A pressure dressing is a specialized type of bandage designed to apply continuous, firm force directly over a wound to control severe external bleeding. This medical technique is a standard part of first aid, but in the context of military operations, its use is governed by the Tactical Combat Casualty Care (TCCC) guidelines. TCCC is the set of evidence-based, battlefield trauma care protocols used by the US Army and other military branches to reduce preventable death in combat zones. The pressure dressing serves as an important tool in the systematic approach to hemorrhage control. Its proper application requires an understanding of where it fits within the hierarchy of treatment and the specific anatomical sites where it is most effective.
The Role of Pressure Dressings in Tactical Casualty Care
Pressure dressings are situated within the broader TCCC treatment algorithm, specifically addressing massive hemorrhage after initial steps have been taken. The first and fastest measure for life-threatening bleeding on an arm or leg is the application of a limb tourniquet. A pressure dressing is typically used for compressible wounds that are bleeding severely but are not amenable to a tourniquet, or as a secondary measure to maintain control after other initial treatments. The dressing works by intensifying the direct force applied to the wound site, which helps to compress damaged blood vessels and support clot formation. Pressure dressings are also the final step after a wound has been packed with hemostatic gauze, securing the material and the pressure over the bleeding source.
Determining the Application Site: The “Where”
The location for applying a pressure dressing is always directly over the source of the bleeding to maximize its effect on the damaged vessel. Pressure dressings are primarily intended for two types of wounds: compressible extremity wounds where a tourniquet is not necessary or is being replaced, and certain wounds to the head or torso. For extremity injuries, the pressure dressing is centered directly over the sterile pad that covers the wound, or over the hemostatic gauze that has been packed into the wound cavity. It is applied to arms and legs after bleeding has failed to stop with initial direct pressure or as a means of securing packed wounds. For wounds to the junctional areas—such as the groin, shoulder, or neck—or the torso, a pressure dressing may be used to secure a wound packed with hemostatic gauze, but it is not the primary pressure-generating device. It is strictly contraindicated to apply a pressure dressing over a suspected penetrating eye injury, as the excessive force can cause further damage. The location is appropriate only for wounds where the external pressure can effectively compress the bleeding vessel against underlying tissue or bone.
Step-by-Step Guide to Application and Assessment
The application process often follows wound packing with hemostatic dressing. The first step is to place the sterile, non-adhesive pad portion of the pressure dressing directly over the wound, ensuring it is centered over the point of most active bleeding or the packed gauze. While placing the pad, firm manual pressure must be maintained to avoid dislodging any forming clot or hemostatic material.
The elastic bandage is then wrapped tightly around the injured limb or area, starting from the sterile pad and continuing to cover all edges. If the dressing includes a pressure bar or clip, the wrap is reversed over this feature, forcing the bar down onto the pad to create intense, localized pressure. The bandage is then secured, typically using a closure bar, clips, or Velcro tabs at the end of the wrap.
Following the application, assessment must be performed to ensure the dressing is effective and safe. The rescuer must check for circulation below the pressure bandage by feeling for a distal pulse. If the skin below the dressing becomes cool, bluish, or numb, or if the pulse is absent, the pressure dressing is too tight and must be loosened and reapplied. This assessment confirms that the pressure is sufficient to stop the hemorrhage but does not completely cut off all blood flow to the rest of the limb, which could cause unnecessary tissue damage.