Bandages can be made from belts, bandoliers, kerchiefs, strips of cloth from clothing or blankets. To cut strips out of a shirt, cut thin strips in a circular fashion around the shirt, starting at the bottom to make long, continuous strips.
Slings can be improvised from shirt tails, a coat, or pieces torn from blankets.
Be creative, and look at things in ways other than their design. Packs, pads, clothing, camp chairs, tents, duct tape - anything that can provide some support. A few items will make the job easier:
a. Something to tie stuff with. The old standby for this is a cravat (a large triangular piece of fabric) which could be used to make slings and swaths much easier, and could be spread out over a large area, making a splint more comfortable.
b. A rigid sheet of anything. A foam sleeping pad, an Alice Pack frame will do nicely.
c. Splint in the position of function; in he position thats comfortable and natural. For an upper extremity injury that generally means holding the injured are in towards the chest at a 90 degree angle. for lower body injury, strive to make the splint as comfortable as possible and in line with the victim's body.
d. Use ALOT of padding.
e. The splint should be adjustable to allow for swelling, etc. Use release knots (think shoelaces) so splint knots will be easier to untie and retie if need be.
f. Fingers and toes should be accessible. You don't want to make matters worse by cutting off circulation, sensation, or motion. Check for circulation by having victim wiggle toes/fingers, checking for color and capillary refill, skin color and temperature.
ARM SPLINTS
Inner Splint An inner splint (semi-rigid sheet closest to the actual injury helps, but isn't strictly necessary in all cases. When using any foreign object as a splint, always make sure to put a layer of padding between the splint and the arm, and wrap a layer of clothing around the extremity before applying splint to the extremity. Make sure you put a layer of padding between the splint and the arm, and wrap a layer of clothing around the arm before applying the splint to the arm.
Secure the splint to the arm by tying cravats or by wrapping fabric, gauze, ace bandage, strips of cloth, etc from the back of the hand all the way to the elbow. Make sure the splint supports the hand, and that there is something in the hand to hold, such as a rolled up bit of cloth. Be sure to wrap the cravat, etc over the back of the hand, then between the thumb and first finger, then back under the splint. This helps secure the hand to the splint and prevents the wrist from flopping around.
Sling: Take a cravat and tie an overhand knot a few inches from the apex of the triangle. This creates a pocket for the elbow to sit in. Have the victim put his/her hand over their heart, is if they were saying the Pledge of Allegiance. Pass the sling around the elbow, tying the two swath ends together around the shoulder. Pad under the knot.
Swath. Tie a cravat (or wrap strips of fabric, etc) around the injured arm and secure it to the other side of the body. The swath should be fairly low (covering the person's elbow), and the wider the better. No chicken winging should be possible. Pad under any knots as these will become uncomfortable pressure points during a long evac.
Variations: For upper arm injury, put splint on the upper arm and secure it with cravats. Make sure to tie one above and one below the injury, not on the injury itself (this could be very painful. Now make a sling, but do not support the patient's elbow. Goal should be to gently support the forearm, but let gravity pull the upper arm a bit, providing a gentle traction. Finish off with double swaths, which should immobilize the shoulder.
For collarbone injuries, just make a sling and swath; no inner splint is required.
LEG AND ANKLE SPLINTING
The first thing you will need to determine is whether the injury is usable or unusable by determining whether the victim can bear weight.
Usable knee injuries: A good splint for usable knee injury limits lateral motion of the knees but still allows for a bit of flex, which makes walking possible. A sleeping bag, pad, or even a tent fly folder over itself many times will make a good frame for a knee splint. Constructing lower extremity splint is easiest with two people.
1. Splint should extend part way up the thigh and part way down the lower leg. The length will partially depend on the extent of the knee injury. The more severe, the longer you will want to make the splint.
2. Place cravats, cloth strips, gauze, etc, under the splint so they're ready to be used.
3. Pad the splint.
4. Move the splint under the victims leg and have helper bend the splint around the leg. Pad any void spaces and under the knee. Keeping a slight bend in the knee from the start makes the splint slightly articulated and keeps the splint much more comfortable for the victim.
5. Bend the splint around the knee, creating a frame, and secure the splint with cravats. Keep the cravats as wide as possible over the leg and avoid placing a cravat over the knee itself. All knots should be on the outside of the leg.
The splint for an ankle depends on how severe it is. Often by simply leaving a boot on and having the patient walk carefully with a trekking pole is all that is required. If the ankle injury is more severe:
1. Pad the patient's ankle. Cut out a piece of foam pad or other rigid item for an inner splint. This splint should extend from just above the bottom of the heel to mid-calf.
2. The ankle hitch secures the splint to the foot. Lay a long cravat (or two tied together) in an S-shape over the front of the ankle. Pull the tails of the S around the back of the ankle and through the newly created loops. Tighten the hitch by pulling down on both ends, then tie the ends of the cravat together on the outside of the foot. There should not be a stirrup on the instep of the patient's boot.
3. Wrap up the splint (from ankle to calf) with cravats act, etc.
Unusable leg injuries (knee injuries, lower leg injuries): Unusable knee injuries require a longer, stiffer splint that immobilizes the ankle.
1. Follow the same procedure above as the usable injury example, but this time, the splint should extend to the upper thigh several inches below the crotch and down past the foot. Again, a foam sleeping pad is excellent for this.
2. Apply the splint following the same procedure as in the usable knee injury example. Place a cravat at the bottom of the pad, and roll the cravat up into the pad until you hit the patient's foot. Now, bend the ends of the pad up and tie them together with the cravat (or any type of lashing), creating a boot. Thread another cravat through the one that you just tied and secure this one around the ankle.
3. Pad any gaps around the ankle, and finish by wrapping an ace or a few more cravats around the lower part of the splint.
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