An investigation of current pressure bandage methods for snake bite.

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We think that the bandaging people put in place when someone is bitten by a snake is not stopping that person getting sick. We want to test if this is because of the bandages we use not being very good, or if the first aid is just difficult to put in place correctly. We will test different materials and a different way of bandaging. We know that the bandages need to be tight, but not too tight and we can measure the pressure inside the bandage to see if they are likely to help someone who has been bitten. We can use the measurments we get to judge which method and/or material is easiest to use. Experimentally first aid has been recommended with certain pressures corresponding to the different techniques. For the pressure immobilization method this corresponds to 40-70 mmHg in the upper limb and 55-70mmHg in the lower limb. In the Monash method, pressures greater than 70mmHg were found to be neccessary on all limbs. We believe that if these pressures cannot be achieved then neither can effective bandaging. 1/ We will first do a pilot study on mannequin's and ourselves to work out the standard deviation and spread of the variance between typical bandage applications. This initial study will also allow us to decide what material we would like to compare to crepe (eg. thicker crepe, elastic compression bandage, pantihose). 2/ We will then conduct a study to find out the spread of pressures generated by five separate subpopulations. a. Emergency nursing staff (4 to 6 people) putting a bandage on 6 times each on a leg and arm. b. Ambulance officers (4 to 6 people) putting a bandage on 6 times each on a leg and arm. c. Doctors (4 to 6 people) putting a bandage on 6 times each on a leg and arm. d. Snake handlers (4 to 6 people) putting a bandage on 6 times each on a leg and arm. e. General public (4 to 6 people) putting a bandage on 6 times each on a leg and arm. This group to have never put on a bandage before. 3/ Then once we have calculated the variance within an individual, within groups and between groups and can calculate a sample size we will compare materials in a randomised study. We will test our preferred material against crepe with the help of volunteers who will bandage alternate lower limbs on the same subject with each material, eg. left crepe and right gold standard. 4/ The other trial will compare pressure immobilization to the new Monash method. We will ask health professionals to perform the first aid in the same way as we compared materials. We will measure all pressures to ascertain which is more often correctly applied. 5/ In a small subset of volunteers we will ask them to keep the bandages on for longer while stationary or travelling and will compare the changes in pressure between these two groups. We aim to find out if a better material could be used, or if there is a technique that is easier to put in place, or if extra training improves the application of the current first aid technique.

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