St John first aid guide for dressings and bandages

Dressings vary greatly in nature and size, so it is important to select the correct dressing for use on a specific wound. A sterile dressing which is past its expiry date should NOT be used.

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A bandage is used in combination with a dressing where a wound is present. A roller bandage is used to secure a dressing in place. A triangular bandage is used as an arm sling or as a pad to control bleeding. It may also be used to support or immobilise an injury to a bone or joint or as improvised padding over a painful injury. A tubular gauze bandage is used to retain a dressing on a finger or toe.

Dressings

Sterile wound dressings

Wound dressings will be in a sterile packet, which should be opened carefully by a person with clean or gloved hands. Then, to avoid contamination of the sterile dressing, it is not removed from the opened packet until the wound is ready to be covered.

Dressings used to control bleeding must be bulky to ensure that adequate pressure is applied over the injured area. The most common dressing is made of combined wool or cellulose, covered in a light cotton woven fabric, and these are generally known as ‘combine dressings’.

Some major wound dressings are labelled as BPC or BP (because they are listed in the British Pharmacopoeia) and consist of a sterile combine dressing with attached bandage. They are ideal  to fill crater wounds or to control severe bleeding.

Sterile gauze squares are used mainly for cleaning a wound. Cotton wool should NOT be used because of loose cotton fibres that might stick to the wound during healing.

Sterile non-adherent dressings

Very light dressings are used on a minor wound to aid healing and most have a non-adherent surface. A non-adherent dressing is often covered on one or both sides with a plastic film containing many perforations. If only one side has a plastic film, that is the side to be placed against the wound. This allows fluids to pass through into an absorbent layer, to keep the wound dry.

Other types of non-adherent dressing have a special synthetic coating on one or both sides to prevent adhesion to the wound surface. The non-adherent layer is always placed against the wound. To reduce confusion and incorrect use, some manufacturers make both sides onadherent.

Non-adherent dressings are used for extensive surface wounds such as an abrasion (graze) or burn.

Improvised dressings

In an emergency a dressing may be improvised from a range of materials. To control bleeding a bulky pad may be made from a bundle of several facial tissues or from any clean, non-fluffy material.

For a minor burn or scald, a piece of clean plastic kitchen wrap may be used initially. However, if the burn is serious, it is vital to use only sterile coverings to avoid the risk of infection. Cooling should be continued until a sterile dressing is available.

Bandages

Roller bandages

Roller bandages vary greatly depending on how they are to be used.

A roller bandage is used to:
• hold a dressing in place on a wound
• maintain pressure over a bulky pad to control bleeding
• support an injured limb or joint
• apply pressure to a limb

Roller bandages are made from lightweight cotton, crepe or elasticised crepe, depending on the pressure to be achieved. A lightweight cotton bandage is used to hold a dressing in place, whereas a crepe or elasticised crepe bandage is used for applying support or firm pressure to a soft tissue injury.

Applying roller bandages

A roller bandage needs to be chosen carefully to ensure that it is the correct width for the body part involved. As a general guide, the following widths are recommended:
• Lower arm, elbow, hand and foot – 75 mm.
• Upper arm, knee and lower leg – 100 mm.
• Large leg or trunk – 150 mm.
It is best to use a bandage with some degree of stretch in the weave. This will make the bandage easy to use and more likely to stay in place for many hours. However, the correct application technique is essential to provide comfort and adequate support for the affected part.

Basic steps to successful use of a roller bandage:

• Bandage the part in the position of greatest comfort to the patient. Support the part adequately before starting to apply the bandage.
• Hold the tightly rolled bandage with the ‘head’ of the bandage on top and wrap the ‘tail’ around the body part without unrolling more than a few centimetres at a time.
• Begin with a locking turn to hold the start of the bandage securely under each following turn.
• Work from the middle of the body or limb in an outwards direction.
• Work from the narrowest part below the dressing and work upwards.
• Ensure that each turn covers two-thirds of the previous turn.
• Cover totally any dressing and padding used.
• Finish with a straight turn at the end of the bandage.
• Secure the bandage with a safety pin or adhesive tape. Avoid the use of metal clips because they are less secure and can fall out during activity.

Applying a roller bandage to the lower arm or leg:

• Apply a dressing or padding over the affected area.
• Start with a diagonal, locking turn below the dressing or padding to secure the dressing.
• Continue up the limb, covering two-thirds of each previous turn.
• Finish with a straight turn to secure the bandage and fasten it with a pin or adhesive tape.

