Medics treat open fractures with antibiotics

Ten to 15 times a month, medics in Galveston County follow an antibiotic protocol when treating open fractures.

The Galveston Area Ambulance Authority and Galveston County Emergency Services District No. 2 have had an active open fracture protocol for about two years.

“We found that often there was a missed opportunity for early antibiotics in patients with obvious or suspected open, long bone fractures,” said Dr. Kent Harkey, medical director for both EMS agencies. “We have a standing protocol where if an open fracture is suspected, we load IV Ancef (cefazolin) assuming there are not any contraindications—such as allergies to the medications.”

This protocol has received positive feedback from the Emergency Department at UTMB and the surgeons, said Harkey, who is also a clinical assistant professor of medicine at UTMB as well as the assistant medical director of Emergency Medicine at the UTMB League City Campus.

“The American College of Surgeons were very supportive of this move in their last site visit to Galveston,” Harkey said.

Earlier administering of antibiotics for open fractures helps reduce the rate of infection, which often are serious and can lead to long-term complications. Bone infections are notoriously hard to permanently treat once they are established, often recurring over time and causing lifelong issues.

“I have standing orders in the form of protocols that empower the medics in the field to use their judgment and the best interest of the patient,” Harkey said.

The protocols go through indications, contraindications, dosing and pearls, which are short and to-the-point tidbits of clinical information. When the medic suspects an open fracture, they use the protocol and administer the antibiotics. Some open fractures are obvious with the bone sticking out, but sometimes the bone retracts, and it appears to be just a laceration.

Harkey is collecting data to analyze the outcomes of this protocol.

“I have no doubt that the early antibiotics have helped with decreasing the morbidity and mortality associated with open fractures and severe trauma,” Harkey said. “It is my hope that as more agencies come under my medical direction, we can expand this protocol to help the citizens of Galveston County.”