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[David_G48]

To all those with medical training I just want to question the accuracy of a bump test or compression test etc. right after an accident. Most of these tests have been documented in an office enviroment after the victims body has had time to settle down and really feel pain, react etc. This person in particular only thought that he had one sprained ankle. I am sure the chemicals released by the body along with a stiff boot and extreme cold had a way to mask many symptoms. So my question is would these tests have actually worked under these circumstances. My 1st hand experience when such a significant fall happens is to assess what you can but immobilize the victim until a proper exam can be done, which I believe is very hard to do on the side of a steep slope above the railroad tracks. Evacuate them to a medical facility if possible or give them shelter while someone seeks help. All these test are useful and I believe should be done and can indicate an injury but can not be fully trusted to rule out the injury because of what I said above.
Please articulate some well sought out responses as I think it will be helpful to all of us who read this thread.
Thank You!
(Glad the person involved made it to safety and has maintained a positive attitude)

[JakeDatc]

It depends what is or isn't broken.  the fibula (outside) is nearly non-weight bearing so if it is not displaced you can probably walk on it and a bump test will hurt but maybe not as much.   I do compression tests in multiple spots along with lower leg..   even a sprain will sometimes hurt right around the injured area.. but if it hurts  down lower when i'm squeezing up higher then that is a + test for me. 

they are tests.. not xrays.. so there is margin for error, pain tolerance, adrenaline etc   just because the test is negative doesn't rule out anything for sure.  I had a football player still play 2+ weeks with a broken collarbone that never came to me.  I had a kid break his tibia and have no real pain at all  and - compression test  and when i picked up his leg to do an ACL test you could see bump where one shouldn't be  

tests are only part of an eval.  HOPS..  history (what happened) Observation(anything look funny?), Palpation (*poke poke* that hurt?), Special tests..     Sometimes you don't need to go through everything to have enough flags to decide to pack and ship them.   

ELM your turn  

[ELM]

Lol...you covered it. 
Your points about checking structures is important. Pain may not be present while you are doing an initial exam.

[David_G48]

I guess that from what Ed and Jake have said is that the test can not be used to rule out injury and in the case at Dracula the tests may not and in my opinion based on what they said would not have indicated how serious it was. The point is that sometimes the best indication is by those who witness the severity of the fall. You have not really added anything that I did not state and in fact I believe you have reinforced the point of safely bringing the victim to a facility for a better prognosis. I brought this up because it is my opinion that when a severe fall happens you should not rely on field testing or the fact that someone thinks their injury is minimal. I have seen this happen too many times when people think the problem is minor and it turns out tragic because they relied too heavily on tests done in the field or how the victim feels.
Thanks for your input.

[JakeDatc]

I said that tests should have been done before they tried to have the guy stand up on 2 broken ankles.   The tests CAN indicate that there is a fracture and is pretty widely used.   I evaluate athletic injuries on a weekly basis and decide if they can play or not without the need for further care.   Just because you aren't trained to do so and think it's overrated doesn't mean it isn't true.   IMO  your opinion is like the parents that run on the field and try to do my job..  i tell them to back off and relax. 

I wasn't at the Dracula accident so I can't know what would have come of an eval..  there are too many unknowns to even guess.  As ELM said too.. i'd be worried about head injury and internal trauma depending on what the ride down was like.  I don't know if the guy was saying AHH my ankle kills blah blah.

I was also saying that when i thought that a guide was involved which would have included WFR.  Once you get untrained folks guessing at crap then who knows what they are going to make up.  Hell even EMT's are pretty crappy at orthopedic evaluations, they just splint and ship and let the MDs figure it all out.   you fall and twist your ankle and you might get C-collared because you said you fell.   

[pappy]

Guess I'm lucky, both times I've broken bones climbing the only test required was sight--arms and legs don't normally have dramatic bends in them. Never called for a rescue, though.