A break or crack in a bone is called a fracture. In the case of an open fracture, the broken bone may pierce the skin surface. But in a closed fracture the skin around the fracture is intact. However, broken bones may be unstable causing internal bleeding and the casualty may develop shock [1].

A bone fracture is a medical condition that occurs when significant pressure is exerted on the bones, caused by: falls, traffic accidents, or bone stress (to which stress fractures in athletes are attributed). Besides, fractures may be attributed to some medical conditions that weaken the bones, such as osteoporosis and some cancers. Fractures caused by diseases are referred to as pathologic fractures [2,3].

First aid is the provision of immediate medical assistance to an ill or injured person until definitive medical treatment can be accessed, or until the illness or injury is fully dealt with. It generally consists of a series of simple, potentially life-saving steps that an individual can be trained to perform with minimal equipment. The principle of first aid is immediate action. Any action taken needs to be careful and deliberate and the first-aider should remain calm at all times [4,5].

Fracture or broken bones usually aren’t life threatening, but they do require immediate medical care. First-aid treatment in fracture includes many steps like Keep the person still and support the injured area, using soft padding. Do not move the person or the injured part unnecessarily. Do not allow the person to eat or drink. They may need surgery. Immobilize the injured area using a splint. A broad arm sling can be used to support and immobilize an injured arm. An injured leg can be splinted to the uninjured leg, using bandages around the knees, ankles and above and below the fracture site [6,7].        

A number of studies conducted in different parts of India reveal widespread ignorance and misconceptions about the fracture among people. As this disease largely relies on the right information at the right time is essential to bring about a behavioral change when the population is most receptive. Hence, this study was undertaken with the objective to assess the knowledge about first aid knowledge regarding fractures among Ortho OPD patients in civil hospital Rohru, district Shimla.

Objectives of the Study

To evaluate the first aid knowledge regarding fractures among Ortho OPD patients in civil hospital Rohru, District Shimla.

Research Methodology

• Research approach: Descriptive

• Research design: Descriptive survey design

• Setting of the study: Ortho OPD of civil hospital Rohru

• Study duration: Between Aug- December 2020

• Study population: Ortho OPD patients in civil hospital Rohru

• Sample size: 400 Ortho OPD patients

• Sampling technique: convenience sampling technique

• Sampling criteria: first five patients attending the Ortho OPD of civil hospital Rohru 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 about first aid knowledge regarding fractures among Ortho OPD patients in civil hospital Rohru, District Shimla.

• Validity of tool - by the experts in this field

• Permission- obtained from the concerned head of the civil hospital

• Data collection by myself and patients was given 5 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with appropriate statistical test in terms of frequencies and percentage

The present study was non-experimental descriptive study carried out to evaluate the first aid knowledge regarding fractures among Ortho OPD patients in civil hospital Rohru, District Shimla.

In the present study 35% (140) of the patients fall were below 40 years of age while 65% (260) were above 40 years. 54% (216) of patients were male and 46% (184) were female.

Among the total patients maximum 301 (75.25%) 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 289 (72.25%), apply a splint to the area above and below the fracture sites 205 (51.25%),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 164 (41%), raise the injury above the heart to ease swelling 132 (33%), keeps the patient lying down and as still as possible 107 (26.75%), Don’t move the patient104 (26%), cover the patient to keep warm 99 (24.75%),apply ice packs to limit swelling 88 (22%), 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 95 (23.75%) didn’t know about any first aid measure in case of fracture (Table 1).

First aid is the provision of immediate care to a victim with an injury of illness, usually effected by a lay person and performed within a limited skill range. First aid is normally performed until the injury or illness is satisfactorily dealt with or until the next level of care, such as an ambulance or doctor, arrives [8,9].

A fracture is the medical term for a broken bone. There are many types of fractures, but the main categories are open and closed. The severity of a fracture depends upon its location and the damage done to the bone and tissue near it. Serious fractures can lead to serious complications if not treated promptly. Possible complications include damage to blood vessels or nerves and infection of the bone (osteomyelitis) or surrounding tissue. Fractures can be identified by symptoms that can be represented by the acronym DOTS: D for deformity, O for open wounds, T for tenderness and S for swelling [10,11].

Table 1: First aid knowledge regarding fractures

In the present study, among the total patients maximum 301 (75.25%) 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 289 (72.25%), apply a splint to the area above and below the fracture sites 205 (51.25%),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 164 (41%), raise the injury above the heart to ease swelling 132 (33%), keeps the patient lying down and as still as possible 107 (26.75%), don’t move the patient104 (26%), cover the patient to keep warm 99 (24.75%),apply ice packs to limit swelling 88 (22%), 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 95              (23.75%) didn’t know about any first aid measure in case of fracture.

