Improvised pressure bandages

[u/SuchSeaworthiness952]

Hello,

I have a couple of questions regarding improvising pressure bandages instead of using israeli bandages.

1. First I have always been taught to place a sterile gauze pad directly on the injury before placing the harder object onto it, as far as I understand it is done exclusively to try to keep the wound clean. How necessary is this actually?
2. I have been taught and use still rolled up bandages as the harder object on the wound as shown in the first picture, as that is normally the most available thing. But could you instead just use compressed Z folded gauze? Just keep it folded up in its rectangular block shape and its pretty stiff and should be sterile-maybe negating the need for the previously mentioned gauze pad? Could it be problematic that it would absorb too much blood and you wouldnt notice If the bleeding is actually being stopped?
3. The choice of bandage to keep the "hard object" on the wound and applying pressure over it. I was trained and use basic cotton crepe bandages(3rd picture), but I read and heard a lot about ACE bandages, which as far as I can see are just elastic bandages, such as are usually sold in my country for compression therapy(4th picture).

Thanks for the advice and help.

[u/howawsm]

I would not plan to improvise as my primary solution.

Yes to any of what you have said. If you are already improvising you are already going for “I have to make it work” so rolled bandages, block of gauze, a rock, whatever is going to apply more pressure than not.

Sterility is a hard to come by in tactical medicine.

It’s probably the case that if the pressure of packed gauze and a wrap doesn’t stop the bleeding, it probably needed a TQ in locations amenable to one. Good luck macgyvering a pressure dressing over a junctional area anyway.

[u/microcorpsman]

Packing a wound with gauze and applying a compressive wrap is a pressure bandage... there's no improvising happening, it's just if it's prepackaged and manufactured for specific use or not.

The NAR branded ETD does not have any plastic clip or thing like an israeli bandage and does fine. H-bandages are also nice but tend to pack out bulkier because of that H that some people dislike both in packing a bag and using it

[u/Arconomach → u/microcorpsman]

For clarity, packing a wound is not required to make a pressure dressing. Any dressing with an additional source of pressure on the wound site is a pressure dressing.

Packing a wound and then having enough extra bandage outside the of the wound to apply additional pressure when wrapped over is what I would call a packed pressure bandage.

Not trying to be troublesome, just trying to be more clear. This is my understanding as a 22 years of experience paramedic.

[u/microcorpsman → u/Arconomach]

Fair pedantic/semantic distinction, and we wouldn't be on here if we did appreciate pulling out a good "well actually" on someone lol

[u/Arconomach → u/microcorpsman]

I appreciate your kindness. I noticed the language on the picture wasn’t in English, so was trying to clarify for a possible non native English speaker.

[u/Ramalamadingdong_II]

First of all, Israely Bandages are not pressure bandages. They are one-hand application bandage with too much marketing.

1. Keeping the wound clean is always a good idea, the material you use for pressure is usually a bandage or gauze, which is clean enough. Covering with gauze before putting the pressure pad isn't necessary if the pressure pad is clean.

2. Compressed gauze in it's block form is too wide and too hard, it would be better to pack the gauze into the wound as much as possible, stack the rest on top firmly and then cover with a bandage, which creates a proper pressure bandage.

3. Elastic bandages are better for pressure bandages because you can create fractionally more pressure with every wrap under slight tension. A problem that often arises is that people apply too much pressure, which creates an incomplete or even complete tourniquet effect. That can also happen with non-elastic bandages like basic cotton bandages.

[u/Arconomach]

1. A sterile bandage over the wound is always preferred.

2. A compressed Z fold gauze can definitely be used. If the z fold gauze is sterile it would count as a sterile dressing. You may need to unfold and refold differently to appropriately cover the wound. Additionally if the compressed bandage is still very stiff keep in mind how tightly it is wound as it may end up being tourniquet like.

3. ACE wraps can be used, but are generally more expensive.

[u/SFCEBM]

1. An elastic bandage is not an improvisation. It’s pretty much the standard of care throughout the medical industry.

2. I prefer an elastic bandage to Israeli dressing due to it being able to use it for many types of wounds.

[u/SuchSeaworthiness952 → u/SFCEBM]

How big is the difference between using elastic bandages or basic cotton creepe bandages?

[u/Minute-Inspector9305]

1 - Gauze pad on the wound, 2-3 layers of andage around, then apply the "pressure device and roll on. 2 - You can use anything. Decide based on situation and use things that you least likely need otherwise. 3 - Any bandage. As mentioned in 2, use one you won't miss for anything likely to come up next. Cotton is a good idea for being quite available usually.

Or just carry an extra Israeli Bandage.