What Changed

On June 22, 2026, the Joint Trauma System (JTS) published a new version of its Orthopaedic Trauma: Extremity Fractures Clinical Practice Guideline (CPG ID 56). It replaces the February 26, 2020 version.

The JTS lists four changes:

  • Updated background and references
  • Updated antibiotic guidance
  • Step-by-step practical guidance added from the Combat Orthopaedic Trauma Surgery (COTS+) Manual
  • External fixator instructions updated to cover current equipment

Most of that is written for surgeons and deployed hospital teams. But the guideline also restates the first-responder basics, and those basics matter to any officer who has to treat a partner shot in the leg.

What It Says

The prehospital guidance is short and direct.

Sequence. "Suspected fractures should be splinted once life-threatening injuries have been addressed." Splinting doesn't come before hemorrhage control, airway, or breathing.

Technique. A splint should immobilize the joints above and below the fracture and be well padded at pressure points.

Femur fractures. "Traction splints may be utilized for femur fractures; however, other splinting methods may be more expedient." A traction splint is one option, not a requirement.

Pelvis. The CPG says a pelvic binder is indicated for severe lower-extremity or pelvic injury and may be used together with a traction splint.

Reassessment. Injured limbs should be checked for signs of compartment syndrome, and the neurologic and vascular exam should be carefully documented for the next level of care.

Open fractures. Antibiotic regimens and a target of operative debridement "as soon as reasonably possible (<24 hours)" are included. For civilian police, antibiotics are a medical-direction and hospital issue, not a patrol task. The broader point still applies: an open fracture is a surgical problem, so pick the destination with that in mind.

Why It Matters Operationally

Officers get shot in the legs, and bullets break bones. Three days before this update, an NYPD Emergency Service Unit detective was shot during a barricade entry in Brooklyn. City officials said he had a tibial fracture. Nothing public says what field care he received, but the injury pattern is common.

The guideline points to three practical problems.

Bleeding hides the fracture, and the fracture distracts from the bleeding. A deformed leg grabs attention. The officer treating it has to deal with the bleeding first. The TCCC Guidelines (01 May 2026) keep that order: control hemorrhage first, and "splint fractures and re-check pulses" later in Tactical Field Care.

A tourniquet and a splint can be on the same limb. A patient can need both. Training should include splinting around a tourniquet without loosening it or covering it up, and marking the tourniquet time where the next provider will see it.

Movement is the real test. An unsplinted lower-leg fracture makes every drag, carry, and stair turn harder and more painful. In a real house, with narrow halls, tight turns, and furniture, a quick improvised splint can make extraction faster. But it can't delay getting out of the line of fire.

ODM's Position

This update adds no new point-of-injury requirements for police, and that is useful information too. The basics hold: threat, then bleeding, then breathing, then bones. We see agencies teach tourniquets well but treat splinting as an EMT topic that patrol doesn't need. We disagree. Officers don't need traction splints in every car. They do need to recognize a long-bone fracture, immobilize it with what they carry, and move the patient without causing more harm.

Keep context in mind. JTS CPGs are written for military care, often with long evacuations. In most U.S. cities, the right move is fast transport to a trauma center with basic immobilization. Civilian protocols come from C-TECC and your local medical director.

What Your Agency Should Do Now

  • Add a fracture step to existing tourniquet drills: apply the tourniquet, then improvise a splint from what's in the kit or the room.
  • Practice splinting around a tourniquet and marking the tourniquet time where it stays visible.
  • Train pulse and sensation checks before and after splinting, and hand that information to EMS.
  • Run at least one lower-leg-wound extraction per cycle through a hallway or stairwell, not an open floor.
  • Ask your EMS medical director whether pelvic binders belong in tactical kits for your area.

Bottom Line

The June 22 update is mostly written for surgeons, but the field message stays the same and it's worth repeating: stop the bleeding, then immobilize, then document. Officers who have practiced that order under stress will move a wounded partner better than officers who only learned it from a slide.

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