Safety and Efficacy of Attempts to Reduce Shoulder Dislocations by Nonmedical Personnel in the Wilderness Setting

Abstract

Shoulder dislocations are common in wilderness sports. Early reduction of the dislocated shoulder significantly relieves the patient's pain and increases the likelihood of a safe evacuation from the wilderness environment. Our hypothesis is that reduction attempts on scene by nonmedical personnel are safe, effective, and can significantly reduce the time to reduction. The objectives of this study were to define the success rate and the complication rate for shoulder reduction attempts by nonmedical personnel in the wilderness setting, and to compare the average time to reduction for those done on scene versus those that waited for reduction at a medical facility. In this prospective, cross-sectional study we administered surveys to users of wilderness sports internet forums between October 2008 and April 2009. These surveys asked respondents to describe previous wilderness sports injuries they experienced. Descriptive statistics were calculated using SPSS software, and the Mann-Whitney U test was used to compare average reduction times, with an alpha of .05 selected as the significance threshold. Overall, there were 112 responses with 58 describing shoulder dislocations that were reduced either on scene or at a medical facility. Reduction on scene, in the absence of a medically trained person, was attempted in 39 of these 58 cases with a success rate of 71.8% (28/39). The median time to reduction on scene was 10 minutes, compared to 180 minutes from the time of injury for those that waited for reduction at a medical facility (P <.001). Other than pain during the reduction, there were no reports of serious complications associated with the reduction attempts. These seminal data suggest that reduction of dislocations in the wilderness setting by nonmedical personnel may be safe and effective, and can significantly decrease the time to reduction. These findings may help guide future teachings of participants in high-risk wilderness sports.