Posted on 14th Apr 2011 @ 10:27 AM

The Revised 9th Edition First Aid Manual of the Voluntary Aid Societies has apparently changed the treatment of a collar bone fracture. They now advocate the use of a support sling rather than an elevated sling.

The following explanation originates from the Red Cross:

"The rationale behind this change is that the most comfortable position for the arm with such an injury is across the chest with the hand slightly raised. This position reduces tension on the injured area which in turn reduces the pain. The risk with an elevation sling is that the position of the fingers on the opposite shoulder may increase tension on the injury and cause more pain."

We are pleased to say that our book, First Aid Made Easy has taken account of this issue for quite some time. You will note on page 38 that it says "keep the elbow down at the casualty's side when using an elevated sling for a collar bone fracture". The issue is that if you you raise the elbow upwards and across the front of the casuatly you will note that it puts strain on the collar bone, so it should be kept at the casualty's side. (Our book talks about the elbow position, the Red Cross talk about the position of the fingers up on the opposite shoulder, same issue).

We try to avoid contradicting the VAS book wherever possible, so we also advised using an elevated sling but we added the information on keeping the elbow by the casualty's side.

There is one other possible benefit of an elevation sling - it only fastens over the good shoulder - so no weight is placed on the collar bone. This is more theoretical than anything however as there is no evidence to show what weight is placed on the collar bone with a support sling (or that this causes discomfort if it is).

In summary, BOTH treatments are an acceptable way to treat a collar bone fracture. An elevated sling is fine so long as you keep the elbow down by the casualty's side.

I suspect that First Aid Made Easy will follow the VAS book in the long term however as we prefer not to contradict it wherever possible and you could argue that it removes the possibility of the first aider forgetting that they need to keep the elbow down and getting it wrong.

The other important thing to teach your students is to speak to the casualty and avoid inflicting pain! The casualty will be able to tell you exactly which position is best!

Kind Regards,

Nigel.