Splint a broken arm or ankle with what's in your truck

Quick answer: Call 911 first. Check the hand or foot for feeling, color and warmth. Pad a rigid support, tie it above and below the break so it holds the joints on both sides, then check the hand or foot again. Don't straighten anything.

Decide whether to build one at all

Most people think a splint is the first thing you do. It isn't. Calling for help is the first thing, and if you've got a second person, they make the call while you work. If you're alone and have signal, put the phone on speaker and set it down beside you.

Now the part nobody says. If an ambulance is ten minutes out and the person is lying somewhere safe, you may not need a splint. Support the limb in the position you found it, with your hands or a rolled jacket under it, and keep the person still. A rushed splint on a badly hurt limb can cause more pain than it prevents.

Build the splint when help is far away, when you have to move the person, or when they can't stop moving the limb themselves. That's a trailhead twenty minutes from the road. It's a hunting camp, a lake cabin, a ball field with a long wait for a rig.

Before you touch anything, rule out the injuries that change everything. A fall from a ladder or a roof, a hard hit on the head, or neck or back pain means you don't move that person at all. Hold them still and wait. The same goes for anything that looks seriously wrong. For the broader picture, read what to do in the ten minutes before the ambulance arrives.

Know what you're looking at

You can't see a break through the skin, so you go by signs:

• The limb looks bent where it shouldn't bend, or one side is shorter.
• Swelling or bruising comes up fast.
• It hurts to touch, and the person can't use it or put weight on it.
• They felt or heard a snap when it happened.

If you aren't sure, splint it anyway. A sprain and a break get treated the same way until someone takes an X-ray.

If bone has come through the skin, stop and fix the bleeding first. Press a clean cloth around the wound without pushing on the bone. Cover it, and don't try to push anything back in. Leave the rest to the paramedics.

Check the hand or foot, and write it down

This is the step people skip, and it's the one that matters most. Before you tie anything, check below the injury:

1. Feeling. Touch a finger or toe and ask what they feel. Numbness or tingling is information.
2. Color and warmth. Pale, blue or cold means blood flow may be cut off. Tell the dispatcher.
3. Movement. Can they wiggle fingers or toes? Don't ask them to move the injured part itself.

Make a note of the time and what you found. You'll check again after the splint goes on, and the paramedics will want to know if anything changed.

Gather the pieces

You're after something rigid, something soft and something to tie with.

Rigid: a board, a rolled magazine or newspaper, a folded piece of cardboard, a trekking pole, a tent pole, a rolled sleeping pad, a stick as long as the limb and a hand wider. The splint should reach past the joint above the break and the joint below it. For a forearm, that means wrist to elbow. For a lower leg, knee to foot.

Soft: a towel, a sweatshirt, a folded blanket, a jacket. Pad every gap, especially around the wrist, the elbow and the ankle bone, where hard material bites.

Ties: belts, bandanas, torn strips of a T-shirt, an elastic bandage, medical tape. Wide is better than narrow. A strap cuts. A folded bandana doesn't.

If you keep one real piece of gear in the truck, make it a SAM Splint, the flat foam-covered aluminum kind that rolls up small and molds to the limb. It's the one that makes the rest of this easy. But everything below works with the junk in your trunk.

Splint an arm

1. Leave the arm in the position it's in. If the elbow is bent, keep it bent. Never straighten to make it fit.
2. Slide the padded splint along the underside of the forearm, with the hand resting on it. Pad the wrist and the gap under the arm.
3. Tie above and below the break. Never tie on the break itself. Keep the knots on the outside of the splint, not against the skin. If you want the full set of options, six knots and the order to learn them in covers the square knot, which is all you need here.
4. Tie snug, not tight. You should be able to slide a finger under each tie.
5. Hang the arm in a sling. A triangle of cloth works, or a shirt with the bottom hem pinned or knotted up over the forearm. Then bind the arm to the chest with a second strip so it can't swing.
6. The hand should sit a little higher than the elbow. Check feeling, color and movement again.

Splint an ankle

An ankle is easier than it looks, because a bulky wrap does the job better than a stiff board.

1. Have the person lie or sit down. Don't let them stand on it, even to test it.
2. Loosen the laces. If the boot comes off without pain, take it off now, before the swelling makes that impossible, and check the foot. If it hurts to move, leave it on. A boot makes a decent splint.
3. Wrap the foot and ankle in a pillow, a rolled blanket or a jacket, and run it from the calf to past the heel. Pad around the ankle bones.
4. Tie it in three places: above the ankle, across the middle of the foot and near the top of the wrap. Snug, then check the toes.
5. If you've got a rigid piece, lay one along each side of the leg, outside the padding, and tie over both.
6. Raise the foot a few inches on a pack or a coat.

Keep watching

Recheck feeling, color and warmth every ten to fifteen minutes. If the fingers or toes go numb, turn pale or swell against the ties, loosen the ties right away. Swelling gets worse after you splint, which is why tight is wrong.

Keep the person warm. A blanket over the rest of the body does more than you'd think. Cold cloth on the injury, with a layer between it and the skin, helps with pain. Don't offer food or water, since they may need surgery. Stay calm and talk to them. A steady voice is a real treatment.

What to do about it before it happens

A splint you've never practiced is a splint you'll fumble. Put a bandana, a roll of elastic bandage and a folded SAM Splint in the glovebox. Then spend twenty minutes with your family practicing on each other, with a kid as the patient and a grown-up as the medic. A course from the American Red Cross or a wilderness first aid class will show you what a page can't.

This is general education, not a substitute for training, and it doesn't replace a paramedic or a doctor. Anything that looks like a break needs an X-ray.

When the rig pulls up, hand over your notes, step back and let the pros take it. Then restock the kit before you put it back.