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Joint Reduction/Manipulation

Question# 726

Would RPPEO consider education on joint reductions/manipulations?

Under the BLS, in Extremity Injury Standard (page 125 1. f.) it states, "If adequate circulation/sensation is absent, after splinting and re-manipulation is possible, gentle re-manipulate the extremity to restore neurovascular status."

I understand reduction would most likely be a delegated act, but with long and painful transfer times with pulseless or neurovascular compromise, is this something that is foreseeable in the future? Is it possible for you to supply references or educational content on how we are suppose to manipulate joints safely under today's standard?


We can appreciate the historical lack of training with respect to managing this complex patient population.

You’re right in your interpretation regarding delegated acts, and as per the Regulated Health Professions Act, “setting or casting a fracture of a bone or a dislocation of a joint” is a controlled act. Thus unless trained and authorized, paramedics can not manipulate the joint.

Having said that, there are provisions in the BLS PCS that allow us to manage these patients. Namely, the Extremity Trauma Standard suggests two places where a bone or joint may be gently manipulated (gentle is defined as no resistance and no severe pain):

Before splinting, where distal pulse is absent, in this case gentle traction (pulling) can be applied.
After splinting, where the pulse was lost due to splinting, gentle manipulation (movement closer to anatomical position) can be done to try regain the pulse.
Recognizing this gap, the provincial education committee is working hard to develop further education and training.

In line with this, as a starting point, there will be a new medical directive that allows for paramedics to safely reduce a patellar dislocation.

The training content is currently being developed, with an aimed roll-out during the 2024 educational season.


BLS PCS - Extremity Trauma Standard

Regulated Health Professions Act

Medical Directive Category



28 August 2023

ALSPCS Version




Please reference the MOST RECENT ALS PCS for updates and changes to these directives.