Uncontrolled bleeding is a leading cause of preventable death in both military and civilian settings. The pressure dressing is specialized equipment designed to provide sustained, compressive force directly onto a wound to stop severe external hemorrhage. Modern military medicine standards, such as Tactical Combat Casualty Care (TCCC), prioritize rapid and effective hemorrhage control as the initial step in trauma response. This focus highlights the pressure dressing’s role as a readily available means to manage life-threatening blood loss.
Identifying Severe Bleeding and the Pressure Dressing
A pressure dressing is a purpose-built trauma bandage, integrating a thick, non-adherent pad, an elastic wrap, and often a pressure bar or closure clip. The primary indication for this device is severe, compressible external bleeding that does not warrant a tourniquet, or when a tourniquet cannot be applied. Compressing the injury site helps the body’s natural clotting mechanisms and any applied hemostatic agents form a stable clot, sealing the damaged vessel. The integrated pressure applicator allows the user to create focused, mechanical pressure directly over the injury, sustaining the necessary force without continuous manual effort.
Application Principles for Extremity Bleeding
The most common application site for a pressure dressing is on the limbs (arms and legs), where the underlying bone structure facilitates effective compression. Before application, the wound must be fully exposed to locate the precise source of active bleeding.
If the wound is deep, it is packed tightly with hemostatic gauze directly into the wound cavity, ensuring the packing extends slightly above the skin line. Firm, continuous manual pressure is then held over the packed wound for a minimum of three minutes to allow the hemostatic agent to begin working effectively.
The pad of the pressure dressing is placed directly over the wound site or the packed gauze. The elastic bandage is wrapped tightly around the extremity, using maximum tension to apply compression over the pad and the underlying injury. If the dressing includes a pressure bar, the wrap is threaded through it and reversed, forcing the bar downward to create a localized, concentrated pressure point onto the bleeding vessel. The wrap must cover all edges of the pad and is secured using the closure clip or integrated straps. After securing the dressing, circulation below the bandage must be checked; signs like coolness, blueness, or numbness suggest the dressing is too tight and needs reapplication with less tension.
Treating Bleeding at Junctional Sites
Junctional sites are areas where the limbs meet the torso (neck, armpit, and groin), presenting a unique challenge for hemorrhage control. These locations are anatomically complex, preventing the effective use of standard limb tourniquets because major vessels cannot be occluded against bone. For severe bleeding, the approach relies on a combination of wound packing and focused pressure, often supplemented by specialized junctional tourniquets if available.
The initial intervention is to locate the source of bleeding and immediately pack the wound cavity tightly with hemostatic gauze to maximize contact with the vessel. After packing, firm manual pressure must be held continuously over the site for at least three minutes to initiate clot formation. The pressure dressing is then applied directly over the packed wound to maintain sustained compression.
Application at Junctional Sites
In the groin, the elastic wrap creates a figure-eight pattern around the waist and the injured leg to hold the pad firmly in place. For the neck and armpit, the bandage is wrapped diagonally across the chest and under the opposite arm to create counter-tension, focusing pressure solely on the injury site. The pressure bar component should not be used on the neck due to the risk of airway compromise.
Deciding Between a Pressure Dressing and a Tourniquet
The choice between a pressure dressing and a limb tourniquet is determined by the severity and location of the hemorrhage. A pressure dressing, often used with hemostatic gauze, is appropriate for severe, compressible bleeding that is manageable and does not involve catastrophic blood loss or amputation. It is also the necessary choice for bleeding at junctional sites, where a limb tourniquet cannot be applied effectively. The pressure dressing controls blood loss while maintaining circulation to the rest of the limb below the injury site.
A limb tourniquet is reserved for catastrophic, life-threatening external bleeding on an extremity, especially when bleeding is uncontrolled or if there is a traumatic amputation. The tourniquet completely stops blood flow to the entire limb, providing immediate, definitive hemorrhage control despite the risk of tissue damage. Pressure dressings may also be used during a tourniquet conversion process, maintaining hemostasis after the tourniquet is removed and restoring blood flow to the limb.