Key findings:

Key findings include: 64% of patients were over 40 years old, and 59.75% were male; 75% of patients correctly identified immobilizing the injured area as the first step in fracture first aid; however, 17% were unaware of any first aid procedures for fractures, indicating insufficient knowledge among the study population.

What is known and what is new?

The known aspect is the importance of administering first aid for fractures to prevent complications. The new contribution is the assessment of first aid knowledge regarding fractures among Ortho OPD patients at Regional Hospital, Keylong in Himachal Pradesh, revealing gaps in knowledge and highlighting the need for targeted community education programs to promote proper first aid practices for fractures.

What is the implication, and what should change now?

The implication of this study is the need for targeted community education programs to improve first aid knowledge regarding fractures, especially among high-risk populations like the elderly. Changes needed include incorporating fracture first aid training into community health initiatives, collaborating with healthcare providers to promote awareness, and developing educational materials in local languages to ensure accessibility and effectiveness.

A crack or split in a bone is known as a fracture. In an open fracture, the broken bone may pierce the skin's surface. Skin around a closed fracture is unaffected, nevertheless. But fractured bones that are unstable could cause internal bleeding and shock in the person. [1]

When the bones are subjected to intense pressure, which may be caused by accidents, falls, or bone tension, a bone fracture can result (to which stress fractures in athletes are attributed). Fractures may also be caused by conditions like osteoporosis and various cancers that weaken the bones. Pathologic fractures are those caused by a disease. [2,3]

First aid refers to the prompt provision of medical care to a sick or injured person until access to definitive medical care is possible or the illness or injury has received sufficient treatment. It frequently comprises a series of simple, potentially life-saving techniques that anyone may learn to use with the fewest possible instruments. The foundation of first aid is the notion of rapid intervention. The first responder must constantly retain composure and take thoughtful, cautious action. [4,5]

Usually, broken or fractured bones don't endanger life, but they do require immediate medical attention. First-aid for fractures includes steps such as Remain calm and support the injured region with comfortable padding. Avoid touching the person or the place where they are injured without need. Don't let them eat or drink anything. Surgery might be necessary. To immobilize the injured area, apply a splint to it. A wide arm sling can be used to support and immobilize an injured arm. An wounded leg can be splinted to the intact limb by wrapping bandages around the knees, ankles, and above and below the fracture site. [6,7

Numerous research carried done in various regions of India demonstrate widespread misunderstandings and ignorance regarding the rift amongst the people. However, such research is scarce in Himachal Pradesh, a Himalayan state with a diverse range of traditions and cultural patterns. Therefore, this study was conducted with the aim of evaluating the first aid knowledge of Ortho OPD patients at Regional Hospital, Keylong in District Lahaul & Spiti of Himachal Pradesh regarding fractures.

Objectives of the Study

To evaluate the first aid knowledge regarding fractures among Ortho OPD patients at Regional Hospital, Keylong in District Lahaul & Spiti of Himachal Pradesh

• Research Approach -Descriptive

• Research Design- Cross Sectional Hospital Based Survey

• Setting of the study- Ortho OPD of  Regional Hospital, Keylong in District Lahaul & Spiti of Himachal Pradesh

• Study duration- July 2022 to  September 2022

• Study population- Ortho OPD patients in Regional Hospital, Keylong in District Lahaul & Spiti of Himachal Pradesh

• Sample size- 400 assuming 50%  adults have adequate first aid knowledge regarding fractures, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique- convenience  Sampling Technique

• Sampling criteria- first five patients attending the Ortho OPD of Regional Hospital, Keylong everyday were selected till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from  them and confidentiality  of the selected  participants was also maintained 

• Inclusive Criteria- Patients selected during the day of data collection in study setting and who were willing to participate in the study.

• Exclusion Criteria: Patients who were not willing to participate in the study 

• Development of Tool-Knowledge related questionnaires

• Description of Tool

Section A-Socio-demographic characteristics of the patients (Age, Gender etc.).