Applying a roller bandage to the elbow or knee:

• Apply a dressing or padding over the affected area.
• Start with a full turn over the point of the elbow or knee to secure the bandage.
• Make a second turn just below the first, exposing one-third of the initial turn over the point of the elbow or knee.
• Make a third turn just above the first, again exposing one-third of the initial turn over the point of the elbow or knee.
• Continue with one or two more turns alternately working from below to above the affected joint, until the dressing or padding is fully covered.
• Avoid any extra turns that will cause pressure on the inside surface of the joint.
• Finish with a full turn above the elbow or knee and secure the bandage with a safety pin or adhesive tape.

Applying a roller bandage to the hand or foot:

• Apply a dressing or padding over the affected area.
• Start with a diagonal, locking turn around the wrist or foot.
• Carry the bandage across the back of the hand or foot to the base of the little finger or little toe and then make a complete turn around the fingers or toes.
• Make another turn across the back of the hand or foot from the fingers/toes to the wrist/ankle.
• Repeat these turns working upwards with each turn until the dressing or padding is covered.
• Finish with a circular turn around the wrist ankle and secure the bandage with a safety pin or adhesive tape.

Triangular bandages

Triangular bandages are usually made from a metre square of cotton or calico that is cut in half diagonally. The bandage can be used in various ways as a sling or for immobilisation of broken bones and soft tissue injuries.

Sling

• In the open form as a sling to support an upper body injury.

Broad-fold bandage

• As a broad-fold bandage with the apex folded down to the base twice to immobilise a lower body injury.

Narrow-fold bandage

• As a narrow-fold bandage with the broadfold bandage folded in half to control severe bleeding, or for immobilisation of a lower limb.
• As a collar-and-cuff sling for an upper body injury.

Pad

• As a folded pad after the ends of the narrowfold bandage have been brought into the centre three times, and for use on a major wound or as padding.

Tying a reef knot with a triangular bandage
When using a triangular bandage it is important to use a reef knot to secure it in place. A reef knot is a flat knot that will not slip undone and, if correctly placed on the body, is comfortable for the patient.

1. Wrap the left end of the bandage over and then under the right end to start the knot.
2. Wrap the right end over and then under the left end to complete the knot.
3. Pull the knot tightly from both sides to ensure that it will lie flat.

It is easy to untie a reef knot without jarring or hurting the patient. Simply choose two paired ends as they come out of the knot at one side. Then pull the ends apart steadily until two loops form and can be slipped off one end.

Arm sling
This sling is used to support a lower arm or hand
injury and for rib or collarbone fractures.

• Encourage the patient to hold the affected arm across the body in the position of greatest comfort.
• First hold the bandage with the base running down the centre of the body and the point to the elbow on the affected side. Gently slip the top point under the supported arm and wrap it around the back of the neck until it rests on the shoulder of the affected side.
• Lift up the lower point and take it to meet the upper point at the side of the neck on the affected side.
• Use a reef knot (see above) to tie the ends together just above the collarbone to avoid any pressure on the back of the neck.
• Adjust the sling so that the fingertips are clearly visible and then bring the point forward and fasten it to the sling with a safety pin.
• Finally, check the circulation in the fingers and compare the tissue colour with the fingertips on the unaffected arm. If there are any signs of an impaired circulation, loosen or remove the sling and any underlying bandages.

Elevation sling
This sling is used for an arm or finger injury where the patient needs the hand and arm to be held in an elevated position.

• Encourage the patient to hold the affected arm across the body with the fingers pointing to the opposite shoulder tip.
• First hold the bandage with the base running down the centre of the body and the point to the elbow on the affected side. Gently place the bandage over the supported arm and carry the top end around the front of the neck until it rests on the unaffected shoulder.
• Gently wrap the lower half of the bandage along the affected arm. Carry the free end of the bandage from the elbow across the back to the opposite shoulder tip.
• Gently twist the top point around the fingers, but avoid placing pressure on any injury. Tie the two ends together with a reef knot (see above) and place it just above the collarbone to avoid any neck pressure.
• At the point of the elbow smooth the loose fabric forwards along the arm under the sling. Secure the sling firmly at the elbow with a safety pin or tape.

Collar-and-cuff sling
This sling is used to hold the lower arm and hand in an elevated position where a full elevation sling is either not required, or for patient comfort in very hot weather. The sling is made with a narrowfold bandage used as a clove hitch.

