Control of Traumatic Wound Bleeding by Compression with a Compact Elastic Adhesive Dressing

Military Medicine, Jul 2006 by Naimer, Sody Abby, Tanami, Menachem, Malichi, Avishai, Moryosef, David

Objective: Compression dressing has been assumed effective, but never formally examined in the field. Methods: A prospective interventional trial examined efficacy and feasibility of an elastic adhesive dressing compression device in the arena of the traumatic incident. The primary variable examined was the bleeding rate from wounds compared before and after dressing. Results: Sixty-two consecutive bleeding wounds resulting from penetrating trauma were treated. Bleeding intensity was profuse in 58%, moderate 23%, and mild in 19%. Full control of bleeding was achieved in 87%, a significantly diminished rate in 11%, and, in 1 case, the technique had no influence on the bleeding rate. The Wilcoxon test for variables comparing bleeding rates before and after the procedure obtained significant difference (Z = -6.9, p

Introduction

The relevance of many issues regarding the on-scene care of polytrauma patients is still under debate.1 In contrast, it is agreed that immediate control of acute external traumatic hemorrhage is one of the instances in which intervention by the rescue team member plays a decisive role in determining the final outcome of the wounded victim.2 Despite ubiquitous utilization of compression and various dressing wound techniques, to our knowledge, no studies have ever examined our clinical conduct, in practice, when faced with the bleeding wound. Recently, laboratory examination of the elastic adhesive dressing (ELAD) demonstrated it as a promising means of applying effective pressure over the body surface.3 ELAD is not a proprietary device; however, it was perfected by personnel solely working in the field and experiencing the drawbacks of various other products until eventually the prototype currently used by our teams was developed. After initially receiving promising results with this device, investigation was initiated to determine whether it would be feasible to apply one single uniform dressing for injuries over most body areas. The objectives of this pilot study were: (1) to determine the degree of change of wound hemorrhage, as determined by health care providers, after the application of the ELAD; (2) to determine the satisfaction of health care providers when using the ELAD; and (3) to determine the frequency of both short- and long-term sequelae to the use of ELAD.

Methods

Consent of Helsinki Ethics Committees in the areas of the participating teams was established before embarking on the trial. The committees were convinced that individual informed consent was not necessary before each application of ELAD, since evidence regarding the safety or efficacy of its alternatives is equally lacking.

Study Design

The study was designed as a prospective trial introducing the compression-dressing unit as the intervention of choice when confronted with consecutive trauma victims. Bleeding wounds encountered were indiscriminately included from all body surfaces amenable to pressure against rigid underlying structures. Bleeding from torso injuries overlying rigid structures such as scapulae, spine, sternum, and pelvic bones were included. By definition, pure abdominal and chest injuries were excluded.

Participating Teams

Trauma teams included physicians, paramedics, medics, or volunteer first-aid providers. Any one of these team members contributed the included cases. Designated trauma teams working mainly in residential areas volunteered to participate for no other reward than a steady supply of the devices when requested. They were prepared by participating in a training session and viewing a demonstration video of the ELAD device. All either observed or practiced applying the device before actual use in the course of a traumatic incident.

ELAD Materials

The ELAD constitutes an elastic bandage with adhesive properties that enhance pressure and avoid layer slipping. This dressing consists of an absorbent pad component, affixed to the terminal portion of a self-adhering elastic bandage strip. The contact pad will absorb only a minimal amount of blood before becoming saturated. Thus, it will stain only slightly at first, but if pressure is insufficient and bleeding continues, the stained area of the pad will gradually enlarge. The cohesive characteristic was achieved via a thin layer of mildly adherent glue covering one of the interfaces, enhancing friction between roll layers but remaining nonadherent to other surfaces. The advantages of the cohesive quality are mainly early attainment of external pressure without slipping at the onset of dressing and obviation of a fastening mechanism when full compression is achieved. The limited stickiness of the materials allow: (1) facilitation of bandage opening and (2) prevention of undesired adherence to manipulating latex gloves or the victim's skin. Likewise, removal of this material from skin and hairy surfaces is rendered painless. The roll component incorporated in the study consisted of resilient material durable enough such that it would not tear upon traction, although it was elastic to the extent of allowing easy stretching across the body surface (Fig. 1).