Risk and benefits of paramedic-initiated shoulder reduction

Abstract

The introduction of prehospital reduction of shoulder dislocation by paramedics is a huge departure from previous teachings. Although shoulder reduction is recommended for use in specific circumstances, such as wilderness areas, little published evidence exists either to provide a solid foundation for its prehospital use, or advise against the introduction of this procedure. Shoulder dislocations, while affecting a minority of the community, are painful and debilitating and require early reduction, as muscle spasm increases with time, making reduction more difficult. In areas associated with prolonged ambulance transport times, the delay to definitive treatment may cause needless pain and suffering to patients sustaining shoulder dislocation. In order to assess the risks and benefits of paramedic reduction of shoulder dislocation, this study systematically evaluated the available evidence. No evidence from clinical studies in the prehospital setting was found: studies from other health settings are used to synthesize recommendations for paramedic practice that enable timely, safe and humanitarian care of patients with shoulder dislocation.