FRACTURE & BURN
Conditions: IED threw teammates to ground. Closed fracture and burn injury. Non-CBRNE, conscious casualty sitting up.
Understanding This Task
This task combines fracture treatment and burn treatment. For the fracture, you must check CSM (Circulation, Sensation, Movement) distal to the injury, then splint, sling, and swathe as appropriate.
Key principle: Recheck circulation after EVERY application (splint, sling, and swathe). Splint in position found. Splints must extend beyond joints above and below.
Common NO-GO Mistakes
- Not checking CSM before and after each application
- Splint not extending beyond joints above and below fracture
- Tying cravats directly over the fracture
- Using ice on burns (cool with water only)
- Applying ointments to burns in the field
Task Basis: 081-831-1034, 081-000-0044
Video Resources
ATP 4-02.11 Doctrine
From Army Techniques Publication 4-02.11, 23 March 2026 — Chapter 13: Fractures and Splinting; Chapter 12: Burns
CSM check — pre and post splint (para 13-18, 13-21, 13-33): Before splinting, check the pulse below the fracture. Watch for signs of poor circulation: coolness, numbness, or lack of a pulse. Note color — pale, white, or bluish-gray skin may indicate impaired circulation. Check temperature by comparing the injured side to the uninjured side. Question the casualty about numbness, tightness, cold, or tingling. Check distal pulses both before and after applying any splint.
Splint above and below the joint (para 13-13, 13-19, 13-27): Splinting involves immobilizing the injured limb to prevent further movement. Ensure splints are long enough to immobilize the joint above and below the suspected fracture. Use at least four ties — two above and two below the fracture. Ties should be square knots, tied away from the body on the splint. Caution: do not wrap too tightly — numbness, tingling, increased pain, or pale/bluish fingers or toes indicates the bandage must be loosened.
No cravat directly over fracture (para 13-16, 13-26): Do NOT apply a cravat on the fracture site — pressure from the cravat could cause additional injury. Swathe bandages are placed above or below the fracture, not on top of it. Splint ends should not be placed against the groin. Pad all bony areas (elbow, wrist, knee, ankle, crotch, or armpit) where the splint touches.
Rule of Nines and burn care (para 12-3, 12-4, 12-20): Burns are classified as superficial (1st degree), partial thickness (2nd degree), or full thickness (3rd degree). Use the Rule of Nines to estimate burn percentage: Head=9%, each Arm=9%, Torso Front=18%, Torso Back=18%, each Leg=18%, Pubic area=1%. Note: first degree burns are not included in burn percentage calculations. For cooling — use available clean water; avoid ice to prevent further skin damage. Apply dry sterile dressing; elastic/restrictive bandages are normally NOT applied to burn casualties due to swelling risk.
Source: ATP 4-02.11, Chapter 13, para 13-13 through 13-27; Chapter 12, para 12-3, 12-4, 12-20
- Check CSM (Circulation, Sensation, Movement) distal to fracture.
- Splint in position found — do not force alignment.
- Cool burns with water, NOT ice. No field ointments.
- Recheck circulation after every splint/sling/swathe application.
PERFORMANCE MEASURES
0/6 GO- 1
Reassure casualty, explain treatment
- Loosen tight/binding clothing. Remove jewelry from affected limb.
-
2
Check circulation below injury (CSM) CRITICAL
- Light skin: Check color (pale, white, bluish gray).
- Dark skin: Depress toenail/fingernail beds, check return of color (slower = circulation problem).
- Feel if injured limb is colder than uninjured.
- Ask about numbness, tightness, cold sensation.
- 3
Splint (improvised or SAM)
- Splint fracture in position found. If no circulation or grossly angulated, gently realign.
- Ensure splint ends do not press against groin.
- Place one splint on each side. Splints must reach beyond joints above and below fracture.
- Tie nonslip knots — NOT directly over fracture. At least 2 cravats above and 2 below.
- Recheck circulation below injury.
- 4
Sling (actual or improvised)
- Pressure on uninjured side. Hand slightly higher than elbow.
- Recheck circulation.
- 5
Swathe
- Apply above and/or below fracture, NOT over it.
- Wrap over injured arm, around back, under uninjured arm. Tie on uninjured side.
- For legs: wrap around both legs, tie on uninjured side.
- Recheck circulation.
- 6
Treat burn
- Cut clothing away from burn. Remove rings/bracelets.
- Apply dry sterile dressing securely but not overly tight.
- Cover extensive burns with sterile sheet/linen.
Go Deeper — ATP 4-02.11 Reference
Detailed doctrine from the Army Techniques Publication: