Teaching Wound Care and Bandaging: An Historical Perspective

Steve Donelan Correspondence information about the author Steve Donelan Email the author Steve Donelan
Teaching Wound Care and Bandaging: An Historical Perspective
DOI: https://doi.org/10.1580/1080-6032(2003)014[0047:TWCABA]2.0.CO;2
Abstract
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Article Outline
I. Introduction
II. History of first aid training
III. First aid training in the 1930s
IV. First aid training since 1993
V. Origins of modern bandaging
VI. Bleeding control
VII. Wound cleaning then and now
VIII. The art of bandaging
IX. Conclusion
X. References

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Introduction
For many years, first-aid courses included a great variety of bandaging and splinting techniques. In the second edition of the American Red Cross
textbook, Advanced First Aid & Emergency Care (1979),1 for example, 22 bandaging techniques are described and illustrated. Many of these

bandages were also included in Standard First Aid when it was a lecture/demonstration course about 20 hours long. Yet in Emergency

Response,2 the American Red Cross textbook for a first responder course that supplanted Advanced First Aid in 1993, only 1 bandage is described

and shown—a simple gauze roller or elastic pressure bandage to control bleeding.

Until the last decade of the 20th century, American Red Cross courses were widely accepted as the standard for first-aid training, and they are still

among the most popular. The content and objectives of their courses are fairly representative of what was taught in first-aid courses, including both

the Standard First Aid course designed for lay people and the Advanced First Aid course (about 50 hours long) designed for professionals. Starting

in the 1980s, Standard First Aid was reduced to a 1-day course, including Adult CPR, and the first-aid content was reduced to a few hours. Most of

the bandaging and splinting techniques were dropped. And whereas Advanced First Aid remained in the course catalog until 1993, the textbook was
not revised after 1979.

This dramatic change in the content and apparent objectives of first aid courses raises several questions:

 •

Who developed the sophisticated bandaging and splinting techniques that were taught for so many years in first-aid courses?

 •

Why did lay people need to know all these techniques?

 •

Why were almost all of these techniques dropped in the 1980s and 1990s, even from the advanced (first responder) courses?

 •

Are these traditional first-aid techniques still being taught in wilderness courses?

 •

Are the traditional techniques in the old books still potentially useful for wilderness situations?
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History of first aid training

Let us begin by looking at the history of first-aid training for lay people in the United States. It probably began in 1880, when The Society for First Aid

Instruction to the Injured was formed in New York City. Medical doctors volunteered their time to teach the public, who paid a small fee to the

Society. In 1889, Dr Matthew J. Shields began teaching first aid to Pennsylvania coal miners for the Jermyn Coal Company, using a textbook that he

wrote. The first sentence began “What to do before the arrival of the doctor.” In 1903 and again in 1908, 3 the American Red Cross produced a first-

aid manual, but the program did not really get started until they hired Dr Shields as Staff Physician in 1910. He and other physicians toured the

United States in railroad cars fitted out as classrooms, teaching first-aid to the public as well as to railroad and mining employees. First-aid contests,
with medals to the winning teams, brought a lot of publicity to the program.4
By 1922, there was a Teacher's Handbook of First Aid Instruction for teaching it in schools, and first-aid stations (staffed by volunteers) were

common at large events such as fairs, track and field meets, and parades. Then in 1927, physicians began to train lay people as first-aid instructors,

which was the key to the expansion of the program. By 1933, the American Red Cross had issued 1 000 000 first-aid certificates to course graduates
and published its first standardized first-aid textbook, which was revised in 1937.5

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First aid training in the 1930s

What was in the 1937 textbook? What were the objectives, and what did instructors teach their students to do? Chapter 1, “First aid—its need and its

use,” begins with 3 accident scenarios that provide some context for the training. The first scenario is an auto accident with a mishandled spinal

injury, the second is a rattlesnake bite on a ranch, and the third is an unconscious swimmer who is not breathing when pulled out of the water. These

scenarios lead into some sobering annual accident statistics for the United States: 100 000 deaths from accidents, 365 000 total disabilities, 1 000

000 people injured in auto accidents, and 3 500 000 accidents in the home that result in some disability. Compare this with 96 000 deaths from
accidents in 1988 out of a much larger population—in 1940, the United States population was about 131 000 000.6

In this context, the objectives of the book and courses are clear—to reduce death and disability from accidents by training lay people to do first aid.

For example, there is a detailed explanation of spinal management, including the technique for straightening a bent or twisted patient (missing from

many current books), as well as securing the patient to a backboard. The book also explains how to improvise backboards from doors, shutters, or

boards. The second scenario reminds us that in the 1930s, a large percentage of the United States population still lived in rural areas, where they

were far from medical help and exposed to hazards that we now associate with wilderness activities. And even in urban areas, there was no
Emergency Medical Services (EMS) system—no way to bring urgent medical care quickly to the accident scene.

The third scenario reminds us of how common drowning accidents are. The book has a 22-page chapter on artificial respiration. This chapter

describes the different accidents that could require resuscitation, including not only drowning but also electric shock, gas poisoning, and being buried

in a cave-in (remember that the first students for these classes were miners). Artificial respiration was still done by the Prone Pressure Method
(developed by Sir Edward Sharpey Schäfer in 1903): laying the patient face down and compressing the rib cage.

About 61% of the 1937 textbook's 256 pages are devoted to injuries and how to treat them, compared with 25% of the 2000 Edition of Emergency

Response. This reflects the changing statistics on the causes of death and disability in the United States. Medical training in the 1930s focused

heavily on treating injuries, because they comprised a large part of most physicians’ practice. For example, farming caused many accidents, keeping

rural doctors busy, and safety conditions for industrial workers in the cities were generally very poor. When physicians taught first aid to lay people,
they naturally focused mostly on accidents and injuries.

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First aid training since 1993

By contrast, Emergency Response contains much more information on medical problems, especially chronic problems such as cardiovascular

disease and diabetes. It also contains sections on many topics absent from the 1937 textbook, such as psychological aspects of emergency care,

behavioral emergencies, drug abuse, legal and ethical considerations, preventing disease transmission, care of infants and children, and special
populations. Some of these topics are also absent from the 1979 Advanced First Aid textbook, which devotes 56% of its 301 pages to injuries and

how to treat them and has only a 19-page chapter on sudden illness.

The new topics and change in emphasis in the 2000 textbook reflect not only a shift in the statistics for causes of death and disability, but also an

expanded view of what constitutes an emergency and a recognition of cultural diversity. First aiders and first responders, especially in an urban

situation, often care for people who are very different from them because of age, culture, or medical conditions. They need to understand these
patients to communicate with them and do effective emergency care.

On the other hand, the omission of most of the skills for treating injuries reflects a reliance on the EMS system (which began with the Emergency

Services Act in 1973) for everything beyond the most urgent treatment. During the 1980s, higher levels of Emergency Medical Technician (EMT)

training developed, and in 1993 (when the American Red Cross Emergency Response program was released) the EMS Education and Training
Blueprint was published; it described 4 levels of training for EMS professionals:

 •

First Responder
  •

EMT Basic

 •

EMT Intermediate

 •

EMT Paramedic
Since then, the curricula for each level of training have been standardized and accepted by most states.

With this system in place, basic first-aid courses for urban situations now train people to activate EMS and take care of patients for the first few

minutes; first-responder courses train people to take care of patients for the first 15 minutes, until more advanced care arrives. But wilderness

responders still need and use many of the traditional skills that have been dropped from urban-oriented courses, so it is worth looking at some of the

old books to see which techniques have changed (and why), which techniques have been rediscovered, and whether there are more techniques in
these sources that would be useful for wilderness situations.

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Origins of modern bandaging

Where did all the bandaging techniques described in the 1937 textbook originate? Because physicians wrote the book and (until 1927) taught all the

courses, they trained students to use the same techniques that they used themselves in their medical practices, with bandages of cotton muslin,

shaped into triangles or strips, and gauze roller bandages. Because the gauze at that time was not stretchy, students had to learn techniques for

making it conform to the limb as they wrapped. As medical bandages and dressings became more sophisticated, however, first-aid courses

continued to train students in traditional bandaging techniques, because lay people were unlikely to have hospital quality equipment and might have
to improvise from whatever cloth was available.

Gwylim G. Davis’ book, The Principles and Practice of Bandaging (1902),7 was meant to train surgeons in the art. In his preface, Davis laments

“Many surgeons seem to wind [gauze bandages] aimlessly around a part without the faintest idea of order or sequence.” Instructors who have taught
bandaging will sympathize.

Among an array of elaborate bandages that only an early-20th century surgeon would use (such as the double spica bandage of the groin), we can
recognize most of the simpler techniques that were useful for first-aid and that found their way into first-aid textbooks. Let us look at these bandaging

and wound care techniques in the 1937 edition of the American Red Cross textbook, and compare them with what is in the current Emergency
Response textbook, as well as some wilderness-oriented textbooks (Figure 1, Figure 2, Figure 3).

Figure 1
Double spica bandage of the groin. Credit: Davis.7

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Figure 2
The gauntlet: a roller bandage covering the fingers and thumb. Credit: Davis. 7

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Figure 3
Spiral bandage with nonstretchy material—the half-twist helps the bandage to conform to the shape of the limb. Credit: Davis. 7

View Large Image | Download PowerPoint Slide

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Bleeding control
In the 1937 book there are 12 pages on bleeding control, starting with photos and descriptions on how to apply “digital pressure” to the ear, throat,
jaw, shoulder, arm, and leg. These are the same pressure points shown in the 1908 American National Red Cross Textbook on First Aid and Relief

Columns. Only the brachial and femoral pressure points are still taught in first aid classes. Figure 48 shows an alternate method of clamping the

brachial pressure point in the crook of the elbow with the forearm, which might still be useful. Students with small hands have trouble clamping this
pressure point with their fingers on a big arm (Figures 4 and 5).

