Safety and Efficacy of Attempts to Reduce Shoulder Dislocations by Non-medical Personnel in the Wilderness Setting

Abstract

The objectives of this study were to explore the success rate and the complication rate for shoulder reduction attempts by non-medical 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 study we solicited online survey responses from users of wilderness sports forums between October 2008 and April 2009. These surveys asked respondents to describe previous wilderness sports injuries they experienced. Descriptive statistics were calculated, 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 56 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 56 cases with a success rate of 71.8% (28/39). The median time to reduction on scene was 5 minutes, compared to 135 minutes from the time of injury for those that were reduced 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 data suggest that reduction of dislocations in the wilderness setting by non-medical personnel may be safe and effective, and significantly decreases the time to reduction. These findings may help guide future instruction of participants in high-risk wilderness sports.