A/N: As requested by Pizza Angel on AO3
"I really don't want to re-splint this without pain relief." Gordon frowned as he examined the patient's broken lower left leg by torchlight and the improvised splint that had been cobbled together from shoelaces and driftwood.
Today's rescue was a weird one. Three men had somehow gotten trapped in one of the many coastal underwater cave systems in Bali. Their sub had died in the water, they'd swum out and managed to find an air pocket. Complicating matters, one of them had broken his leg and a storm was closing in. The eddies and currents of storm surges in the twisting, tight passages of the caves were a bad combination and Gordon wanted to be out of here before the full force of the storm hit.
Gordon had turned his Squid Sense up to 11 on the way in- he'd passed the drowned sub on his way in and despite the hideous mint green paint job of the local rental place, that was not a Joe Public-grade submersible. As for the victims themselves, they were wearing civvies that somehow weren't quite civvie enough to not feel like some kind of uniform, like they'd migrated to styles that felt like what they'd usually wear on duty. (He knew all about that, it took him weeks to not automatically reach for grey after leaving WASP, hence the Hawaiian shirt he wore off duty) Close knit was the other vibe he'd picked up on- they were wary and guarded and making half coded references like he and his family would do when out and about amongst normal people. Squid Sense told him they weren't a threat to him though, that much he knew.
"Can we move him without having to change the splint?" The oldest of the trio, Brad, asked him.
"No." Gordon shook his head. "You've got support on his leg but his foot is unsecured, when it moves it's going to drag on the muscles and everything else and make the damage worse- it's a spiral fracture of the tibia and a partial fracture of the fibula according to the scanner. That's a lot of sharp bone in there and we're going to have to swim a bit to get to my ship. What did you hit?" He asked, directing that to the patient.
Patrick shrugged, pale in the torchlight but gamely chipper despite the pain. "Something in the sub and more like I hit it is about all I can tell you." He replied in a broadly American-Irish accent, grimacing at the memory. "I don't think I need any opiates, I can handle a few minutes of re-splinting before swimming again."
"I'd prefer to give you morphine first." Gordon explained. "It's not just the splinting, but the moving you into Four as well. It's a short trip, but it's a lot easier if your pain is under control and I want to give you something that'll last the whole way." He noted the guarded looks the three were exchanging over his head. "If you're worried about accidentally giving the game away under morphine I'll only give just enough to take the edge off and I've never had anyone tell me about their top secret mission on morphine." He added, the flickers of surprise on their faces telling him he'd hit his mark.
"How did you…" The third man, Richard, started to ask, but Gordon cut him off with a look and a raised eyebrow.
"I saw your sub on the way in. No way that's from the local rental place." Gordon pointed out.
"Told you." Brad muttered to Richard, who grumbled something under his breath.
"We need to get things moving before that storm hits full force." Gordon interrupted, sensing it was time to push things along. "Patrick, can I give you morphine and change out this splint?"
Patrick glanced up at the other two first, then looked at Gordon. "Okay, do it." He nodded.
Gordon quickly prepared the IV and the morphine. From the waterproofed medical kit he'd taken out with him he took a moldable polymer splint with a specially cut layer of foam padding. Normally they used a simple coffin-shaped cardboard splint and a towel for padding for splinting lower legs and arms, a simple and adaptable system used for decades, but that wouldn't work on water rescues and Brains had developed this in response. Gordon laid it out beside Patrick's leg along with the velcro straps he would use to bind the splint just under the knee, just above the ankle and the X shaped straps to secure the foot into the splint. He bent the splint into shape, including a flap that ran the length of Patrick's foot to support it, and looked to the other two. "I need someone to help lift his leg so I can get this splint into place, either of you comfortable with that?"
"I can." Richard volunteered. "You want Pat lying down first?"
"Yep, that'll make things easier." Gordon nodded.
While Gordon handed his torch to Brad to illuminate the area better for him to do his work, Richard moved to help Patrick lie down on the rocky floor. "Lie back and think of England, Pat." Richard teased, only to receive a well aimed swat at his knee in response.
"Wrong island." Patrick growled at him, deepening his Irish brogue to make the point.
"Thin ice there Richard, even I know better than to get those two mixed up." Gordon joined in on the banter, glad it was distracting Patrick from the pain of his broken leg. "Okay, ready for the IV, Patrick?"
"Stab away." Patrick grinned at him, offering his right arm.
The IV was easy enough and three milligrams of morphine eased the lines of pain in Patrick's face. Gordon cut away the improvised splint, it wasn't too bad and they'd obviously had some kind of training, but it wasn't good enough unfortunately. He cut off the shoe, checked the limb baselines and was fairly happy when he found everything tolerable under the circumstances. Richard proved to be an able assistant, smoothly and gently scooping up the injured leg at the knee and ankle so Gordon could remove the improvised splint and slide his splint into place. Once the velcro straps were placed, Richard lowered the leg while Gordon made last minute adjustments, then the straps were placed above and below the break and to secure the foot.
Gordon rocked back on his haunches to survey his handiwork, scooped the rubbish into his kit and nodded to himself. "Right, let's get out of here."
A/N: Yes, that was a crossover, because I can.
Splinting is one of those skills that's best to leave alone unless you know what you're doing, and a big chunk is simply because of the pain and risk of damage. It's a lot of movement to get a splint in place and you don't want your patient to be writhing around if you can help it.
As a first aider your goal is to pack the fractured limb and reduce overall movement- using blankets, towels, jackets, whatever you have. If you're at the beach you can even pile sand around a broken leg, and I've heard of one guy using his dog as an improvised splint because the dog would stay put. Try get at least one thing in a U shape around the lower leg to support the foot, because if the foot moves the leg moves. Keep your patient warm because they could be going into shock and wait for expert help to arrive. Don't feed them or give them a drink unless cleared by expert help, if they need surgery they need an empty stomach and there's the shock= stomach off= vomit problem.
Inflatable splints are something I've seen come in and out of 'fashion' a couple of times, advertised as being a space saver for outdoor first aid kits. I don't like them personally- one, you have to get the thing on somehow- if it's a boot or sleeve style, you can imagine the unnecessary pain and movement the patient will go through to try and get it on and they're not one size fits all. Two- if it's been sitting in your kit for a while, the plastic may degrade and it's useless if it can't hold air or you might pop it. Three- it's going to put pressure on top of the fracture site or an open fracture it'll be pushing on the exposed bone, you don't want that, the patient will not be happy.
If you can get your hands on one of the aluminium and foam splints, those are better in my opinion. They can be bent to shape, you can access the limb for baselines, if it's an open fracture you won't be pressing on the bone and it won't pop. Still add a layer of towel or a tee-shirt for extra padding because arms and legs have all sorts of curves in them. However if you've been trained on an inflatable splint and you're happy with it's use, it's better than an untrained attempt at something with two sticks and some paracord.
P.S. I also want to say thank you to everyone who has been reviewing, as a writer I love getting reviews, finding out the bits people liked and any questions you have. I really do appreciate it every time someone takes the time to review, it really brightens my day.