondly, being in pain is not very enjoyable, and having a large crowd of bystanders assemble around the patient doesn’t make it a bit better. Try to give them the decency of privacy. If you have already called the ambulance, get a few people to spread out, watch out for the ambulance and guide them to the patient. Hush the other ones away or give them tasks like looking for AEDs in nearby public buildings.

Thirdly, lying immobilised, the patient gets cold quite quickly. Make sure to keep them warm. Jackets, a camp fire, or a rescue blanket are always a good idea, even on mild summer days. (Pro Tip: A rescue blanket makes it quite clear to the ambulance drivers where and who the patient is, and it also protects the patient from the watchful eyes of bystanders. Such blankets are usually a part of every first-aid set in public buildings).

Lastly, as a patient you are very dependent on the people around you. Because patients are usually sitting and leaning against a wall or lying on the ground (to prevent meaningful damage if they should collapse), their field of vision is very limited. Pain also distracts, so they are not highly aware of their surroundings. This is why one must explain every action one takes to them, especially if it includes coming very near or touching the patient.

TL;DR

Here’s what you could do (order and items on the list depend on every case, don’t take this as a standard rule). Reiterating from above, always tell the patient what you’re doing.

  1. Check vital functions
  2. Call ambulance
  3. Check vital functions again
  4. Direct someone to get a first-aid set from a nearby public building.
  5. Send a few people as “beacons” for an ambulance, have them look out for it and guide its way upon arrival at the scene.
  6. If there’s still a large crowd, send a few people looking for AEDs1
  7. Ensure warmth of patient.
  8. Distract the patient until arrival of ambulance.

1: It’s not likely that you will need a defibrillator, and I wouldn’t send for one as a standard procedure. However, it is always easier to send people looking for something than just hushing them away.

Narusan

Posted 2017-11-12T20:05:05.560

Reputation: 4 952

By AED, do you mean one of these things? I'm not sure what good one of those would do for a broken bone, although I suppose sending overly curious bystanders to look for one could be useful to get them out of the way.

– Ilmari Karonen – 2017-11-13T00:08:36.043

Could you add a bit about how to notice the fracture in non-obvious (no visible displacement) cases? Or should that go on a separate question? – Džuris – 2017-11-13T00:59:20.177

1@Džuris You cannot. If you have broken bone, the last thing you want is to move it around until it hurts. If it gives you shooting pain, it is obviously broken, but if you're not sure, there's really no way to "know" with external observation. – Nelson – 2017-11-13T06:07:46.777

@Džuris That should be another question. Basically though, swollen limb, pain when moving it and a recent “crash” of some sort (falling done stairs i.e.) are good indicators. When bones snap it becomes obvious. – Narusan – 2017-11-13T06:18:21.033

2It is not always obvious when there is a fracture, actually. There are MANY types of fractures. For example, telling between sprain and fracture and contusion in an ankle injury is not simple. Trained professionals use the Ottawa criteria to determine likelihood of fracture and need for XRay. But it's not advised for non-trained. Pain accompanies almost all fractures, swelling most all, instability many. But don't try to figure out if it is displaced - that is the role of an XRay. You can break off bone fragments and impede healing if you try - and you may create a displacement yourself. – DoctorWhom – 2017-11-13T06:58:51.180

"here, if the patient gets hurt during the journey to a hospital ..." Given that you can't speak to the universality of this bolded sentence, you may want to specify where "here" is. – R.M. – 2017-11-13T13:32:13.767

@R.M. I’ve decided to take that point out. It’s not really important in my line of arguing, and since it is not universal it has little to none value. – Narusan – 2017-11-13T13:52:26.863

@Džuris I went to the ER once with either bone bruises or fractured ribs...not only could they not tell by simple observation, they still weren't completely certain after imaging (x-ray). The best they could say was that it wasn't displaced and therefore wasn't dangerous (i.e. not going to stab my lungs). Since the treatment at that point is pain killers and rest for either type of injury, they didn't do any further imaging and sent me home. Now when anyone asks if I've broken a bone, I have to add on "maybe a fractured rib, no one knows". – user3067860 – 2017-11-13T21:59:22.033

5

So let's assume you're speaking of a large bone, like the arm (humerus, radius or ulna) or leg (femur, tibia or fibula), but not the skull, spine or pelvis.

