Applying a Pelvic Binder – OSCE Guide

This guide provides a step-by-step approach to applying a pelvic binder in an OSCE setting. It is NOT intended to be used to guide patient care.

Applying a pelvic binder may be assessed in an OSCE as an individual skill or as part of a (C)ABCDE assessment.

Pelvic binders

A pelvic binder is a life-saving device used for suspected unstable pelvic fractures (“sprung pelvis”).

Pelvic fractures can cause major haemorrhage and may be rapidly life-threatening, particularly after high-energy mechanisms such as road traffic collisions, crush injuries or falls from height.¹

The main aims of a pelvic binder are to stabilise the pelvic ring and reduce pelvic volume, which can help tamponade (compress) bleeding and limit further haemorrhage until definitive management is available.¹

Bleeding is primarily venous (presacral plexus and prevesical veins, ∼85%) but also includes arterial sources (∼15−20%) and fractured bone ends.²

Indications

A pelvic binder should be applied when an unstable pelvic fracture is suspected, particularly if the patient is haemodynamically unstable and there is no other obvious source of bleeding.³

Indications for application include:

• High-energy blunt trauma
• Pelvic pain, deformity, or leg length discrepancy
• Haemodynamic instability

Contraindications

Contraindications include:^2,4

• Open pelvic fractures with severe soft tissue injury
• Isolated injuries outside the pelvic ring (e.g. femur or hip fractures)

Gather equipment

Commercial pelvic binders include the SAM® Sling, T-POD®, and Prometheus.

SAM® Slings are commonly stocked in emergency departments and are available in three sizes (small, medium and large).

Improvised binders, such as a folded sheet or blanket, can be used if commercial devices are unavailable.⁵

Introduction

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.

Don PPE if appropriate.

Note: applying a pelvic binder is an intervention performed on major trauma patients, some of whom may be unconscious. Carrying out the following steps is good practice.

Introduce yourself to the patient, including your name and role.

Briefly explain what the procedure will involve using patient-friendly language. “I need to apply a strap around the top of your thighs to help stabilise your pelvis.”

Gain consent to proceed with applying the binder. 

Adequately expose the patient’s pelvis.

Preparation

1. Ensure scene safety and assess the patient using a (C)ABCDE approach.⁴

2. Assess for pelvic tenderness, deformity, active bleeding, and the patient’s haemodynamic status. If a pelvic injury is suspected, avoid repeated pelvic manipulation (do not “spring” the pelvis).

3. Initiate resuscitation as required, which may include IV tranexamic acid and blood products via a major haemorrhage protocol.⁶

Apply the pelvic binder

Positioning

1. Identify the greater trochanters. The binder must sit over the greater trochanters (not the iliac crests or abdomen) to be effective.⁷

2. Apply the binder directly to the skin where possible.⁷

3. Carefully slide the binder beneath the patient with minimal movement. Do not log roll the patient.⁸

4. Align the binder over the greater trochanters bilaterally, ensuring it is symmetrical on both sides.^1-3,5-9

Securing the binder

1. Fasten and tighten the binder to achieve firm circumferential compression, following the manufacturer’s instructions. With some binders, you should feel the buckle “click” when appropriate tension is achieved.⁵

2. Ensure the patient’s legs are together.⁷

3. Recheck that the binder remains positioned over the greater trochanters and is central and not riding up.

Note: The patient’s feet should be internally rotated if the binder is correctly applied.⁷

To complete the procedure…

Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.

Reassess the patient and check distal pulses, sensation and motor function in both lower limbs.⁷

Arrange urgent imaging (CT pelvis or trauma imaging) and document the time of application.

Monitor for complications, particularly pressure injury. Prolonged application increases the risk of skin breakdown & pressure sores, so regular skin checks and a removal plan are essential.⁷

Maintain the binder until definitive orthopaedic or radiological intervention is available; BOAST guidelines (2018) advise removal of the binder within 24 hours.⁶

Polytrauma patients should have an X-ray post-binder removal after resuscitation, even if CT trauma imaging is negative, as a well-applied binder can mask a pelvic fracture.⁶

Reviewer

Mr Umair Ashraf

Senior Clinical Fellow

Trauma and Orthopaedics

References

1. Coccolini, F., Stahel, P.F., Montori, G., et al. (2017). Pelvic trauma: WSES classification and guidelines. World Journal of Emergency Surgery, 12(1), 5. 
2. Khaliq F, Rodham P. EMS Pelvic Binders. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
3. Lee C, Porter K. The prehospital management of pelvic fractures. Emerg Med J. 2007;24(2):130–133.
4. National Institute for Health and Care Excellence (NICE). Major trauma: assessment and initial management. NICE guideline [NG39]. 2016. Available from: [LINK]
5. LITFL. Pelvic binders. Life in the Fast Lane. 2021. Available from: [LINK]
6. British Orthopaedic Association. BOAST 3: The management of patients with pelvic fractures. London: BOA; 2018. Available from: [LINK]
7. Royal College of Emergency Medicine (RCEM). Use of Pelvic Binder. RCEM Learning. 2025. Available from: [LINK]
8. Scott I, Porter K, Laird C, Bloch M, Greaves I. The Pre-hospital Management of Pelvic Fractures: Initial Consensus Statement. Faculty of Pre-Hospital Care, RCSEd; 2012. Available from: [LINK]
9. West Yorkshire Major Trauma Network. Standard Operating Procedure: Pelvic Binder. Version 1.4, August 2021.

Image references

• Figure 3. Laboratoires Servier. Pelvis. Adapted by Maha Ejaz. License: [CC BY-SA]