Figure 4
Pressure points that were still taught in first-aid classes in 1937. Credit: American National Red Cross Textbook on First Aid and Relief Columns.3

View Large Image | Download PowerPoint Slide

Figure 5
Using the forearm to apply pressure to the brachial pressure point. Credit: American Red Cross First Aid Textbook. 5

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Tourniquets are described and illustrated next, before direct pressure and elevation. You have to read the text closely to find that tourniquets were

even then considered a last resort and that you should try other methods of bleeding control first. By contrast, all current textbooks direct students to

try direct pressure, elevation, and pressure points in that sequence, although these textbooks typically show only the brachial and femoral pressure
points. Advanced First Aid (1979)1 gives illustrated directions for applying a tourniquet but warns not to loosen it except on the advice of a physician

because of the danger of further bleeding and shock.Emergency Response mentions tourniquets only as a last resort and does not illustrate or give

instructions about the technique; it does not require practice of the skill for certification. Some wilderness textbooks, however, have revived the
tourniquet and give illustrated directions for its use, although they also warn of its dangers. For example, the National Ski Patrol's Outdoor

Emergency Care,8 NOLS Wilderness First Aid,9 and Eric Weiss’ Comprehensive Guide to Wilderness and Travel Medicine 10 all have illustrated

instructions on how to apply a tourniquet. Interestingly, although the 1937 book recommends loosening the tourniquet every 15 minutes to see if the

bleeding has stopped, the NOLS book and the Weiss book suggest doing that only after an hour, and the ski patrol book does not mention that
option.
Why does the 1937 book give so much attention to a technique that is now considered a last resort even in wilderness situations and is not even

taught in most urban first-aid courses? One possible explanation is the background of the physicians who taught the courses in the 1930s. Their first

students were employees of mining and railroad companies, and some of the physicians also worked for those companies. So they must have

treated many severe bleeding injuries from industrial accidents, including crushing injuries and amputations, and may have anticipated that their

students would also have to treat such injuries. In that context, it makes sense that they would want to teach students the most powerful and

effective techniques of bleeding control that they knew. Moreover, some authors clearly think that wilderness rescuers still need to know how to
apply tourniquets, in case other bleeding control methods do not work.

Another consideration is that injured people were much more likely to die in the 1930s because none of the life support techniques that we take for

granted now, at least in urban situations, were available to prevent shock. The only 3 methods for treating shock described in the 1937 book are

externally applied heat, elevating the legs, and giving stimulants if the patient can safely drink (pp. 83–90). None of these are recommended today.
So aside from controlling bleeding, shock treatment in the 1930s was probably not very effective.

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Wound cleaning then and now

For wounds that are not bleeding severely, according to the 1937 book (p. 67), “The chief duties of the first aider are to prevent more germs from

getting in and to use an antiseptic or germicide to destroy as many germs in the wound as possible.” Nobody would disagree with this statement

today, but the book does not describe any technique for cleaning wounds except recommending “benzine, naphtha, oil of turpentine, or ether” to
remove grease and oil, reminding us again that many students in these early courses were industrial workers.

Irrigation is not mentioned in the 1937 Red Cross book. The 1979 edition of Advanced First Aid also recommends cleansing, but only of superficial

wounds, by washing and rinsing, not forceful irrigation. In the 2000 edition of Emergency Response, the American Red Cross textbook for urban-

oriented first responder courses, this advice is reduced to a single line on page 248: “Cleanse the wound with soap and water.”

Some earlier books on wilderness first aid have similar advice, to wash or “gently” irrigate the wound with soap and water, for example Being Your

Own Wilderness Doctor (1972).11 The 12th Edition of Dr Darvill'sMountaineering Medicine still gave the same advice in 1989.12 But the leading

textbooks on wilderness first aid and wilderness medicine published since 1990 all recommend forceful irrigation with water, using a syringe or its

equivalent, to cleanse a wound.8., 9., 10.,13., 14., 15., 16. Most wilderness authors began recommending it in earlier editions of their books. This
recommendation reflects recognition that in a wilderness situation, forceful irrigation is the only effective way to remove wound contaminants that can

become colonization sites for bacteria, although many wilderness textbooks also mention that tweezers may be needed to remove particles that do
not flush out.

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The art of bandaging

For protecting wounds, the 1937 book describes the still familiar sterile gauze and bandage compresses (including the 1-inch bandage compresses
now sold under several brand names for covering small cuts and scrapes). To hold dressings in place, the book describes 3 kinds of bandages:

 •

Triangular (which can be folded into a narrow or broad “cravat”)

 •

Roller or pleated gauze

 •

Four-tail

Triangular bandages are still found among first-aid supplies in stores and catalogs, although the techniques of bandaging with them are seldom

taught in urban-oriented first aid or EMT courses. The 4-tail bandage (traditionally used to bandage the nose or jaw, as seen in Figure 6) is now seen
only as a battle dressing—a thick, sterile dressing with 4 long tails of nonstretchy gauze to secure the dressing anywhere on the body or limb.
Figure 6
Four-tailed bandage of the nose. Credit: American Red Cross First Aid Textbook. 5

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The rolled or “pleated” (folded) gauze of the time was sterilized and came in sealed packages. It was not elastic. According to the 1937 book (p. 57),

“This kind of bandage is extensively used by the surgeon, but, except for use on the fingers and toes, it is not a particularly good first aid bandage.