A good rule of thumb: the larger the bone, the more serious it is.

A second rule: if the skin is broken (the bone is sticking out), it is serious.

So, if you suspect a hand or foot fracture with no blood, you can take the person to an urgent care center or ER.

If you suspect a leg or arm fracture, best to call EMTs.

If you see blood, or the person is unconscious, call the EMTs.

D Bagnall

Posted 2017-11-12T20:05:05.560

Reputation: 51

8if the skin is broken (the bone is sticking out), it is likely serious -- Delete the word "likely". – Carey Gregory – 2017-11-13T00:01:45.137

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It all depends on the bone that is (or might be) broken, and on the overall condition of the patient.

  • Call an ambulance for a fractured skull, vertebra or hip.
  • Call an ambulance for open fractures (bone piercing through the skin).
  • Call an ambulance if the patient is/has been unconscious or under shock.
  • Call an ambulance if you are not sure whether you need one.
  • Call an ambulance if the patient requests it.

Do not move the patient any more than necessary. Especially, if you suspect a spinal injury (broken vertebra), absolutely avoid moving the patient unless strictly necessary to save their life. If you are unsure, call 911 (North America), 112 (Europe) or the local equivalent; they will instruct you what to do.

Secure the accident site if necessary, stay with the patient. Give first aid for any additional conditions (if any), comfort them, make sure they remain conscious, get a blanket to keep them warm if necessary, help them look after their belongings, direct the ambulance to the patient.

It may be OK to take the patient to a hospital on your own if all of the following are true:

  • The broken bone is just a limb and not under stress while sitting (arm, shoulder, collarbone, foot, possibly tibia or fibula)
  • No other complications are present
  • The patient can move without additional pain
  • The patient agrees

Get the patient to the nearest hospital (urgent care should be sufficient for cases that don’t require an ambulance) or suitable physician. If necessary, they will refer the patient to wherever adequate care can be given. Ski areas often have a specialized doctor in most villages, or even a sports clinic; the same may be true for other areas where outdoor sports are common.

From my own experience, most with ski accidents:

  • Once a skier asked me to help her up because she couldn’t get up on her own. That turned out to be a bad decision, as it turned a partial femur head fracture into a full one. Lesson learned: if the patient cannot or will not get up on their own, tell them to stay put and get help.
  • Another time I came to a site where someone had a knee injured. Her husband had already attempted to splint her knee with her ski poles and attempted to get her up. Same mistake as above, we ended up getting help.
  • Yet another time, someone fell on her wrist. She was still OK to ski carefully and I accompanied her to the doctor, who then determined a radius fractured near the wrist.

I know of several skiers who skied downhill with leg or vertebra fractures which were not discovered until they got to the doctor’s. Certainly not recommended if you suspect that kind of injury.

Last but not least: if you feel you might need this kind of knowledge, consider taking a first aid course.

user149408

Posted 2017-11-12T20:05:05.560

Reputation: 141

3

If both legs are OK and there is no way they could have a spinal injury, you may well find it is quicker to get them to hospital in your car. Drive very slowly over bumps and around corners, do not accelerate fast and leave plenty of stopping distance for slow braking. This would be my preferred option for a minor injury to an arm, hand, shoulder or foot.

In any other situation, call an ambulance and follow the phone operator's instructions to the letter. Do NOT try to be clever or show initiative about treating the casualty - you could easily make things worse! That said, be very clear about the situation and telling the operator exactly what happened and any change to the casualty's condition. For example, moving a casualty or removing a bike helmet could increase the damage from a spinal injury, so normally this is a job for the experts - but if the casualty has stopped breathing then the first priority is CPR, because they're guaranteed to die if you don't.

