The medic in survival settings can expect to see their share of injuries, some of which involve open wounds. A working knowledge of dressings and bandages will serve a caregiver well in terms of accumulating supplies in normal times and using them when the you-know-what hits the fan.
Oftentimes, you’ll see the words “dressing” and “bandage” used interchangeably. There is a difference, however. A dressing is applied directly to the wound to promote healing and prevent further damage. A bandage, on the other hand, is something used to hold a dressing in place. Tight bandages can be used to slow blood loss from an extremity. They are available in a wide range of shapes and sizes. Commercial varieties can be purchased or they can be improvised from strips of cloth, blankets, or sheets.
Dressings should, if possible, be soft, sterile, and larger than the wound itself. They shouldn’t form lint or other loose fibers like a cotton ball might. If used properly, dressings will stop bleeding, prevent infection, and protect wounds from worse injury.
A variety of different dressing types exists:
Gauze pads: Gauze pads are woven out of cotton. They usually come in standard sizes, like 4-inch by 4-inch or 2 inch by 2 inch. Standard gauze tends to stick to wounds, so some, like Telfa pads, come with a coating helpful in burns or other settings. Improvisations using ointments or petroleum jelly can perform similar duties.
Adhesive strips: Useful for small lacerations or abrasions, they use a small sterile dressing with a tape-like bandage to secure in place.
Trauma dressings: These tend to be larger at 5-inch by 9-inch or 10-inch by 30-inch and thicker than smaller pads. They may or may not be sterile.
When applying a dressing, washing hands and putting on gloves will decrease the risks of infection. In many circumstances, however, this may not be practical.
Sometimes, a dressing will dry and become stuck to a wound. If this occurs, add some clean, warm water to it. The dressing should be easy to peel off after a few minutes.
Bandages are meant to hold a dressing in place and, often, to apply pressure. Direct pressure assists in the control of bleeding (“hemostasis”). Compression helps to decrease swelling and supports an injured joint or extremity. A popular compression bandage is the Israeli Battle Dressing (IBD), also known as “the Emergency Bandage” in the United States. This versatile item can serve as a covering for a dressing, a compression bandage, or even an elastic wrap to secure a splint in place.
Other bandage types include:
Gauze rolls: Rolls of gauze are similar to the pads used as dressings, but are often several yards long. They come in a wide variety of widths.
Elastic wraps: Sometimes called (“Ace”) wraps, these are rolls made of elastic materials used to cover dressings but are sometimes used by themselves to stabilize sprains of the ankle or other joints.
Self-Adhering wraps: Popular brands such as Coban serve similar purposes as standard elastic wraps but are much easier to secure in place due to their sticky surface.
Triangular bandages: These bandages are, well, triangular and resemble a large bandanna (40 x 40 inches is the usual size). They are extremely versatile, used as slings, swaths, and cravats.
In addition to the various dressings and bandages that should be in your medical kit, be sure to have a good supply of medical or paper tape to secure ends of gauze.
Dressing and Bandage Principles
Different injuries can be dressed in different ways, but the medic should adhere to certain principles (steps are discussed under soft tissue wound care):
Always wash hands and use gloves before working on wounds, if possible.
Flush the wound with clean water until free of debris before placing the dressing.
Remember the definitions of dressings and bandages. Apply the dressing before applying a bandage.
The dressing should be sterile or, at least, as clean as possible.
Avoid touching the part of the dressing that will be in contact with the wound.
Be sure to cover the entire wound with the bandage, plus about two inches above and below.
When wrapping around an extremity, advance one-half to two-thirds of the bandage width every turn.
Avoid tightening so much as to restrict circulation. This is a particularly common problem with elastic wraps. Pulses should be clearly felt and skin coloration should be normal.
On the other hand, always make sure that the bandage is fairly snug. Bandages are sometimes left so lax that they slip off the dressing. This may happen due to loose ends that get snagged on something and stretch.
Prevent covering toes or fingers unless they are specifically injured. If covered, circulation is difficult to assess.
Avoid ending the bandage directly on the area of the wound.
Always have a strategy to prevent wound infection while healing. Antibiotic creams, ointments, or even raw, unprocessed honey (over one year of age) are options.
Set a schedule for frequency for changing wound dressings and bandages.
Joe Alton MD
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