Without considerable practice and much adhesive tape, it is usually quite difficult to make it stay on. However, the first aider frequently finds it

necessary to use any material at hand and some knowledge of the roller bandage is desirable.” Eric Weiss apparently agrees with the last statement
because he explains how to make a roller bandage by cutting a T-shirt in a spiral direction on page 88 of his book. 10

The stretchy and nonsterile gauze rollers now available, however, have become the most common bandages used by urban responders because

they can easily secure a dressing to almost any part of the body, and they conform to the contours of the body or limb. They are also included in

most wilderness first aid kits. Unfortunately, the traditional techniques for bandaging with gauze rollers are not described in most current textbooks,

so students seldom learn how to do good gauze roller bandages. For urban first aiders and EMTs, good technique is not so essential because their

bandages only need to stay on for a short trip to the hospital. But wilderness first aiders and first responders need to know the traditional techniques
for applying bandages that will stay on throughout a trip or a wilderness evacuation.

For bandaging with a stretchy gauze roller, students need to learn and practice:

 •

Anchoring the bandage

 •

Unrolling the bandage in an overlapping spiral

 •

Anchoring the dressing to the bandage

 •

Tying the bandage off

A variation that applies more pressure for controlling bleeding is the figure 8 spiral, in which one alternately angles the unrolling bandage forward and

backward with each turn. For bandaging with an improvised, nonstretchy roller, students also need to know how to do the spiral reverse. Narrow

gauze rollers in the 1-inch or 2-inch width can be used to bandage injured fingers. Anchoring and tying off the bandage at the wrist makes it more
secure, especially for a patient who has to use the injured hand. Some of these techniques are shown in Wilderness Emergency Care17 and can be

viewed on the artist's web site: www.gangof1.com. Several of them are also shown in the wilderness first aid textbook published by the Wilderness
Medical Society in collaboration with the National Safety Council. 18

Triangular bandages are also very versatile. They can be folded into any desired width or used as slings for injured arms. They are especially good

for applying pressure to control bleeding, and if properly applied, they make sturdy bandages that can stay on and help protect injuries even during a
rough walkout or evacuation (Figures 7 and 8).

Figure 7
The triangular bandage has may uses. Credit: Morton B, Handbook of First Aid to the Injured, Revised Edition, 1896.
View Large Image | Download PowerPoint Slide

Figure 8
Cravat bandage of elbow. Credit: American Red Cross First Aid Textbook. 5

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Conclusion
Traditional bandaging techniques have almost disappeared from urban-oriented first aid and first responder courses, but are making a comeback in

wilderness courses. Wound cleansing technique has improved since 1937, and it is one of the most important things that a wilderness responder can

do for an injured patient. Wilderness responders (unlike urban responders) also need to apply bandages that will stay on even if the patient is active

or is being evacuated from the backcountry. They also need to be able to improvise bandages with whatever materials they have. To teach effective

bandaging for wilderness situations, instructors can adapt many techniques from old first-aid books, which were designed to train responders when
equipment was limited and there was no EMS system.

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References
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Terjemahan
Pengenalan

Selama bertahun-tahun, pertolongan pertama kursus termasuk berbagai macam perban dan splinting teknik. Dalam edisi kedua dari
buku Palang Merah Amerika, perawatan lanjutan pertolongan pertama gawat darurat & (1979), 1 misalnya, 22 perban teknik
dijelaskan dan diilustrasikan. Banyak dari ini perban juga dimasukkan dalam pertolongan pertama standar ketika kursus kuliah
demonstrasi sekitar 20 jam panjang. Namun dalam tanggap darurat, 2 buku Palang Merah Amerika pertama kursus responder
digantikan Advanced pertolongan pertama pada tahun 1993, hanya 1 perban dijelaskan dan ditampilkan — sederhana roller kasa
atau elastis tekanan perban untuk mengendalikan perdarahan.

Sampai dekade terakhir abad ke-20, kursus Palang Merah Amerika secara luas diterima sebagai standar untuk Pelatihan pertolongan
pertama, dan mereka masih berada di antara yang paling populer. Isi dan tujuan mereka kursus yang cukup mewakili apa yang
diajarkan dalam kursus pertolongan pertama, termasuk kedua standar pertolongan pertama kursus dirancang untuk orang awam
dan kursus Advanced pertolongan pertama (sekitar 50 jam panjang) dirancang untuk profesional. Mulai tahun 1980-an, standar
pertolongan pertama diturunkan menjadi pertolongan pertama kursus 1-hari, termasuk CPR dewasa, dan konten diturunkan
menjadi beberapa jam. Sebagian besar teknik perban dan belat dijatuhkan. Dan sedangkan pertolongan pertama Advanced tetap
dalam kursus Katalog hingga 1993, buku tidak direvisi setelah 1979.

