The ‘3Ps’ of Wound Care: Positioning and Pressure

Three P’s of Wound Care?

Yes, OK – so that’s only 2 ‘P’s’ but read on…. You’ll see why it’s also the 3P’s of Wound Care. Now before we get in to the body of this post, please note that the 3P’s of Wound Care are not the same as the 3P’s of First Aid – I guess ‘3P’s’ are just easy to remember. Make sure you’re reading the post you want (or read both!).

Next, the following applies to wound care in the first aid setting, and is specifically relevant to the OFA1 (WCB, WEFA, Workplace, etc.) course as well as other courses. If you have more advanced Wound Care training, great. Allow this to serve as a refresher of the absolute basics. If wound care is new to you – read on. Here’s a simple way to master the basics in less than 1,500 words.

2 Crossed adhesive dressings

Current First Aid Treatments for basic wound management

These can be remembered by thinking of the 3P’s – the 3 P’s for wound care are:

  • Position the patient
  • Position the limb/injury
  • Apply Pressure

A simple example would be:

Have the patient sit down (preferably on the floor) with their bleeding hand elevated and bandage it appropriately.

When to use the 3P’s of Wound Care

The 3P’s are used for major bleeding. This is the kind of wound that needs rapid bandaging before being dealt with by advanced care practitioners (your EMS, nurses, medics, etc. as appropriate to your location). The kind of bleeding where, if you don’t sit the casualty down, they’re going to collapse anyway. The kind of injury that needs stitches or surgery.

When not to use the 3P’s

If the wound obviously needs an adhesive dressing (Band-Aid or Plaster) then the treatment is….. Apply one! After first checking to make sure they aren’t allergic to the product in your kit. You don’t need the principles below for a paper cut.

Taking each of the (wound care) 3P’s in turn

Position the patient

Lay the patient down

Lie them down before they collapse!

They need to be positioned for 2 major reasons:

1. They need to be at rest. By ‘resting’ the heart rate is reduced, and so the rate of blood loss is reduced. This is because less blood is being pumped all over the floor! Keeping the red stuff inside the patient and circulating is one of the primary aims of first aid.

2. The loss of blood is likely to lead to shock, and ultimately fainting or collapse (or both). Your aim is to have your treatments completed before they become unconscious from blood loss, still have them sit/lie down as appropriate before the end up on the floor without your help. Helping them gently to the floor while they can still help themselves is preferable to waiting for them to collapse on top of you.

Position the Limb

The bit that is bleeding needs elevating (lifting up in the air).

The idea is that gravity reduces blood flow to the wound, and so blood loss is slowed down. The problem with this is…. Well, it’s not always very effective. If there is a serious (arterial) bleed, the blood is actively being pumped out by the heart. Elevating the wound just gives the heart more work to do.

That said, it might be better than nothing. Depending on the level of training you have had, you’ll have been taught to elevate, or not. Go with what you were taught. If you’ve not been to a class yet, either book yourself on to our next course, or contact your local branch of the Red Cross for a course in your area. There are different concepts around elevating the limb, depending on your level of training. Pressure is much more important (and is your primary treatment).

Of course, if it’s not a simple hand/foot injury, then positioning becomes more difficult. In this case you really will benefit from a course to learn all the details. For example an unconscious person with injury to the ribs, causing injury to the lungs should be positioned with the affected side down.

If the area that’s cut also has other injuries eg: a broken bone, then it shouldn’t be elevated. Same applies if elevating it causes more injury and/or more pain.

PressurePressure dressing

The last ‘P’ is to apply pressure to the injury to prevent blood loss. This really could be pressure from anything, but the best treatment is bandaging. There are all kinds of bandages that can be applied in different ways. It will depend on the injured area, extent of injury, and what you have available to you when treating the person.

Before you apply any pressure, look at the wound. Do not apply direct pressure over an injury that has something (glass, metal, etc.) still stuck in it. You risk making the injury worse.

The general idea is to use something that won’t stick to the wound, that won’t leave bits of itself in the wound (like eg: ‘cotton balls’ would do) and that is sterile. This should be the first layer in contact with the wound. You might then want a second layer to soak up blood coming through. Then you need pressure to stop the blood flow and pretty much anything goes! Crepe (or ‘tensor’) bandages are often best, but it will depend on what you have available.

No tourniquet

Although ‘anything goes’ – this doesn’t. (Unless you’ve had different and very specific training). The problem with tourniquets is that they get left in place and forgotten. They cut off circulation to the whole arm/leg so that gangrene may set in and more damage is done to the casualty. If you need to, use indirect pressure (pressure on the artery leading to the injury) to reduce blood flow.

Don’t clean it

Let the hospital do that. When you’re on a course and we deal with minor wound care, we discuss different ways of treating small cuts & scrapes. On the OFA1 course you even get a hand out detailing the signs of infection so you know what to watch for. With the type of major wound we’re talking about here, you won’t have time to clean it (blood loss is too fast) and it won’t really benefit you or the person anyway. The priority is to get the wound bandaged under pressure as quickly as you can.

Pressure Dressing

OK, we said 'anything goes' and 'don't clean it', but really.....?

What comes after the 3 P’s?

There are many considerations, but you need to have in mind: transportation and shock treatment.

With bleeding this severe, the person needs transporting to hospital. Hopefully it’s as simple as phoning the ambulance service and having them collected, but your situation may vary.

Do not allow them to transport themselves – the risk of collapse due to blood loss is too great and it would be unsafe.

Similarly don’t transport them on your own (unless you really have no choice!) for the same reasons. You may be in a hurry to get help, but if they collapse in the back of your vehicle, then what? Keep going to get help faster? Stop to try to deal with them? What if they’re at a point where they need CPR? Better to just not put yourself in that situation.

Shock is a whole other topic, for another day!

About Tony Howarth

Tony is a First Aid & CPR Instructor Trainer with Sea 2 Sky Safety Training Services and the company founder. Tony started with the British Red Cross in 1994. Has acted as first aid attendant for hundreds of events & treated many hundreds of people as a result. He is experienced in training a wide range of courses. He previously worked as an ambulance attendant with the British Red Cross. He is now in BC as a first aid instructor, and an instructor trainer (one who trains others to become instructors) Finally, Tony works at UBC Hospital as a pharmacist when not busy training safety
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3 Responses to The ‘3Ps’ of Wound Care: Positioning and Pressure

  1. Pingback: 4 B’s of First Aid: – How to prioritize care | Safety un-Limited

  2. Pingback: Toddlers’ Preventable Injuries (#2 Your stairs) | Safety un-Limited

  3. Really is too useful and assist course what we need it.

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