# First Aid/Immobilization

The proper method of slinging depends on where the injury occurred on the arm. After applying a sling, ensure circulation to the arm has not been compromised by doing a distal circulation check. Remember also that moving an arm into a position where you can put a sling on it may be painful for the victim. If that is the case, simply immobilize in the position found. You will have to improvise something based on the victim’s position of comfort.

## The arm sling – for injuries to the forearm

* Support the injured forearm approximately parallel to the ground with the wrist slightly higher than the elbow.
* Place an open triangular bandage between the body and the arm, with its apex towards the elbow.
* Extend the upper point of the bandage over the shoulder on the uninjured side.
* Bring the lower point up over the arm, across the shoulder on the injured side to join the upper point and tie firmly with a reef knot.
* Ensure the elbow is secure by folding the excess bandage over the elbow, securing it with a safety pin.
This can be accomplished by using the victim’s shirt or sweater as a sling. Simply pin the bottom hem to their chest using multiple safety pins, going over the arm. This works surprisingly well!

## Elevated sling – for injuries to the shoulder

* Support the victim’s arm with the elbow beside the body and the hand extended towards the uninjured shoulder.
* Place an opened triangular bandage over the forearm and hand, with the apex towards the elbow.
* Extend the upper point of the bandage over the uninjured shoulder.
* Tuck the lower part of the bandage under the injured arm, bring it under the elbow and around the back and extend the lower point up to meet the upper point at the shoulder.
* Tie firmly with a reef knot.
* Secure the elbow by folding the excess material and applying a safety pin, and then ensure that the sling is tucked under the arm giving firm support.

## Collar and cuff – for upper arm or rib injuries

* Allow the elbow to hang naturally at the side and place the hand extended towards the shoulder on the uninjured side.
* Form a clove hitch by forming two loops – one towards you, the other away.
* Put the loops together by sliding your hands under the loops and closing with a “clapping” motion. If you can tie a clove hitch, simply tie it on the wrist.
* Slide the clove hitch over the hand and gently pull it firmly to secure the wrist. Extend the points of the bandage to either side of the neck, and tie firmly with a reef knot.
* Allow the arm to hang naturally.
* It is especially important for this sling that you ensure that circulation to the hand is not compromised – do distal circulation checks often.

## Femoral fractures

The femur is the largest bone in the body, and has a large artery, the femoral artery, directly beside it. Because a mechanism of injury which can fracture the femur is likely to also displace the fracture, it is possible that the femoral artery will be damaged internally. Damage to the femoral artery is likely to cause massive internal bleeding, so it is a major emergency; Call EMS immediately. Be sure to maintain as much immobilization as possible and monitor ABCs until EMS arrives.