Bonner County EMS System Procedures Trauma: Shoulder Dislocation Reduction-9065

SHOULDER DISLOCATION REDUCTION

Clinical Indications Management of simple shoulder joint dislocation in the instance of loss of distal pulses or prolonged

time to facility arrival. This protocol applies to dislocations of the shoulder resulting from an indirect force; all other potential dislocations should be treated as one would treat any other potentially unstable joint injury (i.e. splint in a position that maintains stability and neurovascular function while facilitating transport).

PROCEDURE GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control **

***Higher level providers are responsible for lower level treatments*** Monitor vitals and assess for distal pulses and signs of circulatory compromise. E Check and document finger motion and sensation over the fingers and deltoid

region of the affected side. With the patient in the supine position, and while sitting adjacent to the

dislocated shoulder, apply gentle traction to the arm to overcome muscle spasm. Gradually abduct and externally rotate the arm until it is at a 90-degree angle toward the patient’s body. This is most easily achieved by keeping the elbow in the 90 degrees of flexion throughout the maneuver. Hold the arm in this position (“baseball throwing position”) and maintain traction until the dislocation has been reduced.

An alternative method of reduction takes advantage of gravity. Ten pounds is secured to the patient’s arm while he/she is lying face down with the arm hanging unsupported. This process can be facilitated if the rescuer stabilizes the upper portion of the scapula with one hand while rotating the lower tip medially with the other. Reassess and treat in the same fashion after the reduction is complete.

Once either the dislocation is reduced or the rescuer decides to discontinue reduction attempts, adduct the humerus so that the elbow is alongside the body. Then internally rotate the arm across the body and sling and swathe.

Reassess and document distal neurovascular status. Transport patient to the appropriate facility.

A2

Consider sedation or analgesia for patient discomfort. P . **Discuss any ongoing neurovascular compromise with Medical Control * M2EMT providers may perform these procedures if credentialed with the appropriate OM.

A history confirming that there has been no direct injury to the affected joint and an examination with findings consistent with a dislocation must be obtained prior to treatment. The following procedures should be stopped if pain increases and/or resistance are encountered.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective 01/01/16 final 5/20/2023 page 1 of 2

Bonner County EMS System Procedures Trauma: Shoulder Dislocation Reduction-9065

QA Parameters: 100% of patients requiring shoulder dislocation reduction.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective 01/01/16 final 5/20/2023 page 2 of 2