All dressings for significant bleeding should be secured with a pressure bandage. Although it may seem intuitive that all Combat Paramedics/Providers are familiar with pressure bandage application and principles, significant variation has been noted in both civilian and military studies looking at pressure bandage practices.

In several studies, it has been shown that pressure bandages with a pressure bar are equal to or superior to those without a pressure bar. The bar is very effective in elevating the applied pressure directly under the pressure bar while at the same time not applying unnecessary pressure over other areas covered by the bandage, which allows control of hemorrhage at the site of injury (under the pressure bar area) without having to have a full tourniquet effect. However, not all units deploy with bandages that utilize a pressure bar, and familiarity with multiple bandages is desirable.

It is vitally important to maintain pressure on the wound throughout the process of applying the pressure bandage. The most common mistake is releasing pressure on the wound dressing to wrap the bandage. If another responder is available to assist, it is much easier to maintain active pressure. If using a pressure bar bandage, remember to reverse the direction of the wrap after a full wrap to push the bar down directly over the wound and dressing. And be sure to secure the bandage well, as they are prone to being caught during casualty movements or reassessments.

### Comparison of Battle Dressings

- Emergency Bandage, H-Bandage, and Olaes®, all of which possess mechanisms to focus pressure, produced the highest peak pressures over the simulated wound site.
- Battle Wrap™ did not achieve the target contact pressure.
- Honeycomb Bandage was the only device to significantly reduce distal blood flow. (Dory, 2022)

Remember, a pressure bandage should be tight but is not supposed to be a tourniquet.

After applying a pressure bandage, check for circulation distal to the bandage. If the skin below the bandage is cool, bluish in color, or numb indicating decreased circulation or if the distal pulse is absent, the pressure bandage may be too tight. The pressure bandage should be loosened slightly and resecured. All dressing and bandages should be reassessed frequently and especially after a casualty has been moved.