Quick answer
For a sprain or strain, follow RICER for the first 48 to 72 hours: Rest, Ice (20 minutes every 2 hours, never straight on the skin), Compression, Elevation, Referral. At the same time avoid HARM — no Heat, Alcohol, Running or Massage. For a suspected fracture, keep the person still, control any bleeding, and immobilise the limb with a padded splint secured above and below the break. Never try to push a broken or dislocated bone back into place.
Call Triple Zero (000) for a suspected broken neck or back, a head injury, a broken hip or thigh, a bone through the skin, an obvious deformity, heavy bleeding, or if the limb below the injury is pale, cold, blue or numb — that last one means the blood supply is threatened and it cannot wait.
Australia teaches this slightly differently from most of the world, and the difference is the bit people skip. Overseas you will see RICE. Sports Medicine Australia and the national first aid unit teach RICER — the extra R is Referral, and it exists because self-managing a soft tissue injury is how a straightforward sprain turns into a joint that keeps giving way for years.
Sprain, strain, or break?
Honest answer: often you cannot tell without an X-ray, and you are not expected to. A bad sprain and a small fracture can look and feel identical. Treat it as the worse of the two and get it assessed.
| Injury | What it is | Typical signs |
|---|---|---|
| Sprain | Overstretched or torn ligament — the tissue joining bone to bone | Pain, swelling, bruising and instability around a joint. Ankles and knees mostly. |
| Strain | Overstretched or torn muscle or tendon | Pain on using the muscle, tightness, sometimes a sudden sharp catch mid-movement. |
| Fracture | A broken bone | Pain or tenderness at the site, swelling, deformity, discolouration or bruising, loss of function — and sometimes the person felt or heard it go, or a coarse grating. |
Points that push it toward “get an X-ray today”: an obvious deformity, they heard or felt a crack, they cannot bear any weight on it at all, or the pain is over a bone rather than the soft tissue around it.
RICER, step by step
Sports Medicine Australia's protocol for the first 48 to 72 hours after a soft tissue injury — the window where you can genuinely limit bleeding and swelling inside the tissue.
| Step | What to do |
|---|---|
| R — Rest | Stop, and take the weight off it. Continuing to use it is what turns a small tear into a large one. |
| I — Ice | 20 minutes every two hours. Never put ice straight on the skin — wrap it in a damp cloth or use a cold pack in a tea towel. |
| C — Compression | A firm elastic bandage over the area. Firm, not tight: if the toes or fingers go numb, cold or blue, take it off and reapply it looser. |
| E — Elevation | Raise the injured part, above the level of the heart where you can manage it. |
| R — Referral | Get it properly assessed. This is the step RICE leaves out, and the reason it is in the Australian acronym. |
And no HARM
For the same 48 to 72 hours, avoid the four things that increase blood flow and swelling: Heat — no hot packs, hot showers or liniments. Alcohol. Running, or any use of the injured part. Massage, however much it feels like it should help. All four make the bleeding inside the tissue worse.
Most soft tissue injuries settle within one to six weeks, depending on age, health and how bad the tear was. If it is not steadily improving, that is your cue to use the R.
Suspected fracture: what to do
- Follow DRSABCD and call 000 if the injury is serious.
- Keep the person still. Do not move them unless they are in danger — especially with a suspected neck or back injury.
- Control any bleeding and cover open wounds with a clean dressing. See severe bleeding first aid. Do not press directly on a bone end.
- Check for other injuries. A fall that broke one bone often broke something else.
- Immobilise it. Place a padded splint along the injured limb and secure it with bandages above and below the break, never over it. For a leg, immobilise the foot and ankle too — and the uninjured leg can serve as the splint.
- Check the bandages are not too tight, and check circulation every 15 minutes — warmth, colour and feeling in the fingers or toes beyond the injury.
- Support and rest the limb, and get medical assistance.
Open fractures
If bone is visible or there is a wound over the break, cover it with a clean dressing and control bleeding by pressing around the area, not on the bone. Do not push anything back in, do not wash it out, and treat it as a 000 call — the infection risk alone makes it urgent.
Never try to put it back
St John's guidance is blunt about this: do not try to force a broken or dislocated bone back into place.
It looks straightforward in films and it is not. Without imaging you cannot know what the bone ends are sitting against, and attempting it risks fracturing the bone around the joint, trapping soft tissue inside it, or causing permanent nerve and blood vessel damage. Splint it in the position you find it and let a hospital do the rest.
Dislocations
- Follow DRSABCD and support the limb in the position you found it, using soft padding and bandages.
- A cold pack on the joint helps the pain.
