title: Investigating pressure bandaging for snakebite in a simulated setting: bandage type, training and the effect of transport.
abstract: BACKGROUND
  The clinical evidence base for the use of pressure bandaging in snakebite is limited. We aimed to investigate if pressure bandages (PB) generated and maintained presumptive optimal pressures in a simulated setting.
  
  
  METHODS
  A total of 96 subjects were recruited, 78 health professionals and 18 from the general public. Participants were asked to apply PB with crepe and with an elasticized bandage without instruction. A paediatric blood pressure cuff attached to a pressure transducer was used to measure the pressure generated. PB application with elasticized bandages was repeated by 36 participants (18 general public and 18 health professionals) with feedback on pressures attained, and reassessment on the sixth subsequent attempt. Pressure was also measured under correctly applied bandages during an ambulance ride.
  
  
  RESULTS
  The median pressure generated under crepe bandages was 28 mmHg (interquartile range [IQR]: 17-42 mmHg) compared with 47 mmHg (IQR 26-83 mmHg) with elasticized bandages, with most subgroups applying the elasticized bandage closer to the estimated optimal pressure (55-70 mmHg). Following training, the median pressure for the 36 participants was 65 mmHg (IQR 56-71 mmHg), closer to the optimal range than initial attempts. On initial bandaging, 5/36 (14%) participants achieved optimal pressure range with elasticized bandages, compared with 18/36 (50%) after training (P = 0.002). Crepe bandages initially correctly applied did not maintain desired pressure during ambulance transport on urban roads over 30 min. Elasticized bandages maintained pressure.
  
  
  CONCLUSIONS
  PB was poorly done by the general public and health professionals. Crepe bandages rarely generated optimal pressures compared with elasticized bandages, but training did improve participants' ability to apply elasticized bandages. PB recommendations should be modified to specify appropriate bandage types.
authors.affiliation: Tropical Toxinology Program, Menzies School of Health Research, Charles Darwin University, and Northern Territory Clinical School, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Canale
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
mesh_terms: D001132:Arm; D001458:Bandages; D002983:Clinical Competence; D003250:Constriction; D005392:First Aid; D006801:Humans; D007103:Immobilization; D007866:Leg; D008348:Manikins; D016544:Patient Simulation; D011312:Pressure; D012909:Snake Bites / Q000628:therapy*; D018709:Statistics, Nonparametric