Perubahan ini dramatis dalam konten dan jelas tujuan dari kursus pertolongan pertama menimbulkan beberapa pertanyaan:

• •Yang mengembangkan perban canggih dan teknik yang telah diajarkan selama bertahun-tahun di kursus pertolongan pertama
splinting?

• •Mengapa orang awam perlu tahu semua teknik ini?

• •Mengapa ada hampir semua teknik ini dijatuhkan pada 1980-an dan 1990-an, bahkan dari lanjutan (pertama responder) kursus?

• •Teknik pertolongan pertama tradisional ini masih diajarkan dalam kursus yang lebih luas?

• •Apakah teknik tradisional dalam referensi lama masih berpotensi berguna untuk situasi yang lebih luas?

Sejarah Pelatihan pertolongan pertama

Mari kita mulai dengan melihat sejarah Pelatihan pertolongan pertama bagi orang-orang awam di Amerika Serikat. Itu mungkin
dimulai pada tahun 1880, ketika masyarakat untuk diberikan instruksi pertolongan pertama untuk korban luka dibentuk di New York
City. Ada Dokter medis sukarela yang mengajar ke masyarakat, masyarakat membayar dengan biaya yang ringan. Pada tahun 1889,
Dr Matius J. Shields mulai mengajar pertolongan pertama untuk penambang batu bara Pennsylvania untuk Jermyn perusahaan
batubara, menggunakan sebuah buku yang ditulisnya. Kalimat pertama mulai "Apa yang harus dilakukan sebelum kedatangan
dokter." Pada tahun 1903 dan lagi di 1908,3 Palang Merah Amerika diproduksi pertolongan pertama manual, tetapi program itu
tidak benar-benar memulai sampai mereka menyewa Dr Shields sebagai staf dokter pada tahun 1910. Dia dan dokter lain berkeliling
Amerika Serikat di kereta api mobil dilengkapi sebagai ruang kelas, mengajar pertolongan pertama untuk umum serta kereta api dan
karyawan pertambangan. Pertolongan pertama kontes, dengan medali untuk tim menang, membawa banyak publisitas untuk
program.4

Tahun 1922, ada seorang guru membuat Handbook pertolongan pertama instruksi untuk diajarkan di sekolah-sekolah, dan
pertolongan pertama (dikelola oleh para sukarelawan) yang umum pada umumnya acara pameran, memenuhi atletik dan parade.
Kemudian pada tahun 1927, dokter mulai untuk melatih orang-orang awam sebagai instruktur pertolongan pertama, yang
merupakan kunci untuk perluasan program. Pada tahun 1933, Palang Merah Amerika telah dikeluarkan 1 000 000 sertifikat
pertolongan pertama untuk kursus lulusan dan diterbitkan dengan standar pertolongan pertama buku teks pertama, yang direvisi
dalam 1937.

Pelatihan pertolongan pertama di tahun 1930-an

Apa yang ada dalam buku 1937? Apa itu tujuan, dan apa yang instruktur mengajar siswa untuk melakukan? Bab 1, "pertolongan
pertama — kebutuhannya dan penggunaannya," dimulai dengan 3 skenario kecelakaan yang memberikan beberapa konteks untuk
pelatihan. Skenario pertama adalah kecelakaan mobil dengan mishandled cedera tulang belakang, yang kedua adalah gigitan ular
berbisa di sebuah peternakan, dan yang ketiga adalah perenang bawah sadar yang tidak bernapas ketika ditarik keluar dari air.
Skenario ini membawa ke dalam beberapa statistik kecelakaan serius tahunan untuk Amerika Serikat: 100 000 kematian akibat
kecelakaan, cacat total 365 000, 1 000 000 orang luka-luka dalam kecelakaan mobil, dan 3 500 000 kecelakaan di rumah yang
mengakibatkan beberapa cacat. Bandingkan ini dengan 96 000 kematian akibat kecelakaan pada tahun 1988 dari populasi lebih
besar banyak-pada tahun 1940, penduduk Amerika Serikat adalah sekitar 131 000 000.6

Dalam konteks ini, tujuan buku dan kursus jelas-untuk mengurangi kematian dan cacat dari kecelakaan dengan melatih orang awam
untuk melakukan pertolongan pertama. Sebagai contoh, ada penjelasan rinci mengenai manajemen tulang belakang, termasuk
teknik untuk meluruskan membungkuk atau memutar pasien (hilang dari banyak buku saat ini), serta mengamankan pasien untuk
backboard. Buku ini juga menjelaskan bagaimana untuk berimprovisasi backboards pintu, jendela atau papan. Skenario yang kedua
mengingatkan kita bahwa di tahun 1930-an, sebagian besar dari populasi Amerika Serikat masih tinggal di daerah pedesaan, dimana
mereka jauh dari bantuan medis dan terkena bahaya yang sekarang kita kaitkan dengan kegiatan gurun. Dan bahkan di daerah
perkotaan, tidak ada sistem Emergency Medical Services (EMS) — tidak ada cara untuk membawa perawatan medis mendesak
cepat ke lokasi kecelakaan.

