You may be familiar with applying pressure to a wound by holding a gauze pad against the bleeding spot with your hand (hopefully while wearing gloves). You might also be familiar with devices that can be used to tie off a bleeding arm or leg. However, these medical treatments have limitations that don’t impact pressure dressing.
This article explains when to use pressure dressing, how to apply the dressing, and types of pressure dressing.
Tourniquet
When properly applied, a tourniquet is often 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 (leg, hand, etc.), and it cuts off circulation to the entire limb, potentially rendering the extremity numb and less useful.
Manual Pressure
Holding pressure manually requires you to use your hands to physically push down upon a wound. This is also known as direct pressure. While it can be effective, it obviously ties up your hands, leaving you little opportunity to perform other tasks that may need to be done such as calling 911.
Pressure Dressing
With a pressure dressing, you work to treat a hemorrhage by bandaging the wound safely while stopping blood flow.
Unlike a tourniquet, pressure dressings can be applied to wounds on the trunk of the body or on the head. It can also be more effective than manual pressure because it frees up your hands, and allows consistent pressure to be applied to the area for a long period of time. Manual pressure may be also be difficult to maintain if you are in rugged conditions (camping or backpacking, natural disasters, etc.) or in situations where help may be delayed (active shooter incidents).
Assess blood loss. If it is too excessive, gently clean the wound of debris. Cover the open wound with a sterile, non-adhesive gauze pad or other sterile bandaging. Over the gauze, place absorbent padding such as rolled cotton. Lie it flat (not bunched up) against the skin. Wrap a support bandage around the padding. The pressure bandage should extend a few inches above and below the wound. Tie the support bandage, but do not tie it so tight that it stops blood flow around the wound. You should be able to slip a pinky into the bandage. If the wound is in an extremity, elevate it.
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.
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 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 them separately. We 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.
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.
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.
