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Joint Immobilization (Splinting)

Category: Procedures Sources: raw/nremt/psychomotor-skills.md Last updated: 2026-04-03

Overview

Joint immobilization uses splinting to stabilize an injured joint — most commonly the ankle, knee, wrist, elbow, or shoulder. The goal is to prevent movement at the injured joint, reduce pain, prevent further neurovascular injury, and facilitate safe transport. PMS (pulse, motor, sensation) assessment before and after splinting is the critical safety check.

Key Points

  • Indications: Suspected joint injury — dislocation, fracture involving a joint, significant ligament injury, severe pain/swelling at a joint after trauma
  • Do not force reduction: Do not attempt to reduce (relocate) a dislocated joint in the field. Immobilize in the position found.
  • Splint in position of function unless the joint is found in a position that compromises neurovascular status — then gentle straightening may be attempted ONE time.
  • Immobilize the joint: Splint must immobilize the joint above and the joint below the injury (for a bone fracture) OR the bone above and below an injured joint. For joint injuries, immobilize both adjacent bones.
  • PMS assessment: Assess pulse, motor, and sensation distal to the injury before AND after splint application. Document any changes — a change in PMS after splinting means the splint may be too tight or has caused vascular compromise.
  • Padding: Pad bony prominences and void spaces to prevent pressure points and maintain position.
  • Splint types: Rigid (cardboard, plastic, SAM splint), soft (pillow, sling-and-swath), vacuum (moldable to position), traction (for femur — separate skill).

Assessment Relevance

Joint injury is found during secondary-assessment — DCAP-BTLS at each extremity, PMS check. The initial PMS in the secondary assessment provides the baseline for comparison after splinting.

Splinting is not a primary-assessment intervention — it is done after life threats are managed and the patient is assessed. For a priority patient (shock, airway compromise), splint en route if possible.

Neurovascular compromise distal to injury (absent pulse, absent sensation, paralysis) changes the urgency. A pulseless extremity requires expedited transport and ALS notification — do not delay transport to splint perfectly.

Procedures

  1. BSI/PPE.
  2. Expose the injury — cut clothing if needed.
  3. Assess baseline PMS: Pulse distal to injury (radial for arm, dorsalis pedis/posterior tibial for leg), motor (can patient move fingers/toes?), sensation (can patient feel you touching fingers/toes?).
  4. Select appropriate splint type and size.
  5. Pad the splint: bony prominences, voids, and the injured joint area.
  6. Position the splint: Place it along the limb to immobilize the joint above and below the injury site (or bones above and below the injured joint).
  7. Secure with bandage wraps, starting distal and moving proximal. Snug, not tight — should not impede circulation.
  8. Immobilize in position of function (for joints: roughly mid-range; for wrist: neutral; for ankle: 90°) unless position compromises neurovascular status.
  9. Reassess PMS after splint application. Compare to baseline.
  10. If PMS worsens after splinting: loosen the splint and reassess. If still compromised, adjust or remove.
  11. Elevate the splinted extremity if no other contraindications.
  12. Document: injury site, splint type and size, baseline and post-splint PMS.

NM Protocol Notes

  • EMT-B splinting scope in NM includes rigid, soft, and vacuum splints. Traction splinting (femur fracture) is a separate skill.
  • Analgesia (pain relief) for isolated extremity injuries is not within EMT-B scope in most NM systems — comfort measures include immobilization, elevation, and ice (if available and not contraindicated).
  • Cold packs can be applied over the splint for swelling and pain reduction; protect the skin from direct ice contact.

NREMT Relevance

Joint immobilization is tested as part of the splinting skill stations on the NREMT exam. Examiners assess: - PMS assessment before splinting (baseline) - Appropriate splint selection and sizing - Padding of bony prominences - Immobilization of the joint above and below, or bone above and below the joint - Correct splint security (not too tight) - PMS reassessment after splinting

Critical failures: no PMS assessment, failing to immobilize above and below the injury, splint too tight causing vascular compromise, attempting to reduce a dislocation.

Sources

  • raw/nremt/psychomotor-skills.md — Joint Immobilization (Splinting)