Skenario ketiga mengingatkan kita tentang bagaimana umum tenggelam kecelakaan. Buku ini mempunyai sebuah bab 22 halaman
pada pernafasan buatan. Bab ini menjelaskan berbagai kecelakaan yang dapat memerlukan resusitasi, termasuk tidak hanya
tenggelam tetapi juga sengatan listrik, gas keracunan dan terkubur di gua-in (ingat bahwa siswa pertama untuk kelas-kelas ini adalah
penambang). Pernafasan buatan masih dilakukan dengan metode tekanan rawan (dikembangkan oleh Sir Edward Sharpey Schäfer
pada 1903): meletakkan wajah pasien dan mengompresi rusuk.

Sekitar 61% dari buku 1937 256 halaman yang dikhususkan untuk cedera dan bagaimana memperlakukan mereka, dibandingkan
dengan 25% dari edisi 2000 tanggap darurat. Hal ini mencerminkan perubahan statistik pada penyebab kematian dan cacat di
Amerika Serikat. Pelatihan medis di tahun 1930-an bertitik berat pada mengobati luka-luka, karena mereka terdiri sebagian besar
dari kebanyakan dokter praktek. Sebagai contoh, pertanian disebabkan banyak kecelakaan, menjaga pedesaan dokter sibuk, dan
keselamatan kondisi pekerja industri di kota-kota yang umumnya sangat miskin. Ketika dokter diajarkan pertolongan pertama untuk
orang awam, mereka secara alami berfokus terutama pada kecelakaan dan cedera.
Pelatihan pertolongan pertama sejak tahun 1993

Sebaliknya, tanggap darurat berisi lebih banyak informasi mengenai masalah medis, terutama masalah kronis seperti penyakit
jantung dan diabetes. Hal ini juga berisi bagian tentang banyak topik absen dari buku 1937, seperti aspek psikologis perawatan
darurat, perilaku darurat, penyalahgunaan obat, pertimbangan hukum dan etika, mencegah penularan penyakit, perawatan bayi
dan anak-anak, dan populasi khusus. Topik ini terdapat juga absen dari 1979 Advanced pertolongan pertama buku pelajaran, yang
mencurahkan 56% dari halaman 301 untuk cedera dan bagaimana memperlakukan mereka dan hanya sebuah bab 19-halaman pada
sakit mendadak.

Tidak hanya pergeseran dalam statistik untuk penyebab kematian dan Cacat mencerminkan topik baru dan perubahan dalam
penekanan dari 2000 buku, tetapi juga expanded Lihat apa yang merupakan keadaan darurat dan pengakuan dari keragaman
budaya. Pertama aiders dan koor, terutama dalam situasi perkotaan, sering perawatan untuk orang-orang yang sangat berbeda dari
mereka karena usia, budaya, atau kondisi medis. Mereka perlu memahami pasien untuk berkomunikasi dengan mereka dan
melakukan perawatan darurat yang efektif.

Di sisi lain, kelalaian dari sebagian besar keterampilan untuk mengobati cedera mencerminkan ketergantungan pada sistem EMS
(yang dimulai dengan undang-undang layanan darurat pada tahun 1973) untuk segalanya luar pengobatan paling mendesak. Selama
1980-an, tingkat yang lebih tinggi teknisi medis darurat (EMT) pelatihan dan dikembangkan dan pada tahun 1993 (Kapan program
tanggap darurat Palang Merah Amerika adalah dirilis) EMS pendidikan dan pelatihan Blueprint diterbitkan; ini menggambarkan 4
tingkat pelatihan untuk EMS profesional:

••

Responder pertama

••

Dasar EMT

••

EMT Intermediate

••

Paramedis EMT

Sejak itu, kurikulum untuk setiap tingkat pelatihan telah standar dan diterima oleh sebagian besar negara.

Dengan sistem ini di tempat, kursus pertolongan pertama dasar untuk perkotaan situasi sekarang melatih orang untuk mengaktifkan
EMS dan merawat pasien selama beberapa menit pertama; pertama-responder kursus melatih orang untuk merawat pasien untuk
15 menit pertama, sampai tiba perawatan yang lebih maju. Tapi responder yang lebih banyak masih membutuhkan dan
menggunakan banyak keahlian tradisional yang telah dijatuhkan dari kursus berorientasi perkotaan, sehingga layak melihat
beberapa buku lama untuk melihat teknik yang telah berubah (dan mengapa), teknik yang telah ditemukan, dan Apakah ada
sumber-sumber lain teknik ini yang akan berguna untuk situasi yang lebih luas