As a first aid measure, first thing is to assess the patient rapidly for any signs of deformity, open injuries, tenderness and swelling. Also, check for the inability to move the injured area or any sign of bleeding. When there is bleeding, apply pressure on the wound to prevent blood loss. Then apply the RICE (Rest, immobilize, cold and elevate) method [12,13].

Have the patient rest the affected area and prevent any movement to reduce pain. Support the fractured part or encourage the patient to support it. Immobilize or stabilize the injured area on the ground. If movement is needed, apply splints on either side of the injured part for stability. Broad bandages are useful in preventing joint movement on either side of the break in the bone. Splints should always be padded and any space in between the body and the splint must be filled in gently with more padding to keep it from moving. Secure the splint properly. If the foot is suspected to be fractured, the foot and ankle must be immobilized. Make sure the bandages are not too loose or too tight and repeat this check about every 15 minutes. If available, apply a cold pack, ice, or cold water in a plastic bag to the injured area. Remember to put a folded gauze pad or cloth between the ice pack and the skin to prevent skin damage. Leave the ice pack on for about 20 minutes. Do not apply the cold compress directly on an open fracture. Always elevate the injured part above the heart level, if it’s possible. However, do not elevate it if you suspect a broken bone or if moving the area will cause pain [14,15].

Help them get into a comfortable position, encourage them to rest and reassure them. Cover them with a blanket or clothing to keep them warm. If it is an open fracture, cover the wound with a sterile dressing or a clean non-fluffy cloth. Apply pressure around the wound and not over the protruding bone, to control any bleeding. Then secure the dressing with a bandage [6,12].

If the person doesn’t appear to be breathing or has become unconscious, begin cardiopulmonary resuscitation. Remember, call for medical help if you suspect the fracture is in the patient’s back, neck, or head, the fractured bone has pushed through the skin or there is heavy bleeding [6,9].

Good first-aid care of fractures is always important. Any negligence can increase pain and bleeding and can damage tissues around the injury. This can lead to complications in the repair and healing of the injury later on.

1. St. John Ambulance. “What Are Fractures?” St. John Ambulance, https://www.sja.org.uk/get-advice/first-aid-advice/bones-and-muscle-injuries/broken-bones-and-fractures/#:~:text=What%20are%20fractures%3F-,A%20break%20or%20crack%20in%20a%20bone%20is%20called%20a,the%20casualty%20may%20develop%20shock. Accessed 1 June 2021.

2. Physio- pedia. “Hip Fracture.” https://www.physio-pedia.com/Hip_Fracture. Accessed 2 June 2021.

3. WebMD. “Understanding Fractures – Basic Information.” https://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information. Accessed 2 June 2021.

4. Medical News Today. “What to Know about Bone Fractures.” https://www.medicalnewstoday.com/articles/153849. Accessed 3 June 2021.

5. POLHN. “World First Aid Day 2019.” https://polhn.wpro.who.int/blog/world-first-aid-day-2019/. Accessed 4 June 2021.

6. Healthline. “Broken Bones: Types, Symptoms and Treatment.” https://www.healthline.com/health/first-aid/broken-bones. Accessed 4 June 2021.

7. News-Medical. “Broken Bone First Aid.” https://www.news-medical.net/health/Broken-Bone-First-Aid.aspx. Accessed 5 June 2021.

8. West Bengal Forest Department. “Cm18.” http://www.westbengalforest.gov.in/upload/development/cm18.pdf. Accessed 6 June 2021.

9. NHS Inform. “First Aid.” https://www.nhsinform.scot/tests-and-treatments/emergencies/first-aid. Accessed 7 June 2021.

10. Cleveland Clinic. “Bone Fractures.” https://my.clevelandclinic.org/health/diseases/15241-bone-fractures#:~:text=Closed%20or%20open%20fractures%3A%20If,forms%20where%20the%20bone%20breaks. Accessed 7 June 2021.

11. Medicine Net. “Broken Bone (Types of Bone Fractures).” https://www.medicinenet.com/broken_bone_types_of_bone_fractures/article.htm. Accessed 7 June 2021.

12. Neuron. mefst. “First Aid to the Injured.” https://neuron.mefst.hr/docs/katedre/klinicke_vjestine/Dr%20Lojpurr%20FIRST%20AID%20TO%20THE%20INJURED.pdf. Accessed 7 June 2021.

13. “Nursing Center”. Journal Article: Broken Bones. https://www.nursingcenter.com/journalarticle?Article_ID=845534andJournal_ID=606913andIssue_ID=845514. Accessed 8 June 2021.

14. News-Medical. “Broken bone first aid.” https://www.news-medical.net/health/Broken-Bone-First-Aid.aspx. Accessed 9 June 2021.

15. Healthline. “How to make a splint.” https://www.healthline.com/health/how-to-make-a-splint. Accessed 10 June 2021.