Sections B- Questions regarding first aid knowledge in case of fractures

• Validity of tool - by the experts in this field

• Permission- obtained from the concerned head of the Regional Hospital, Keylong

• Data collection by the researcher themselves and patients were given 5 minutes time to complete that questionnaire and collected at the end of the prescribed time.

• Data analysis- Data was collected and entered in Microsoft excel spreadsheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc.

• Ethical Considerations- Participants confidentiality and anonymity was maintained

The present study was a non-experimental descriptive study carried out to evaluate the first aid knowledge regarding fractures among Ortho OPD patients at Regional Hospital, Keylong in District Lahaul & Spiti of Himachal Pradesh.

In the present study 36% (144) of the patients were below 40 years of age while 64% (256) were above 40 years.  59.75% (239) of patients were male and 40.25% (161) were femal

Table-1: First aid knowledge regarding fractures

Among the total patients maximum 300(75%) replied that immobilization of  the injured area is the first aid measure in case of fracture followed by apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing 288 (72%), apply a splint to the area above and below the fracture sites 204(51%), stop any bleeding 190 (47.5%),give painkillers to patient 190 (47.5%), keep the fracture area clean and keep it away from dirt or sand 163 (40.75%), raise the injury above the heart to ease swelling 132(33%), keeps the patient lying down and as still as possible 106(26.5%), Don’t move the patient104(26%), cover the patient to keep warm 99(24.75%),apply ice packs to limit swelling  87(21.75%), avoid any attempt to force a fracture or dislocation back into place  or re-align the fracture 81(20.25%), Do not allow the person to eat or drink 78 (19.5%) and lay the person down with the head slightly lower than the trunk 45(11.25 %). Still 68 (17%) didn’t know about any first aid measure in case of fracture. (Table-1)

First aid refers to the immediate care provided to an injured or illness victim. It is frequently delivered by an untrained layperson. First aid is often administered until the illness or injury is sufficiently addressed, or until the next stage of care, such as a doctor or ambulance, arrives. [8,9]

A fracture is the term used in medicine to describe a broken bone. Although there are many other types of fractures, open and closed fractures are the two most common. The fracture's severity depends on the fracture's location and the extent of the surrounding bone and tissue damage. Serious consequences might arise from severe fractures if they are not treated immediately. Potential side effects include damage to blood vessels or nerves, as well as osteomyelitis, an infection of the bone. DOTS, an acronym for the signs that can be utilized to spot fractures, stands for Deformity, Open Wounds, Tenderness, and Swelling. [10,11]

In the current study, 64% (256) of the patients were over 40 years old, compared to 36% (144) of the patients who were under 40. Male patients made up 59.75% (239) and female patients made up 40.25% (161). Maximum of 300 patients (or 75%) said that the first step in treating a fracture is to immobilize the injured area. This was followed by 288 (72%), applying pressure to the wound with a sterile bandage, a clean cloth, or a clean piece of clothing, 204 (or 51%), applying a splint to the area above and below the fracture sites, 190 (47.5%), stopping any bleeding, and 190 (47.5%) prescribing painkillers to the patient. Still, 68 (17%) people were unaware of any first aid procedures for fractures.

Quickly inspecting the patient for any signs of abnormalities, open wounds, discomfort, or swelling is the first step in providing first aid. Check for any bleeding as well as any immobility or difficulty moving the injured area. When a wound is bleeding, apply pressure to stop more blood loss. Then, one should employ RICE (Rest, Immobilize, Cold, and Elevate). [12,13]

Allow the patient to rest the painful area and refrain from any motion. If you can, encourage the patient to support the broken component. Immobilize or stabilize the damaged region on the ground. If movement is necessary, place splints for stability on either side of the affected area. Broad bandages are useful to prevent movement of the joints on either side of the shattered bone. In order to prevent movement, splints must always be cushioned, and any spaces between the body and the splint must be delicately filled in with additional padding. Place the splint correctly. If the foot has a fracture, the foot and ankle need to be immobilized. Every 15 minutes, recheck the bandages to make sure they are not too tight or loose. If you have access to any of these, apply a cold pack, ice, or cold water in a plastic bag to the injured area. Put a folded gauze pad or piece of fabric between the ice pack and the skin to prevent skin injury. It is recommended to leave the ice pack on for around 20 minutes. It is not recommended to immediately apply a cold compress to an open fracture. Always elevate the wounded area above the level of the heart, if at all possible. If there is no possibility of a broken bone or if moving the area will make you uncomfortable, merely elevate it. [14,15]

