A pressure dressing is a specialized bandage application designed to apply firm, sustained pressure directly to a wound to stop severe or life-threatening bleeding (hemorrhage). This first aid measure works by applying mechanical force to injured blood vessels to slow blood flow and facilitate the body’s natural clotting process. Unlike a simple covering, a pressure dressing uses targeted compression to maintain hemostasis and stabilize the injury. While effective for immediate control, professional medical help is always required for severe wounds.
Identifying Severe Bleeding and Preparation
Recognizing severe bleeding is the first step in a time-sensitive emergency, as significant blood loss can lead to hypovolemic shock within minutes. Severe bleeding is characterized by blood that is pumping or spurting from the wound, or blood that soaks quickly through initial bandages and does not stop or slow with manual pressure. Any wound that is deep, large, or involves an extremity, the torso, or the head should be treated as a severe bleed.
Before touching the injured person, scene safety must be ensured, and emergency medical services (EMS) should be contacted immediately by calling 911 or the local equivalent. Personal protection is important; disposable gloves, if available, should be worn to reduce the risk of infection transmission. The wound must be fully exposed by cutting or tearing away clothing, but do not attempt to remove any objects that may be impaled, as they can help tamponade the bleeding.
Necessary materials should be gathered, including sterile gauze pads or a clean cloth, a second bulky material to act as the pressure point, and a roller bandage or elastic wrap for securing. Once the scene is safe and help is on the way, apply firm, direct pressure to the wound with the cleanest material available. This manual pressure should be maintained continuously until the pressure dressing can be applied or until professional help arrives.
Step-by-Step Application Instructions
The application of the pressure dressing begins after initial manual pressure has been applied and the wound is covered with a sterile or clean absorbent base layer. This initial layer of gauze or cloth is placed directly over the wound to absorb blood and protect the tissue. The goal is to focus compression directly on the bleeding source, not just to wrap the limb.
Next, a bulky, pressure-inducing material is placed directly over the wound site, on top of the initial absorbent layer. This second layer, which can be a tightly folded gauze roll, an unopened bandage, or a clean wad of cloth, acts as the concentrated pressure point. This material transmits the pressure from the outer wrap down onto the injured vessels.
A roller bandage or elastic wrap is then used to secure this pressure point firmly in place. When wrapping, start distal (further from the heart) and wrap toward proximal (closer to the heart) to support circulation and reduce swelling. The bandage should be wrapped tightly and securely over the bulky material, ensuring maximum pressure is exerted directly over the wound.
One technique to increase focused pressure is to twist the bandage roll one full turn (180 degrees) directly over the pressure pad before continuing the wrap. Wrapping should continue until the entire pressure pad is covered and the bandage roll is nearly finished. The end of the bandage is then secured with tape, a clip, or by tucking the end under a previous layer, ensuring the securing method does not loosen the overall tension.
Immediately after securing the dressing, check the tightness to ensure it is firm enough to stop the bleeding, but not so tight that it acts as a tourniquet and cuts off all arterial blood flow. A guideline for proper tension is that one finger should be able to fit beneath the knot or securing point. The pressure dressing should extend a few inches above and below the injury site for even compression.
Recognizing Complications and Next Steps
Continuous monitoring of the injured person and the dressing is necessary after application. Blood soaking completely through the dressing indicates the pressure is insufficient or the bleeding is too severe. If this occurs, the original dressing must not be removed, as this could disrupt any forming clots; instead, a new absorbent material should be placed directly over the saturated dressing, and a second, tighter pressure dressing should be applied on top of the first.
A major complication is a dressing that is too tight, which can be identified by checking the distal circulation in the extremities. Signs of compromised circulation include pale or blue skin, coolness, tingling, or numbness in the fingers or toes beyond the dressing. The capillary refill test, where the nail bed is pressed until it turns white and the color return is timed, should show a return to pink color within two seconds. If circulation is restricted, the bandage must be slightly loosened until the signs of ischemia resolve.
The injured person must also be monitored for signs of shock, which can result from significant blood loss. Signs of shock include cool, pale, or clammy skin, a rapid pulse, weakness, or confusion. If shock is suspected, the patient should be laid down, and if there are no contraindications such as head or torso injury, the legs should be elevated about 12 inches to encourage blood flow to the core.
Continuous monitoring of the patient’s consciousness, breathing, and circulation must be maintained until professional medical personnel take over. Immediate medical transport remains imperative regardless of the successful application of the pressure dressing. Any information about the time of dressing application and the patient’s condition should be passed on to the arriving EMS team.
A roller bandage or elastic wrap is then used to secure this pressure point firmly in place. When wrapping, it is beneficial to start distal (further from the heart) and wrap toward proximal (closer to the heart) to support circulation and reduce swelling. The bandage should be wrapped tightly and securely over the bulky material, ensuring the maximum pressure is exerted directly over the wound.
One technique to increase focused pressure is to twist the bandage roll one full turn (180 degrees) directly over the pressure pad before continuing the wrap. The wrapping should continue until the entire pressure pad is covered and the bandage roll is nearly finished. The end of the bandage is then secured with tape, a clip, or by tucking the end under a previous layer, making sure the securing method does not loosen the overall tension.
Immediately after securing the dressing, the tightness must be checked to ensure it is firm enough to stop the bleeding, but not so tight that it acts as a tourniquet and cuts off all arterial blood flow. A general guideline for proper tension is that one finger should be able to fit beneath the knot or securing point. The pressure dressing should extend a few inches above and below the injury site for even compression.
Recognizing Complications and Next Steps
Continuous monitoring of the injured person and the dressing is necessary after application. A failure sign is when the blood soaks completely through the dressing, indicating the pressure is insufficient or the bleeding is too severe. If this occurs, the original dressing must not be removed, as this could disrupt any forming clots; instead, a new absorbent material should be placed directly over the saturated dressing, and a second, tighter pressure dressing should be applied on top of the first.
A major complication to watch for is a dressing that is too tight, which can be identified by checking the distal circulation in the extremities. Signs of compromised circulation include pale or blue skin, coolness, tingling, or numbness in the fingers or toes beyond the dressing. The capillary refill test, where the nail bed is pressed until it turns white and the color return is timed, should ideally show a return to pink color within two seconds. If circulation is restricted, the bandage must be slightly loosened until the signs of ischemia resolve.
The injured person must also be monitored for signs of shock, which can result from significant blood loss. Signs of shock include cool, pale, or clammy skin, a rapid pulse, weakness, or confusion. If shock is suspected, the patient should be laid down, and if there are no contraindications such as head or torso injury, the legs should be elevated about 12 inches to encourage blood flow to the core.
Continuous monitoring of the patient’s consciousness, breathing, and circulation must be maintained until professional medical personnel take over. The imperative for immediate medical transport remains regardless of the successful application of the pressure dressing. Any information about the time of dressing application and the patient’s condition should be passed on to the arriving EMS team.