Asal-usul perban modern

Dimana semua teknik bandaging yang dijelaskan dalam buku ini 1937 berasal? Karena dokter menulis buku dan (sampai 1927)
mengajar semua kursus, mereka melatih siswa untuk menggunakan teknik yang sama yang mereka gunakan sendiri dalam praktik
medis mereka, dengan perban kapas kain kasa, berbentuk segitiga atau strip, dan kasa roller perban. Karena kain kasa pada waktu
itu tidak elastis, siswa harus belajar teknik untuk membuat itu sesuai dengan ekstremitas ketika mereka dibungkus. Seperti perban
medis dan dressing menjadi lebih canggih, namun, pertolongan pertama kursus terus melatih siswa tradisional perban teknik,
karena orang awam cenderung memiliki peralatan kualitas rumah sakit dan mungkin harus berimprovisasi dari kain apapun yang
tersedia.

Gwylim G. Davis' buku, The prinsip-prinsip dan praktek dari perban (1902), 7 dimaksudkan untuk melatih ahli bedah dalam seni. Di
kata pengantarnya, Davis menyesalkan "banyak ahli bedah tampaknya angin [kain kasa perban] tanpa tujuan di sekitar bagian tanpa
sama dari perintah atau urutan." Instruktur yang telah mengajarkan perban akan bersimpati.

Di antara array yang rumit perban yang hanya awal-20 abad ahli bedah akan menggunakan (seperti perban kelas spica ganda
pangkal paha), kita dapat mengenali sebagian besar teknik sederhana yang berguna untuk pertolongan pertama dan yang
menemukan cara mereka ke dalam buku-buku pelajaran pertolongan pertama. Mari kita melihat ini perban luka teknik perawatan di
edisi 1937 buku Palang Merah Amerika dan membandingkan mereka dengan apa yang ada di buku tanggap darurat saat ini, serta
beberapa buku yang berorientasi lebih luas

Mengontrol Perdarahan

Di buku 1937 ada 12 halaman pada kontrol perdarahan, mulai dengan foto dan deskripsi tentang bagaimana menerapkan "digital
tekanan" telinga, tenggorokan, rahang, bahu, lengan, dan kaki. Ini adalah titik-titik tekanan sama ditunjukkan pada 1908 American
National Palang Merah buku teks tentang pertolongan pertama dan bantuan kolom. Hanya brakialis dan femoralis tekanan poin ini
masih diajarkan di kelas-kelas pertolongan pertama. Angka 48 menunjukkan metode alternatif jepit titik tekanan brakialis di crook
siku dengan lengan, yang masih mungkin berguna. Siswa dengan tangan kecil kesulitan menjepit tekanan titik ini dengan jari-jari
mereka pada lengan besar

Tourniquets dijelaskan dan diilustrasikan berikutnya, sebelum tekanan langsung dan elevasi. Anda harus membaca teks untuk
menemukan bahwa tourniquets bahkan kemudian dianggap jalan terakhir dan bahwa Anda harus mencoba metode lain kontrol
perdarahan pertama. Sebaliknya, Semua saat ini buku langsung siswa untuk mencoba tekanan langsung, ketinggian, dan titik-titik
tekanan dalam urutan itu, walaupun buku ini biasanya menunjukkan hanya brakialis dan femoralis tekanan poin. Maju pertolongan
pertama (1979) 1 memberikan ilustrasi petunjuk untuk menerapkan tourniquet tetapi memperingatkan tidak untuk melonggarkan
itu kecuali atas saran dari dokter karena bahaya lebih lanjut perdarahan dan shock. Tanggap darurat menyebutkan tourniquets
hanya sebagai terakhir resor dan tidak menggambarkan atau memberikan petunjuk tentang teknik; tidak memerlukan praktek
keterampilan untuk sertifikasi. Beberapa buku lainya, bagaimanapun, telah menghidupkan kembali tourniquet dan memberikan
ilustrasi petunjuk untuk penggunaannya, meskipun mereka juga memperingatkan dari bahaya. Misalnya, perawatan dalam keadaan
darurat nasional patroli Ski Outdoor, 8 NOLS gurun pertolongan pertama, 9 dan Eric Weiss' Panduan komprehensif untuk gurun dan
Medicine10 perjalanan telah diilustrasikan instruksi tentang bagaimana menerapkan tourniquet. Menariknya, meskipun buku 1937
merekomendasikan melonggarkan tourniquet setiap 15 menit melihat jika perdarahan sudah berhenti, NOLS buku dan buku Weiss
menyarankan melakukan itu hanya setelah satu jam, dan buku ajar tidak menyebutkan pilihan itu.