Help them find a comfortable position, put them to sleep, and reassure them. Wrap them up in clothes or a blanket to keep them warm. If the fracture is open, cover the wound with a piece of clean, non-fluffy fabric or a sterile dressing. Apply pressure around the wound rather than directly over the protruding bone to stop any bleeding. After that, secure the dressing with a bandage. [6,12]

If the victim doesn't seem to be breathing or appears to have passed out, begin cardiopulmonary resuscitation (CPR). If you think the patient has a fracture to their back, neck, or head, if the fractured bone has broken through the skin, or if there is severe bleeding, remember to get them immediate help. [6,9]

The participants' knowledge of the first aid treatment of fractures was either poor or inadequate, according to the survey's findings. Fracture first aid therapy must always be performed expertly. Any negligence could aggravate the pain and bleeding from the wound while also damaging the neighboring tissues. Later, this can make it more challenging to heal and fix the injury.

No funding sources.

None declared.

The study was approved by the Institutional Ethics Committee of Regional Hospital, Bilaspur.

1. St. John Ambulance. Available at: https://www.sja.org.uk/get-advice/first-aid-advice/bones-and-muscle-injuries/broken-bones-and-fractures/#:~:text=What%20 are%20fractures%3F-,A%20break%20or%20crack%20in%20a%20bone%20is%20c alled%20a,the%20casualty%20may%20develop%20shock. (accessed on 01 July 2022)

2. Physio-pedia. Available at:  https://www.physio-pedia.com/Hip_Fracture(accessed on 02 July 2022)

3. Webmd. Available at:  https://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information(accessed on 02 July 2022)

4. Medicalnewstoday. Available at: https://www.medicalnewstoday.com/articles/153849(accessed on 03 July 2022)

5. Polhn. Available at: https://polhn.wpro.who.int/blog/world-first-aid-day-2019/(accessed on 04 July 2022)

6. Healthline. Available at: https://www.healthline.com/health/first-aid/broken-bones(accessed on 04 July 2022)

7. News-medical. Available at: https://www.news-medical.net/health/Broken-Bone-First-Aid.aspx(accessed on 05 July 2022)

8. Westbengalforest. Available at: http://www.westbengalforest.gov. in/upload/ development/cm18.pdf(accessed on 06 August 2022)

9. Nhsinform.  Available at: https://www.nhsinform.scot/tests-and-treatments /emergenci es/first-aid(accessed on 07 August 2022)

10. Clevelandclinic. Available at:  https://my.clevelandclinic.org/health/diseases/15241-bone-fractures#:~:text=Closed %20or%20open% 20fractures%3A%2 0If,forms%20where %20the%20bone%20breaks. (accessed on 07 August 2022)

11. Medicinenet. Available at: https://www.medicinenet.com/b roken_bone_types_of_ bone_fractures/article.htm(accessed on 07 August 2022)

12. Neuron.mefst. Available at: https://neuron.mefst.hr/docs/ katedre/klinicke_vjestine/Dr%20 Lojpurr%20FIRST %20AID%20TO% 20THE% 20INJURED.pdf(accessed on 07 August 2022)

13. Nursingcenter. Available at: https://www.nursingcenter.com/journ alarticle?Article_ID= 845534&JournalID=606913&Issue_ID=845514(accessed on 08  September 2022)

14. News-medical. Available at:  https://www.news-medical.net/health/Broken-Bone-First-Aid.aspx(accessed on 09 September 2022)

15. Healthline. Available at: https://www.healthline.com/health/how-to-make-a-splint(accessed on 10 September 2022)