Prehospital Patella Dislocation Reduction Protocol

January 27, 2020

Written by Vivian Lei

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Prehospital patellar reduction by EMS providers appears to be safe, effective, and reduces pain.

Why does this matter?
Patellar reduction is a relatively straightforward procedure, and early reduction can relieve pain as well as potentially decrease downstream resource utilization. This database review study is a starting point in suggesting prehospital patellar reduction is feasible, effective, and safe.

That knee ain’t right…
This study was a retrospective review of the quality assurance database of New York State EMS services, where patella reduction is within the EMT scope of practice. EMS providers who performed a patella reduction completed a survey and recorded mechanism of injury, number of reduction attempts, the result of each attempt, pre-and post-reduction pain scores (scale from 0-10), complications observed by the performer of the procedure, and the transport outcome. During the 21 month survey period, 90 patients underwent prehospital patella reduction. Of these, 92% were successfully reduced. Sixty-two patients did not require any pain medications and, within this medication-free group, 98% of reductions were successful, with 23% eventually declining transportation to the hospital. No complications were reported, and pain scores significantly improved following successful reduction.

Of course, larger and more rigorous studies are needed. Additionally, it is still important to remember that many patellar dislocations are associated with osteochondral fractures and require follow-up for operative intervention.

Source
Implementation of a Prehospital Patella Dislocation Reduction Protocol. Prehosp Emerg Care. 2019 Dec 17:1-6. doi: 10.1080/10903127.2019.1704322. [Epub ahead of print]

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