Under pressure - a sensor-based analysis of simulated prehospital pressure dressing application for hemorrhage management.

backgroundThe concept of "x-ABCDE", with "X" representing exsanguinating hemorrhage, highlights the priority of immediate bleeding control in trauma care. Despite being a fundamental intervention, pressure dressing techniques lack standardization. Studies show high variability in achieved pressures, often below therapeutic targets or exceeding harmful levels, with no correlation between subjective estimates and objective measurements.

objectivesTo objectively assess current practices of pressure bandage application and identify influencing factors including material type, technique, and provider experience.

methodsThis prospective, single-center, simulation-based observational study was conducted from August 2024 to January 2025 at a Level I Trauma Center. Emergency medical providers applied pressure dressings according to personal preference using available materials. Pressure distribution was measured via two calibrated capacitive pressure sensors (61 measurement fields). Analysis included correlation tests, group comparisons, and multiple regression.

resultsA total of 124 emergency medical providers (75% male; 36% paramedics, 44% emergency medical technicians, 13% trainees, 7% emergency physicians) completed pressure dressing applications, with 116 datasets included in final analysis. Mean maximum pressure was 169.35 ± 84.33 mmHg (range 50-412 mmHg) with application duration of 51.20 ± 18.14 s. Emergency physicians generated significantly higher pressures than non-physician groups (p < 0.001). The short-tug technique was the strongest predictor of maximum pressure (p < 0.001), followed by bandage material. Israeli bandages achieved highest pressures (205.40 ± 98.12 mmHg), followed by medium-stretch (171.68 ± 75.03 mmHg) and elastic fixation bandages (135.50 ± 58.63 mmHg). Excessive pressures > 250 mmHg occurred in 28% of Israeli bandage applications versus 11.1% for medium-stretch and 1.6% for elastic bandages. Pressure distribution showed volar focusing with highest values measured by the smaller sensor in the central area, best achieved through medium-stretch bandages. No correlation was found between subjective self-assessment and objective pressure measurements (p = 0.541).

conclusionsPressure dressing application varies significantly by material, technique, and experience. While the short-tug technique and Israeli bandages achieved highest peak pressures, medium-stretch bandages demonstrated the most therapeutically consistent pressure distribution, with pronounced target pressure focusing and the lowest rate of excessive pressures within the present observational simulation setting. Lack of correlation between self-assessment and objective performance highlights the need for standardized training protocols and evidence-based technique guidelines.