Kenapa referensi 1937 memberikan begitu banyak perhatian ke teknik yang sekarang dianggap sebagai pilihan terakhir bahkan
dalam situasi gurun dan tidak bahkan diajarkan dalam kursus-kursus pertolongan pertama yang paling perkotaan? Satu penjelasan
yang mungkin adalah latar belakang dokter yang mengajar kursus di tahun 1930-an. Siswa pertama mereka adalah karyawan
pertambangan dan perusahaan kereta api, dan beberapa dokter juga bekerja untuk perusahaan-perusahaan. Jadi mereka harus
diperlakukan banyak cedera pendarahan parah dari kecelakaan industri, termasuk menghancurkan cedera dan amputasi, dan
mungkin telah diantisipasi bahwa murid-murid mereka juga harus mengobati luka-luka tersebut. Dalam konteks itu, masuk akal
bahwa mereka ingin mengajar siswa yang paling kuat dan efektif teknik perdarahan kontrol yang mereka tahu. Selain itu, beberapa
penulis jelas berpikir bahwa gurun penyelamat masih perlu untuk mengetahui bagaimana untuk menerapkan tourniquets, dalam
kasus lain metode pengendalian perdarahan tidak bekerja.

Pertimbangan lain adalah bahwa orang-orang yang terluka lebih cenderung meninggal di tahun 1930-an karena tidak ada teknik
dukungan kehidupan yang kita ambil diberikan sekarang, setidaknya dalam situasi perkotaan, yang tersedia untuk mencegah syok.
Hanya 3 metode untuk mengobati kejutan yang dijelaskan dalam buku 1937 eksternal diterapkan panas, mengangkat kaki, dan
memberikan stimulan jika pasien dapat dengan aman minum (ms. 83-90). Hal ini disarankan hari ini. Jadi selain mengendalikan
perdarahan, terapi kejut di tahun 1930-an adalah mungkin tidak sangat efektif.

Luka pembersihan dulu dan sekarang

Untuk luka yang yang tidak mengalami pendarahan yang parah, menurut buku 1937 (ms. 67), "tugas-tugas pertolongan pertama
adalah untuk mencegah lebih kuman masuk dan menggunakan antiseptik atau germicide untuk menghancurkan sebanyak kuman di
luka mungkin." Tak seorang pun akan tidak setuju dengan pernyataan ini hari ini, tapi buku tidak menggambarkan teknik apapun
untuk membersihkan luka kecuali merekomendasikan "benzine, NAFTA, minyak terpenten atau eter" untuk menghilangkan lemak
dan minyak, mengingatkan kita lagi bahwa banyak siswa di ini awal kursus adalah pekerja industri.

Irigasi tidak disebutkan dalam kitab Palang Merah 1937. Edisi pada tahun 1979 dari Advanced pertolongan pertama juga
merekomendasikan pembersihan, tetapi hanya luka-luka yang dangkal, oleh cuci dan pembilasan, tidak kuat irigasi. Dalam edisi
2000 tanggap darurat, buku Palang Merah Amerika yang berorientasi perkotaan pertama responder program, saran ini dikurangi
menjadi satu baris pada halaman 248: "Membersihkan luka dengan sabun dan air."

Beberapa buku sebelumnya tentang pertolongan pertama lebih luas punya saran serupa, untuk mencuci atau "lembut" mengairi
luka dengan sabun dan air, contoh yang Anda sendiri gurun dokter (1972).11 12 edisi Dr Darvill'sMountaineering Kedokteran masih
memberikan nasihat yang sama dalam 1989.12 tapi buku terkemuka di gurun pertolongan pertama dan obat-obatan gurun yang
diterbitkan sejak 1990 semua merekomendasikan kuat irigasi dengan air, menggunakan jarum suntik atau yang setara, untuk
membersihkan luka. Penulis lain mulai merekomendasikan itu di edisi-edisi sebelumnya buku-buku mereka. Rekomendasi ini
mencerminkan pengakuan bahwa dalam situasi lain, irigasi yang kuat adalah cara hanya efektif untuk menghilangkan kontaminan
luka yang dapat menjadi kolonisasi situs untuk bakteri, meskipun banyak gurun buku juga menyebutkan bahwa pinset mungkin
diperlukan untuk menghilangkan partikel-partikel yang tidak terbilas.

Seni perban

Untuk melindungi luka, 1937 buku ini menjelaskan masih akrab Steril Kasa dan perban kompres (termasuk kompres 1 inci perban
yang sekarang dijual di bawah nama merek beberapa untuk menutupi kecil luka dan goresan). Untuk menahan dressing di tempat,
buku ini menjelaskan 3 macam perban:

• •Segitiga (yang dapat dilipat menjadi sempit atau luas "cravat")

• •Roller atau kain kasa lipit

• •four-tailed
perban Segitiga masih ditemukan antara perlengkapan pertolongan pertama di toko dan Katalog, meskipun teknik-teknik perban
dengan mereka jarang diajarkan di perkotaan yang berorientasi pertolongan pertama atau kursus EMT. Perban 4-ekor (secara
tradisional digunakan untuk perban hidung atau rahang, seperti yang terlihat pada gambar 6) sekarang dianggap hanya sebagai
dressing pertempuran — tebal, steril dressing dengan 4 ekor panjang dari kasa yg tidak melar untuk mengamankan luka di mana
saja pada tubuh atau ekstremitas.