Pressure Bandages

When and How to Apply Pressure to a Wound Using Bandages

The most effective method to control hemorrhage is to use pressure. When you think of applying pressure, you probably think of holding a gauze pad against a wound with your hand—hopefully while wearing gloves.

The problem with holding direct pressure manually is that you don't always have a free hand. There are times when the injury is on a hand or you have to use your hands to do something important, like getting to safety. You need a handsfree treatment option that still fixes the problem.

One option is a tourniquet, which, when properly applied, is generally the fastest and most complete bleeding control device available. A tourniquet has its limitations, however. It will only work if the injury is on an extremity and it cuts off circulation to the entire limb, potentially rendering the extremity numb and less useful.

Pressure dressings provide another safe alternative to holding pressure manually. With a pressure dressing, hemorrhage control is focused on stopping bleeding directly on the wound rather than by removing blood flow to the entire limb. Unlike a tourniquet, pressure dressings can be applied to wounds on the trunk of the body or on the head.

When to Use a Pressure Dressing

wounded
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When you have to use your hands and feet, a pressure dressing might be a better option than a tourniquet or than holding direct pressure manually. They're also better than your hands when you might have to hold the pressure for a long time, such as during austere conditions (camping or backpacking, zombie apocalypse, natural disasters, etc.) and in situations that will delay help (active shooter incidents).

Pressure dressings come in all shapes and sizes, but there are some pre-made dressings that come with great pedigrees. The following list of dressings and agents to help stop bleeding are great additions to your first aid kit. These are essential products, especially if you'll be far from help for any period of time.

Israeli Bandage

Israeli bandages are the granddaddy of all modern pressure dressing devices. They're used all over the world and are a favorite among the United States military. The bandage was invented by an Israeli military medic and is still manufactured in Israel, hence the nickname.

These bandages use a small plastic frame (called the pressure bar) to focus pressure directly on the wound. The rescuer wraps the bandage around the limb (or the head) and through the frame with the bar positioned directly over the injury. Then, the bandage direction is reversed, and the bar pushes on the wound.

Like a tourniquet, an Israeli bandage is only useful if the device is correctly applied with sufficient pressure.

It takes practice to properly apply an Israeli bandage, so if you buy one, get an extra to use for practice.

Hemostatic Agents

Some dressings come with additives called hemostatic agents. These additives stimulate clotting through various formulations (depending on the agent). These substances got a bad reputation early on because they would have a very strong exothermic reaction (they got very hot). Eventually, the formulas were improved and the agents now are able to encourage clotting without generating heat.

Hemostatic agents are available as loose, granular substances that can be poured directly into a wound. Many of them resemble cat litter (which won't work). The loose substances are fine if you want to carry it separately. I recommend a bandage with the hemostatic agent infused into the bandage material.

It's easier to use a bandage, just wrap it around the limb and cover the wound. Like other hemorrhage control devices, keep it tight. Don't pull the bandage off the injury before you get the patient to a doctor. Pulling the bandage off can remove the clot and start the bleeding all over again. If blood soaks through a bandage of any sort, add another bandage or another layer of bleeding control.

If you have the ability and need to do it: apply a tourniquet.

Packing a Wound

One form of pressure dressing that works differently is to pack the wound. This is still pressure, but it's applied to the wound from the inside rather than externally. The idea is to pack the wound with gauze, which will expand as it soaks up available blood.

In many cases, a bandage designed for packing has a lot of free bandaging that can be stuffed into a bullet wound one finger at a time, or laid into a longer laceration back and forth like a "Z" until the gauze is flush with the skin at the opening of the wound.

Once the wound is packed, wrap it with a plain bandage to keep the packing material inside the injury.

Several versions of wound packing material are now infused with hemostatic agents. This adds an extra layer of protection.

Self-Adhesive Compression Bandages

Self-adhesive bandages are not typically thought of as bleeding control dressings. These bandages are more often used as compression bandages for orthopedic use (such as RICE). The most common example of their use for bleeding control is to use them on skin tears.

However, self-adhesive bandages work very well as pressure dressings, especially if you place a roll (or small stack) of gauze right on top of the wound and then wrap over it with these strong, stretchy bandages.

Sources:

Day MW. Control of Traumatic Extremity Hemorrhage. Crit Care Nurse. 2016 Feb;36(1):40-51. doi: 10.4037/ccn2016871.

Drew B, Bennett BL, Littlejohn L. Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts. Wilderness Environ Med. 2015 Jun;26(2):236-45. doi: 10.1016/j.wem.2014.08.016.

Littlejohn L, Bennett BL, Drew B. Application of current hemorrhage control techniques for backcountry care: part two, hemostatic dressings and other adjuncts. Wilderness Environ Med. 2015 Jun;26(2):246-54. doi: 10.1016/j.wem.2014.08.018.

Navarro A, Brooks A. Use of local pro-coagulant haemostatic agents for intra-cavity control of haemorrhage after trauma. Eur J Trauma Emerg Surg. 2015 Oct;41(5):493-500. doi: 10.1007/s00068-014-0441-4

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