A fracture is a break or split in a bone. The broken bone may puncture the skin surface in an open fracture. However, the skin surrounding a closed fracture is unharmed. However, unstable shattered bones might result in internal bleeding and shock in the victim.[1]

A bone fracture is a medical ailment that develops when the bones experience severe pressure, which can be brought on by accidents, falls, or bone stress (to which stress fractures in athletes are attributed). Additionally, diseases like osteoporosis and some malignancies that weaken the bones may be to blame for fractures. Pathologic fractures are fractures brought on by an illness.[2,3]

First aid is the administration of prompt medical care to a sick or injured individual until access to definitive medical care is possible or the disease or injury has been adequately treated. It often consists of a set of easy, possibly life-saving actions that anyone can learn to undertake with the bare minimum of tools. First aid is based on the idea of quick intervention. The first-aider should always maintain composure and execute cautious, deliberate actions.[4,5]

Broken or fractured bones typically don't pose a life threatening concern, but they do necessitate prompt medical attention. The steps in first-aid for fractures include things like Keep the person calm and use soft padding to support the wounded area. Avoid making unnecessary movements with the individual or the wounded area. Don't let them consume any food or beverages. They might require surgery. Put a splint on the wounded area to immobilise it. An injured arm can be supported and immobilised using a wide arm sling. Using bandages around the knees, ankles, and above and below the fracture site, an injured leg can be splinted to the intact leg.[6,7] 

A number of studies conducted in different parts of India reveal widespread ignorance and misconceptions about the fracture among people. But such studies are limited in hilly state of Himachal Pradesh having different type of customs and cultural pattern. Hence, this study was undertaken with the objective to assess the knowledge about first aid knowledge regarding fractures among Ortho OPD patients at Zonal Hospital Dharamshala in Himachal Pradesh.

OBJECTIVES OF THE STUDY:

To evaluate the first aid knowledge regarding fractures among Ortho OPD patients at Zonal Hospital Dharamshala in Himachal Pradesh

• Research approach -Descriptive

• Research design-Descriptive survey design

• Setting of the study- Ortho OPD of  Zonal Hospital Dharamshala in Himachal Pradesh

• Study duration- August 2018 and October 2019

• Study population- Ortho OPD patients at Zonal Hospital Dharamshala in Himachal Pradesh

• Sample size-400 Ortho  OPD patients

• Sampling technique- convenience  sampling technique

• Sampling criteria- first five patients attending the Ortho OPD of Zonal Hospital Dharamshala 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 Zonal Hospital 

Dharamshala

• 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 Zonal Hospital Dharamshala in Himachal Pradesh

In the present study 36.25% (145) of the patients fall were below 40 years of age while 63.75% (255) were above 40 years.  58% (232) of patients were male and 42% (168) were female.

Table 1: First aid knowledge regarding fractures

Among the total patients maximum 316 (79%) 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 303 (75.75%), apply a splint to the area above and below the fracture sites 215 (53.75%),stop any bleeding 200(50%),give painkillers to patient 200 (50%), keep the fracture area clean and keep it away from dirt or sand 172 (43%), raise the injury above the heart to ease swelling 139 (34.75%), keeps the patient lying down and as still as possible 112 (28%), Don’t move the patient109(27.25%), cover the patient to keep warm 104 (26%),apply ice packs to limit swelling  92 (23%), avoid any attempt to force a fracture or dislocation back into place  or re-align the fracture 85 (21.25%), Do not allow the person to eat or drink 82 (20.5%) and lay the person down with the head slightly lower than the trunk 47 (11.75 %).  Still 72 (18%) didn’t know about any first aid measure in case of fracture. (Table-1)

First aid is the emergency care given to a victim of an injury or disease. It is often provided by a layperson with a restricted skill set. Typically, first aid is given until the injury or disease is adequately treated or until the next level of treatment, such as a doctor or ambulance, comes.[8,9]

A broken bone is referred to medically as a fracture. Although there are many different kinds of fractures, the two primary ones are open and closed. The location of the fracture and the degree of injury to the bone and tissue nearby determine the severity of the fracture. If not treated right away, major fractures can result in serious complications. Blood vessel or nerve damage, as well as infection of the bone (osteomyelitis), are all potential side effects. DOTS, which stands for Deformity, Open Wounds, Tenderness, and Swelling, is an acronym for the symptoms that can be used to identify fractures.[10,11]

In the present study, maximum 316 (79%) of the total patients responded that immobilisation of the injured area is the first aid measure in case of fracture, followed by applying pressure to the wound with a sterile bandage, a clean cloth, or a clean piece of clothing 303 (75.75%), applying a splint to the area above and below the fracture sites 215 (53.75%), stopping any bleeding 200 (50%) and giving the patient 200 painkillers (50 percent ). Still, 72 (18%) people were unaware of any first aid procedures for fractures.

The first step in administering first aid is to quickly examine the patient for any indications of deformities, open wounds, discomfort, or swelling. Additionally, look for any bleeding or an inability to move the damaged area. Apply pressure to the wound when it is bleeding to stop further blood loss. RICE (Rest, Immobilize, Cold, and Elevate) should then be used.[12,13]

To relieve pain, have the patient rest the affected area and avoid any movement. Encourage the patient to support the fractured part if you can. On the ground, immobilise or stabilise the damaged area. Apply splints for stability on either side of the damaged area if movement is required. In order to keep the joints on either side of the broken bone from moving, broad bandages are helpful. Splints must constantly be cushioned, and any gaps between the body and the splint must be gently filled in with additional padding to prevent movement. Put the splint in place properly. The foot and ankle need to be immobilised if there is a fracture in the foot. Check the bandages again every 15 minutes to make sure they are not too tight or loose. Apply a cold pack, ice, or cold water in a plastic bag to the damaged region if you have access to any of these. To avoid causing skin damage, place a folded gauze pad or piece of fabric between the ice pack and the skin. The ice pack should be left on for around 20 minutes. Applying a cold compress immediately to an open fracture is not advised. If at all feasible, always raise the damaged area above the level of the heart. Elevate it only if there is no chance of a shattered bone or if moving the area will make you uncomfortable. [14,15]

Assist them in settling into a comfortable position, induce sleep, and reassure them. To keep them warm, wrap them in garments or a blanket. If the fracture is open, clean, non-fluffy fabric or a sterile dressing should be applied to the wound. To stop any bleeding, apply pressure around the wound rather than directly over the sticking-out bone. After that, bandage the dressing in place. [6,12]

Start cardiopulmonary resuscitation (CPR) if the person doesn't appear to be breathing or has lost consciousness. Remember to seek medical attention if you believe the patient has a fracture to their back, neck, or head, if the fractured bone has broken through the skin, or if there is significant bleeding.[6,9]

According to survey results, the participants' understanding of the first aid treatment of fractures was either insufficient or unsatisfactory. The first aid treatment of fractures must always be done well. Any carelessness might worsen the injury's pain and bleeding while also harming the tissues nearby. Later on, this may make it more difficult for the injury to be repaired and to recover.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Civil Hospital Theog, India.

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