- Check circulation below the joint. If the limb is pale, cold, blue or has no feeling, call 000 immediately — that is a threatened limb, not a wait-and-see.
- Get medical aid even if it seems to have gone back by itself.
Before anyone sets a bone, they need to know about blood thinners, osteoporosis, allergies and past surgery.
A MedibandPlus profile carries the conditions, medications, allergies and emergency contacts an emergency department needs — especially when the patient is in too much pain to think straight.
Store your conditions, medications and emergency contacts — explore MedibandPlusPart of the Mediband family. Designed in Australia since 2004.
When to call 000, and when the GP will do
Call an ambulance
- Suspected neck, back or head injury — do not move them
- A broken hip, thigh or pelvis
- Bone through the skin, or an open wound over the break
- Obvious deformity, or the limb is at a wrong angle
- The limb below is pale, cold, blue or numb
- Heavy bleeding, or the person is drowsy or shocked
- You cannot move them safely yourself
Same-day medical assessment
- They cannot bear weight on it at all
- The pain is over a bone, not the soft tissue
- They heard or felt a crack
- Swelling came on very fast
- It is a child, or an older person who may have osteoporosis — a minor fall can break a bone
- It is not improving after 48 to 72 hours of RICER
Related reading: how to stop severe bleeding, the 10 most common medical emergencies, and what to say when you call an ambulance. If you take a blood thinner or have a bone condition, that is exactly what an emergency department needs to know — you can create your emergency profile in a few minutes.
Fractures and sprains FAQs
What does RICER stand for?
Rest, Ice, Compression, Elevation and Referral. It is the Australian protocol for soft tissue injuries such as sprains and strains, taught by Sports Medicine Australia and in national first aid training, and it is followed for the first 48 to 72 hours. The final R, Referral, is the step the international RICE version leaves out, and it means getting the injury properly assessed rather than just managing it yourself.
How long should you ice a sprain?
20 minutes at a time, every two hours, for the first 48 to 72 hours. Never put ice directly against the skin, because it can cause an ice burn. Wrap it in a damp cloth or use a cold pack inside a tea towel.
What is the No HARM protocol?
No Heat, no Alcohol, no Running and no Massage, for the same 48 to 72 hours after a soft tissue injury. All four increase blood flow to the injured area and make bleeding and swelling in the tissue worse, which slows recovery. That means no hot packs, hot showers or liniments, no drinking, no using the injured part, and no rubbing it however much you want to.
How can you tell a sprain from a break?
Often you cannot without an X-ray, and you are not expected to. Signs pointing to a fracture include an obvious deformity, hearing or feeling a crack, being unable to put any weight on it at all, tenderness directly over a bone rather than the soft tissue, and swelling that comes on very fast. When in doubt, treat it as the more serious injury and get it assessed.
Should you try to put a dislocated joint back in?
No. Australian first aid guidance says not to try to force a broken or dislocated bone back into place. Without imaging you cannot know what the bone is sitting against, and attempting it can fracture the surrounding bone, trap soft tissue in the joint, or cause permanent nerve and blood vessel damage. Support the limb in the position you found it, apply a cold pack, and get medical help.
How do you splint a suspected broken arm?
Place a padded splint along the injured limb and secure it with bandages above and below the break, never directly over it. Keep the person still, support the arm, and check every 15 minutes that the bandages are not too tight by looking at the warmth, colour and feeling in the fingers. If the hand becomes pale, cold, blue or numb, loosen the bandages immediately.
When should a fracture go to hospital by ambulance?
Call 000 for a suspected neck, back or head injury, a broken hip, thigh or pelvis, bone through the skin, an obvious deformity, heavy bleeding, if the person is drowsy or shocked, or if the limb below the injury is pale, cold, blue or numb. That last sign means the blood supply is threatened and needs an emergency response.
Sources
- Sports Medicine Australia — Soft tissue injuries — the RICER protocol, ice for 20 minutes every two hours, the 48–72 hour window, the No HARM protocol, and typical recovery times.
- St John — Fracture and dislocation — signs of a fracture, splinting above and below the break, checking circulation every 15 minutes, and not forcing a bone back into place.
- healthdirect — Sprains and strains — recognition and when to seek care.
- healthdirect — Fractures — fracture types and treatment overview.
- Triple Zero (000) — when and how to call.
Disclaimer: This article is general first aid information, not medical advice or a substitute for accredited first aid training. In an emergency, always call Triple Zero (000). For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland) or speak with your GP. Any suspected fracture, dislocation or injury that is not improving should be assessed in person. MedibandPlus stores and provides access to a member’s own medical information; it does not assess, diagnose or treat any condition.
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