First aid
Guidance on stabilizing and transporting patients with suspected pelvic or sacral fractures after high-energy trauma.
In high-energy incidents, recognizing pelvic or sacral injuries early improves outcomes, guiding stabilization, posture, and transport decisions to minimize pain, prevent further injury, and support vital organ function during prehospital care.
July 24, 2025 - 3 min Read
In many high-energy trauma situations, pelvic or sacral fractures are not immediately obvious, yet they demand careful management to prevent secondary damage. Initial assessment should prioritize airway, breathing, circulation, and disability, followed by a focused examination of the pelvic region without moving the patient unnecessarily. If possible, request assistance for log rolling and immobilization procedures. Visual cues such as pelvic tenderness, instability, or deformities, along with signs of shock, can indicate potential fractures. Actions should minimize movement, preserve neutral alignment, and maintain comfort, while preparing for rapid transport to an appropriate medical facility with imaging capabilities and definitive orthopedic care.
Stabilizing an unstable pelvis requires deliberate, noninvasive support that reduces movement and preserves perfusion. Use a firm, wide wrap, sheet, or commercial pelvic binder around the hips, ensuring it is snug but not restricting respiratory effort. Avoid placing excessive pressure on the abdomen, bladder, or groin, and monitor skin integrity under the binder. Once applied, reassess the patient’s vital signs, pain level, and circulation to the lower extremities. The goal is to create temporary stability to limit further displacement while facilitating safe transport. Clear communication with the receiving EMS or hospital team helps tailor subsequent imaging and surgical planning.
Supportive stabilization, careful immobilization, and clear communications guide transfer.
Pelvic fractures can accompany nerve or vascular injuries that worsen with movement, making careful handling essential. When immobilizing, maintain the patient in a neutral, slightly flexed position to relieve nerve tension and reduce strain on the sacral region. If the patient is able to cooperate, explain each step of the procedure to reduce anxiety and improve tolerance. Do not attempt to reposition the pelvis without considering potential fracture patterns, as misalignment can escalate bleeding or neurological compromise. Continuous monitoring for signs of internal hemorrhage, changes in consciousness, or pale, cool extremities should guide the urgency of transport and analgesia strategies.
Pain control in the prehospital setting should be balanced with safety and priorities. Administering analgesics may be appropriate when airway, breathing, and circulation are stable or improving, but avoid dosing that obscures the patient’s neurological status or hinders evaluation for other injuries. If analgesia is given, document the type, dose, and response, and anticipate potential hemodynamic effects. Maintain IV access where feasible and fluids according to local protocols. Keep the patient warm and comfortable, as hypothermia and dehydration can worsen outcomes after pelvic trauma. Coordination with dispatch and hospital teams ensures appropriate pathways for definitive care.
Handoff efficiency and ongoing assessment improve patient safety.
When preparing for transport by ambulance or aircraft, ensure the patient remains on a flat, stable surface with the binder in place and additional padding to reduce pressure points. Avoid unnecessary movement, especially hip flexion, abduction, or rotation, as these maneuvers can aggravate a fracture or cause bleeding to worsen. Continuous monitoring of pulse, blood pressure, respiratory rate, and oxygen saturation provides early cues about deteriorating conditions. If there is suspicion of associated injuries, such as bladder or urethral damage, prepare to monitor urinary output and consider catheterization only if it can be performed safely without exacerbating injury.
A thorough documentation process supports continuity of care across settings. Record the mechanism of injury, observed deformities, and any instability noted at the scene. Document the binder position and the exact steps taken to minimize movement, including who assisted and when restraints were applied. Note the patient’s baseline mobility, pain scores, and responses to analgesia. Sharing this information with the receiving facility helps them anticipate imaging needs, surgical consultations, and potential transfusion requirements. Implementing a standardized handoff reduces delays and improves the accuracy of prehospital-to-hospital information transfer.
Multidisciplinary teamwork ensures timely intervention and recovery.
In-hospital imaging decisions begin with a targeted approach to pelvic trauma. Pelvic radiographs illuminate gross fractures, while CT scans offer detailed visualization of sacral involvement, acetabular damage, and associated vascular injuries. Early communication between EMS, trauma surgeons, and radiology ensures rapid access to the most informative studies. If the patient remains unstable, prioritize resuscitation and stabilization while arranging urgent measures to control bleeding and support organ function. The team should anticipate the possibility of concurrent injuries in the abdomen or spine, guiding a coordinated treatment plan that minimizes delays in definitive care.
Definitive care for suspected pelvic fractures often involves multidisciplinary input. Orthopedic specialists assess stability, fracture pattern, and the feasibility of surgical intervention, while interventional radiology may be essential for controlling arterial bleeding with embolization. Delayed weight-bearing and physical therapy plans should be communicated early, allowing the patient to engage in meaningful rehabilitation as soon as feasible. Coordinated pain management strategies, ranging from regional anesthesia to multimodal regimens, contribute to comfort and recovery. Throughout, imaging results inform decisions, from nonoperative management to complex operative procedures.
Consistent monitoring and careful handoffs support healing and outcomes.
Extrication and movement in confined spaces require meticulous technique to prevent further injury. Enlist the help of trained rescuers and use a sliding board or scoop stretcher to minimize twists or torsion at the pelvis. The patient’s pelvis and spine should stay aligned with the torso, while caregivers coordinate synchronized lifting to avoid abrupt forces. If any resistance or pain worsens during movement, pause and reassess alignment, pausing to reassess instead of forcing a progression. Clear, calm communication reduces anxiety and enhances cooperation, making the entire transfer smoother and safer for both patient and team.
In cases of suspected pelvic externally visible trauma, maintain vigilance for hidden injuries. Flat positioning should be preserved during immobilization, but monitor for signs of abdominal distention, rapid deterioration, or new fractures becoming evident as the patient is moved. Prepare for rapid consultation with surgical teams if imaging reveals pelvic instability that could require urgent stabilization. In all steps, document pain levels, neurovascular status, and any changes in mobility to ensure a precise clinical trajectory from the accident scene to definitive care.
After stabilization, ongoing monitoring focuses on preventing complications that arise from pelvic fractures. Watch for signs of shock, infection, or urinary retention, and ensure adequate fluid balance as you transition from prehospital to hospital care. Deep venous thrombosis risk increases with immobilization, so consider early mobilization strategies within medical safety constraints and prescribed anticoagulant guidelines. Nutrition and hydration support tissue healing, while skin care around immobilization devices prevents breakdown. Reassess neurovascular status regularly, and prepare pediatric or geriatric considerations if the patient’s age influences rehabilitation potential.
Once stabilized, rehabilitation planning begins with setting realistic goals and timelines. Early engagement with physical therapy helps preserve range of motion and prevent stiffness, while gradual weight-bearing protocols promote bone healing and functional recovery. Psychological support addresses trauma response, reducing fear as mobility improves. Family education enables supportive at-home care, ensuring safe ambulation and fall prevention. Regular follow-up appointments with orthopedic and trauma teams track healing progress, adjust activity restrictions, and optimize return-to-work plans. Ultimately, comprehensive, patient-centered care supports a durable recovery and reduces the risk of long-term disability after high-energy pelvic or sacral injuries.