TBH though, your questions suggest you're asking in the wrong place - not the wrong forum, but just generally by asking on the net. You won't learn anything useful here. Get yourself to a properly-run first aid course, learn what to do from people who actually know, and do some hands-on practise so that you can actually do it yourself.

Graham

Posted 2017-11-12T20:05:05.560

Reputation: 139

1+1 for the last sentence. That deserves a bit more emphasis. – Narusan – 2017-11-13T13:55:38.350

What constitutes "no way they could have a spinal injury?" – Carey Gregory – 2017-11-14T13:52:03.667

@CareyGregory Like I said, if you're asking a question like that, you're in the wrong place. No-one here can answer that question for you. Anyone who claims to be able to reliably give you that kind of information online is a positive danger to you and yours. And I don't want to be too rude, but anyone who thinks finding a little information online is good enough is also a danger to anyone they are responsible for. Find yourself a first-aid course, and be safe. – Graham – 2017-11-14T14:58:08.797

@Graham It would be hard for you to misunderstand my comment more than you apparently did. The question was rhetorical and my point was precisely that it's impossible for laymen to make such a determination. I've had a wee bit more than a first aid course. – Carey Gregory – 2017-11-14T15:40:35.127

@CareyGregory My apologies then. :) FWIW, if someone's just dropped a heavy object on their foot/hand, then it's reasonable to expect there's no spinal injury. A first aid course covers enough to do a halfway-safe check, although of course we're in no way as good as someone with real training. A layman can make that determination to some degree - but they need to know enough about the circumstances of the injury, and to know the limitations of where they're safe to make that call. – Graham – 2017-11-14T16:34:40.333

Yes, agreed that even laymen can rule out spine injuries with many fractures, but it's one of those things that's hard to spell out in a few words that laymen can understand and follow reliably. I've always thought that high school should include a mandatory basic first aid course, which would give sufficient time to cover things like this. – Carey Gregory – 2017-11-14T20:08:10.793

@CareyGregory Yes, that'd be a really good idea. It's an important life skill. By the way, rhetorical questions can be an issue unless you make it really clear - that's one of the downsides of text as a format. There are plenty of people who genuinely do think they can learn stuff online without proper hands-on training, and that was really the point of my last paragraph. – Graham – 2017-11-15T11:10:05.627

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If you are untrained on this subject matter, the best practise is to do nothing about the fracture.* Even most certified first aiders are not trained to handle broken bones.

*By nothing I don't literally mean nothing. I would assume that you have already called for ambulance. If he is in a dangerous location you can try to move him, but you will have move the area of the broken bone as little as possible. If he is unconscious and not breathing proceed to CPR, even if his rib cage is fractured. If he is in an awkward position you can try supporting him with things around you.(for example he could be lying on his side and supporting himself with his arms. Slide a bag for him to lie on.) If he is bleeding seriously carry out first aid. General idea is keep him alive until help arrives, other things can wait.

See Jian Shin

Posted 2017-11-12T20:05:05.560

Reputation: 29

1

From personal experience I can definitely attest that a person with a broken arm can indeed (under reasonable circumstances) hobble to a car and be driven to the hospital (not sure which department, presumably first aid initially).

In my case I was the child with the broken arm and my mom drove met to the hospital.

This way (even with safe driving) I was in the hospital slightly faster then in any other scenario, and we did not put unnecessary pressure on the medical system.

Note that I was not in significant pain, and no blood/bone was coming out (just an arm at an odd angle).

Dennis

Posted 2017-11-12T20:05:05.560

Reputation: 11

At the risk of sounding horrible, it's also a lot cheaper if you're in a user-pays medical system (the US) to not go via ambulance. – user3067860 – 2017-11-13T21:52:21.020