• Make a clove hitch with two large loops of the bandage. One loop is made with the bandage end pointing upwards and the other end pointing downwards.
• Fold the two loops inwards towards the middle, ensuring that both ends are trapped between the loops.
• Encourage the patient to hold the affected arm across the body with the fingers pointing to the opposite shoulder tip. Then gently slide the two loops over the hand and lower arm with the ends hanging downwards.
• Carry the two bandage ends up on either side of the limb and around the patient’s neck.Adjust the bandage so that it is possible to tie a
  reef knot (see above) just above the collarbone on one side to avoid any pressure on the neck.
• The knot may be placed on either side of the neck depending on the location of the injury and the comfort of the patient.

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A key part of any first aid kit, bandages are generally used to cover wounds, apply pressure to bleeding wounds and to support and immobilise sprains, strains and broken bones. They’re generally lightweight, flexible and breathable, but different types have different characteristics, and are better suited for various injuries. With such a range of bandages to choose from, it can be confusing to know how to make the right choice.

This simple guide breaks down the different types of bandage, their characteristics, use cases and how to apply them.

There are three main categories of bandage: roller bandages, triangular bandages and tubular bandages.

Roller Bandages

The most common type of bandage, roller bandages are typically made from a continuous strip of lightweight and breathable cotton, and includes crepe bandages, cohesive bandages, conforming bandages and elastic adhesive bandages.

Crepe Bandages

Characteristics:

Crepe bandages are typically made from cotton and are thicker, woven bandages that are flexible enough to be wrapped around various parts of the body without difficulty. They’re elasticated, so are strong enough to provide sufficient compression to affected areas, while still being breathable and allowing muscles or joints to flex.

Use cases:

• Providing pressure to a limb or joint, most commonly ankle or knee
• Holding a dressing in place
• Applying pressure to control bleeding wounds
• Supporting a strain or sprain

Application method:

Always ensure you’re wearing protective gloves, and have sufficiently cleaned the wound or affected area before applying a bandage.

Gently wind the bandage around the affected area in a diagonal motion, making sure that each new layer covers at least half of the previous layer. With the first layer of bandage, be careful not to apply with too much tension, which could cut off blood flow. The subsequent layers will then provide enough security to hold the bandage in place. Lastly, ensure you have covered below and above the injured area (limb or joint), before cutting the end of the bandage and securing it in place with tape, or the clips provided.

Cohesive Bandages

Characteristics:

Thin, versatile and easy to use, cohesive bandages are designed to stick to itself but not to skin or hair. This means it requires no tape or pins to hold in place, and carries no risk of pulling out hairs when removing. They’re woven specifically to allow maximum flexibility, stretching up to double its normal length.

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Use cases:

• Compressing and supporting strains and sprains
• Holding wound dressings in place
• Often used in sports like football, to strap fingers, wrists or ankles
• Often used on pets and race horses

Application method:

Always ensure you’re wearing protective gloves, and have sufficiently cleaned the wound or affected area before applying a bandage.

Roll out a sufficiently sized piece of bandage, and apply the first layer of the bandage without tension, ensuring that at least half of each wrap is overlapping the layer adjacent to it, to allow it to stick together. Once the first layer is applied, continue to wrap over the injured area, increasing the tension slightly to allow the bandage to be held in place.

Always make sure to check blood flow in the fingers if applied on the arm, wrist or hand, and in the toes if applied to the ankle or foot. Do this by pressing the toe or finger for five seconds until it loses its colour, once released the colour should return within two seconds. If it doesn't, unwrap the bandage and apply with less tension.

Conforming Bandages

Characteristics:

Conforming bandages have a similar appearance to cohesive bandages, however require tape to hold them in place. As their name suggests, this type of bandage conforms closely to the body while being highly flexible and breathable. They’re usually made with synthetic materials, and are fray resistant and secure—a great option for applying pressure.

Use cases:

• Holding a dressing in place
• Applying pressure to control bleeding wounds
• Compressing and supporting a strain or sprain

Application method:

Always ensure you’re wearing protective gloves, and have sufficiently cleaned the wound or affected area before applying a bandage.

For general application, place the gauze (if using) over the wound and begin wrapping the bandage twice around the injury to hold it in place. Move your way up the limb, wrapping the bandage and ensuring that each new layer covers half of the previous layer. Complete by wrapping the bandage around once more and securing in place.

