Bleeding is the largest direct cause of death in most fatalities due to accidental or intentional violence. Rapid and appropriate response can stop bleeding in the vast majority of cases.
It doesn’t matter if your emergency is as mundane as a car accident or as unlikely as bad prepper fiction apocalypse, it may pay off big to be ready to apply that rapid and appropriate response … and the single most appropriate tool to stop bleeding is compression bandaging. (This is the consensus opinion I get from the literature. I am not myself a physician, so their opinions are more valuable than mine.)
Salty and I talk about both parts of this series, compression bandaging and clotting aids, in this podcast:
How does it work?
The premise is straightforward: Put something clean and absorbent (and preferably non-stick) over the bleeding wound. Apply pressure. Leaking blood vessels are squeezed shut, and with no fresh flow flushing out already-leaked blood, over the next several minutes the clotting factors and platelets in the blood do their job and convert the fluid blood into a thick gel. Bleeding stops.
The trouble isn’t ended, since there are still tissues not getting the blood flow they need and there’s a big mess to clean up, but the immediate threat to life has been handled. Normal wound care — debriding, sealing if necessary, and doing the longer-term bandaging, come later. If you’d like some help with those topics, you can click on these links, or just use the BBBY search tool on ‘wounds’ or ‘wound care’:
The problems are that hanging out for twenty minutes or so applying direct pressure to a wound is uncomfortable to both the wounded and the caregivers and it might be helpful to leave it on for longer anyway, especially if the patient starts moving again once the bleeding has stopped.
The Israeli compression bandage
The standby answer in the prepping community is the Israeli bandage — and for good reason.
An Israeli bandage; they come in single-bandage sterile sealed packs.
The underside of this bandage has a sterile pad. You’re looking at the top side, and the curved loop along the top is the ‘pressure bar’. The rest of the bandage is like an Ace elastic wrap, with a little dealie on the end so you can conveniently attach it to itself.
The idea is to put the sterile pad over the wound (maybe with extra sterile gauze in there, and if it’s Really serious maybe even gauze impregnated with a clotting aid). The bandage gets wrapped around, run through the loop in the pressure bar, and wrapped around the other direction so the bar is situated right over the wound. You pull it good and tight, then wrap some more and attach it to itself.
It looks something like this:
How to use an Israeli bandage.
In an old style compression bandage, such as the WWII version shown below, the bandage was wrapped and tied, leaving the pressure pretty equal around the whole limb; just a little higher under the knots.
WWII era compression bandages; the first attempt as it were.
In the Israeli modification, the highest pressure is right under the pressure bar, so it’s easy to put it right over the wound (which is best!). (1) The wound pressure is also much higher with the Israeli, and that’s important for heavy bleeding. As an added bonus, the Israeli bandage can be used as a regular elastic wrap (as for wrapping a sprained ankle, or holding a SAM splint in place) or arranged as a sling.
Elastic adhesive bandaging
Israeli’s work great, especially on limbs, but they aren’t the only choice. I first met elastic adhesive bandaging in a standard medical setting. The Red Cross often uses it for those of us who tend to leak a bit at blood drives, for example. You stretch it as you wrap it, and it sticks to itself — not clings like it will never let go, but firmly enough to be quite stable. It doesn’t stick to skin.
Elastic adhesive bandaging is great stuff, sticking to itself only and providing some pressure.
For heavy bleeding, you pack a bunch of sterile gauze on the wound and overwrap it with several passes of elastic adhesive tape. If the bleeding is Really bad, you might use clotting-aid impregnated gauze for the first level contacting the wound. This approach works great, even on body parts that are difficult to compress with an Israeli such as very high on limbs and on torsos. (2,3)
What’s this about clotting aids?
The ‘clotting aid impregnated gauze’ I’ve been mentioning can help stop very serious bleeding. You can find more about them here:
How tight should the compression bandages be?
If it can be done while stopping the bleeding, you’d really like to keep blood flowing to the rest of the limb. That’s why tourniquets are not preferred; they don’t allow this. Israeli bandages are especially good at this as they put considerably more pressure at the site of the pressure bar than elsewhere.
If you pinch a toenail or fingernail on the bandaged limb and the other side, and it takes about equally long for the color to return to the nail bed on each side, that’s a good sign that you’re not suppressing blood flow to the bandaged limb (that’s the capillary refill test).
If the fingers and toes of the bandaged hand turn funny colors (dusky red or purple), it would be good if you didn’t need to keep that level of pressure on for long.
If nothing else stops the bleeding, tourniquets are the answer of last resort. They cut off all blood flow to the limb in question, damaged and undamaged. That can cause more tissue injury and even death (of the tissue; nobody’s stupid enough to tourniquet a neck so the entire person should survive). They can also damage vessels and nerves at the site of application. Their risks beat bleeding to death, but tourniquets are seldom necessary.
References
I only list a few references here, because there was a lot of ‘same song, second verse’. The sources on bandaging tended to agree to a large extent, with good things to say about both Israeli and elastic adhesive dressings, and less good to say about alternative methods.
1) Shipman N1, Lessard CS. Pressure applied by the emergency/Israeli bandage. Mil Med. 2009 Jan;174(1):86-92.
2) Naimer SA1, Chemla F. Elastic adhesive dressing treatment of bleeding wounds in trauma victims. Am J Emerg Med. 2000 Nov;18(7):816-9
3) Naimer SA1, Anat N, Katif G; Rescue Team. Evaluation of techniques for treating the bleeding wound.Injury. 2004 Oct;35(10):974-9
Fantastic post, will be sharing it to multiple pages! A bandage I was turned onto in a class is called the Olaes modular bandage. It’s best feature is that the pressure bar can also act as a eye cup for eye injuries, I’m starting to switch over some of our Izzys to these when on sale. Although over on ebay, rescue essentials has a civilian version of the Israeli bandage for half the price made by same company that makes the Izzy’s. As a fyi tourniquets are being more readily accepted as no longer last resort but the whole “know when to use it” comes into play.
Thanks, jh, I hadn’t heard of the Olaes. (I’d seen people warming up to the tourniquets in the literature, but a couple of my medical practitioner friends tell me they still tend to see more tourniquets than are a good idea, so I didn’t want to promote them much. That said, I’m sure your right about the ‘know when’ approach.)
Thanks for the shares, too! The whole point is to get the information out there.
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