First aid
Essential steps for safe immobilization and transport of patients with suspected pelvic fractures from low-energy falls.
When a patient sustains a low-energy fall, pelvic fragility may cause hidden injury. Proper immobilization and careful transport minimize pain, prevent further damage, and improve outcomes by stabilizing the pelvis, controlling bleeding, and ensuring rapid medical assessment and transfer to appropriate care.
Published by
Matthew Young
July 23, 2025 - 3 min Read
Pelvic fractures resulting from low-energy falls are a common concern among older adults and individuals with underlying bone conditions, yet they can be easy to overlook in the emergency setting. The pelvis forms a ring structure that, when fractured, can disrupt blood vessels, nerves, and nearby organs. Early recognition hinges on a combination of clinical signs, including localized tenderness in the groin or pelvis, pain with movement, and sometimes pelvic instability. A careful history is essential, noting the mechanism of injury, the patient’s activity level, and any anticoagulant use, which can complicate management by increasing bleeding risk. Prompt, calm assessment supports safer handling and transport.
When approaching a patient with suspected pelvic injury, responders should prioritize minimizing movement of the pelvis while maintaining airway, breathing, and circulation. Begin with a rapid, systematic survey to identify life-threatening conditions, then reassess frequently as transport decisions unfold. Visual inspection for obvious deformities or swelling, coupled with gentle palpation on the perineal region only if tolerated, helps gauge potential instability. If the patient is conscious, explain every action to reduce anxiety and encourage cooperation. Do not attempt to realign or compress the pelvis. Immobilization should be achieved using devices designed for pelvic stabilization, and any immobilization should avoid excessive pressure that could aggravate injuries.
Proper immobilization and transfer require careful technique and patient communication.
The cornerstone of safe transport is preventing secondary injury while ensuring adequate perfusion and airway protection. Use a scoop stretcher or long spine board as appropriate, with straps placed to secure the upper body, hips, and legs without compressing the abdomen or groin. Elevate the head of the bed only if the patient’s breathing warrants it, and maintain a neutral spine during movement. Communicate with the patient throughout the process, asking about pain levels and location so adjustments can be made without compromising stability. Continuous monitoring of vital signs is essential, particularly for signs of internal bleeding, shock, or evolving respiratory compromise.
A triangle of immobilization strategy can be employed to safeguard the pelvis without rigidly pinning the entire lower extremities. Place a padded board behind the patient’s back and hip, then secure the torso with wide, nonrestrictive straps. For additional stabilization, use a pelvic binder or wrap that applies even circumferential pressure without squeezing the abdomen. Avoid tight knots or bunched fabric that could impair circulation. If available, a sheet splint can provide a temporary, low-profile solution to reduce movement during transfer. Confirm that the patient remains comfortable and that movement at the pelvis is minimized during every step.
Safe pelvic immobilization blends technique, communication, and ongoing evaluation.
In terms of ventilation and circulation, be prepared to support breathing while the pelvis is immobilized. If the patient shows signs of respiratory distress, adjust positioning to optimize airway patency without compromising pelvic stability. Monitor oxygen saturation and capnography if available, and administer supplemental oxygen as indicated. Bleeding control in pelvic fractures can be challenging due to hidden vessels, so rely on a combination of localized pressure for superficial wounds and careful assessment for intra-abdominal or retroperitoneal bleeding. Do not press directly on suspected intra-pelvic injuries, and avoid aggressive external manipulation that could worsen bleeding.
Pain management should balance relief with safety, especially in the context of potential vascular injury or shock. Administer analgesia only if protocols and training allow, and avoid delaying transport to obtain medications when the patient is unstable. Reassure the patient that every effort is being made to minimize discomfort. Document the patient’s pain level, location, and any changes during immobilization. As transport continues, reassess mental status, orientation, and cooperative ability, because confusion can mask evolving complications. Clear, concise instructions help the patient participate in their own safety while you preserve pelvic stability.
Community responders should emphasize stabilization, safety, and timely handoff.
Special considerations arise with older patients or those on anticoagulants, as their bleeding risk is higher and injuries may present atypically. If anticoagulation is suspected or confirmed, ensure rapid access to medical oversight and adjust transport decisions accordingly. Maintain gentle handling to avoid iatrogenic injury while preserving hemodynamic stability. A higher index of suspicion for associated injuries—such as bladder, ureteral, or vascular damage—should guide the team’s assessment priorities. Document any anticoagulant use, recent falls, or preexisting conditions that might influence both transport speed and treatment upon arrival at the hospital.
For caregivers and bystanders who find themselves stunned by a fall, the most important actions are to stay calm, limit movement, and call emergency services immediately. Provide reassurance to the patient without offering false optimisms and keep the environment quiet to reduce pain and anxiety. If the person loses consciousness, monitor for responsiveness and breathing while awaiting professional responders. Do not attempt to straighten or realign the pelvis, and avoid lifting the patient by the legs or torso. The objective is to preserve stability, prevent hypothermia, and ensure rapid, safe handoff to the medical team equipped to assess pelvic integrity with imaging and targeted therapies.
Clear handoffs and documentation support timely, accurate care.
The transport corridor should be prepared with attention to smooth terrain and minimal bumps that could jostle the pelvis. If there is a patient with suspected pelvic fracture, ensure the path to the ambulance is clear, secure equipment, and maintain a constant dialogue with the patient. The team should coordinate closely, assigning roles to maintain steady immobilization, monitor vital signs, and anticipate equipment needs such as padding, straps, and ankle and knee supports. Every shift in position should be deliberate and slow, avoiding abrupt movements that could amplify pain or cause further injury. A methodical approach reassures the patient and promotes a safer transfer.
The post-transfer handoff to hospital staff should include a comprehensive summary of prehospital observations, immobilization methods, vital sign trends, and any complications encountered during transport. Include details about the mechanism of injury, the patient’s baseline health status, and the presence of any external bleeding or visible deformities. Ensure imaging requests are prioritized based on suspicion for pelvic disruption. A clear, concise report helps the receiving team decide on imaging modalities, such as pelvic radiographs or CT scans, and expedites definitive care if bleeding or organ injury is suspected.
Once at the hospital, the immobilization and transport procedure transitions into a more definitive evaluation. The medical team will typically perform a focused physical exam, review imaging results, and assess hemodynamic stability. They may implement pelvic stabilization devices or proceed with spinal precautions depending on findings. Early involvement of trauma and orthopedic specialists improves outcomes by enabling rapid decision-making about surgical versus conservative management. Continued monitoring remains essential, as pelvic fractures can evolve through edema, hematoma expansion, or associated injuries that require promptly adjusted treatment plans and multidisciplinary coordination.
In conclusion, safe immobilization and transport of suspected pelvic fractures from low-energy falls demand a deliberate, patient-centered approach. The priority is to prevent further injury while preserving ventilation, circulation, and consciousness. By using appropriate immobilization strategies, careful handling, active communication, and seamless transfer to hospital care, responders can reduce pain, mitigate complications, and support faster, more accurate diagnoses. Education, practice, and adherence to established protocols help ensure that every patient receives consistent, high-quality care from the earliest moments of injury through to definitive treatment and recovery.