If using conforming bandages on elbows or knees to support strains or sprains—or to hold dressings in place—lightly flex the joint and apply the bandage in a figure of 8 motion.

If using conforming bandages on hands to support strains or sprain— or to hold dressings in place—begin from the inside of the wrist and wrap across the back of the hand diagonally to the end of the little finger, while leaving the thumb free.

Elastic Adhesive Bandages

Characteristics:

Elastic adhesive bandages are extremely adhesive and sticky, and are designed to be taped directly onto the skin. They are generally thick, and heavier in weight than other roller bandages. They provide more stability and rigidity, but may not be suited to injuries to areas where range of motion is highly important.

Use cases:

• Compressing and supporting a strain or sprain by applying to a joint
• Applying over a conforming, cohesive or crepe bandage to provide additional pressure to control bleeding wounds

Application method:

Always ensure you’re wearing protective gloves, and have sufficiently cleaned the wound or affected area before applying a bandage. Unroll a sufficient amount of elastic adhesive bandage, wrapping around the affected area. Due to its thickness, the area may only require one layer of bandage.

Triangular Bandages

Characteristics:

Triangular bandages are one of the most versatile options, as they are usually a very large single sheet of thick cotton that can be shaped to suit a range of injuries. They’re large in size, provide great stability and are a key part of any first aid kit.

Use cases:

• Supporting broken bones, dislocations and soft tissue injuries as a sling
• Providing protection for head injuries
• Acting as a tourniquet, in rare situations where this is required (i.e severe bleeding cannot be stopped, and creating a tourniquet cuts off the blood supply to the affected area)

It is important to remember that treating bleeding injuries doesn't require a tourniquet in most cases. However, recent studies have shown that early use of a tourniquet can save lives. If the bleeding can’t be stopped, and a tourniquet is necessary, a triangular bandage will work highly effectively.

Application method:

Always ensure you’re wearing protective gloves, and have sufficiently cleaned the wound or affected area before applying a bandage.

There are a number of ways to apply a triangular bandage, including arm slings, elevated slings, broad-fold and narrow-fold bandages, and pads. The location on the body, and severity of injury will determine how to use the triangular bandage, as explained below:

Arm sling

Ask the patient to support their arm horizontally with their other hand. Carefully guide the bandage under the arm, with the point of the triangle resting underneath the elbow of the injured arm. Bring the top of the bandage around the back of the patient’s neck.

Following this, loop the lower end of the bandage up over the arm to meet the top of the bandage at the shoulder of the injured side. Tie these ends of the bandage together in a reef knot above the collar bone.

Adjust the sling to ensure it covers their full arm and hand, and fasten the end of the bandage by the elbow with a safety pin, or twist the fabric and tuck it in. Ensure to check circulation in the fingertips every 10-15 minutes, by pressing their nail for 5 seconds until it becomes pale. Then, release and check if the colour returns within 2 seconds.

Elevated sling

Some injuries will require the arm to be elevated. If this is the case, ensure the patient creates the elevated angle with their affected arm, and follow the same steps as above.

Broad-fold bandage

Broad-fold bandages are mainly used for lower-body injuries. They’re created by folding the point of the triangle down to the base twice, which allows them to be looped around the affected area to create a supportive, circular bandage.

Narrow-fold bandage

Narrow-fold bandages can also be used to support lower-body injuries, to suppress bleeding, and as a collar-and-cuff sling for upper body injuries. It is created by folding a broad-fold bandage again.

Pad

If you’re needing a large dressing for a major wound, create a pad from the triangular bandage by folding each corner into the centre three times, or as many/little as necessary for the size of the wound.

Tubular Bandages

Characteristics:

Tubular bandages are often used to support and secure dressings on fingers and toes, due to their size and ability to allow freedom of movement. As their name suggests, they’re shaped like a tube, which gives them unique use cases. They’re elasticated and made from cotton, and don’t require tapes or pins to hold in place.

Use cases:

• Holding dressings on fingers, toes, or other affected areas
• Supporting injured joints
• Protecting skin under a cast of a broken bone

 Application method:

When using a tubular bandage, it is important to ensure you have the correct size, whether that be for a toe, finger or any other region of the body. If you can, use a plastic tube applicator to help with treatment. Place the bandage on the applicator, rolling it down and ensuring it is fully loaded on. From here, stretch the applicator adjacent to the area you wish to apply the bandage to, and roll it on gently, with care for the injury. If this is over the top of a dressing, ensure that it hasn't been moved in the process.

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