Bushwalk Australia

Mongoose wrote:In regards to snake bite bandages I carry two of these:
https://www.chemistwarehouse.com.au/buy ... cm-x-10-5m

I hope they are specifically designed to apply the correct pressure and not just a repackaged bandage, the indicator would be useless if so.

The manufacturer does not specify a compression pressure and this article from the adelaide bushwalkers is highly sceptical (rightly on my opinion):
https://www.google.com/url?sa=t&source= ... 6597065350

This article was written by a researcher on snake bite treatnent. He doesnt provide any links to his assertions but as he rightly states doing something is better than nothing and the research on envenomation treatment is not necessarily cut and dry anyway.
I am happy to do some research on it but,as always, I suggest a first aid course with a reputable provider to learn how to estimate the correct pressure without rwlying on visual cues that have no reliable or published clinical research to establish their effectiveness.
The bandage might be a completely accurate way to get the right pressure but there is no way of telling. I am not sure if this has to go through the TGA or not.
In my oponion or is probably a great elastic bandage for treating snakebite but the squares might not be an accurate indicator at all.

Apologies for typos: fat fingers small phone spellcheck turned off.

Thanks splarker.
This logically addresses some of the obvious concerns.
I find in the first aid directions that they recommend you should not be able to put, get, a finger easily between the bandage and the skin if it is correct for tautness, that seems at least something to work with.
Also that trainees only seemed to apply the correct pressure soon after training then over time began doing them too loose or not sufficiently taut.

Having just done a first aid course courtesy of ParkCare the instructor used bandages with indicators. My thoughts are that even if the indicators are designed for a slightly lower pressure than optimal, at least they give an easily understood and relatively accurate method of gauging the pressure; far better than no indicator. I expect most of us would be hard pressed to reliably apply the bandage at a suitable pressure six months after training without some form of indicator. If the pressure is a little low then that will still restrict the flow of venom and the body will be better able to cope. Many thanks to slparker for trying to clarify the situation which will allow us to achieve an optimal solution but until then I will happily use an indicator type bandage. With better knowledge of the optimal pressure it will be easier to adjust ones application technique to achieve a better outcome with the indicator being stretched a bit beyond square.

Yes Mark, I will go and get a couple of indicator bandages and trial the set up and 'just beyond', being mindful of the tautness required, and I will practise until I can get into a FA refresher.
Did you find it was the 'set o press' that seemed to give you the desired tautness 'just beyond square'?
Given there seem to be several, just looking for a starting point-will trial, as I said for myself.
I will try and put up the pic of the Tiger that struck at my left calf.

I am only just graduating to an indicator bandage. Until now I have only had the old stretchy crepe bandages and only ever used them on sprains. Having read the SA bushwalker's article it seems that the whole issue of "correct" pressure is rather clouded. It sounds as if the increasing size of limb (forearm, calf, thigh) requires increasing pressure so the squares are not going to work as they indicate a specific pressure and the supposed "correct" pressure was determined by experiment on very small monkeys rather than human sized limbs and they vary enormously. As the article concludes - any pressure is likely better than none.

Setopress bandages, and any other elastic bandages, make great snakebite bandages, whether you use the squares or not.
The bandages are designed for compression of the lower limbs, so (theoretically) applying them to a snakebite on the leg at a tension just greater than the squares indicate would give you a compression tjat is closer to the recommended pressure and possibly better that attained by skill decay 6 months after a first aid course.

I cannot recommend this as a guide because it is pretty hit and miss but it is obviously going to give you more compressive force than just attaining the square on the setopress.

If nothing else, the square gives you a guide on what is too little pressure which is still pretty useful as most first aid practitioners underestimate the tigjtness required.

As Mark F has suggested the recommended pressure was described as clouded but i seem to recall recent studies establishing a reasonable figure of pressure to inhibit lymphatic drainage. This is a well studied field in physiology, despite what the article suggests.

"The bandage
should be firm and tight, you should be
unable to easily slide a finger between the
bandage and the skin." ENVENOMATION - PRESSURE IMMOBILISATION TECHNIQUE --In splarker's article.

It was this aspect of PIT stated in the article linked by splarker that I was referring in my comment above. The possibility of using it as a starting point and perhaps using the squares ('beyond the square' or whatever is required based on some trial/practise to get an understanding) to help determine something like this level of tautness, referred to above.
PIT does not suggest using a 'brand' of elasticated bandage (I don't believe) just that an elasticated bandage would be best.
The quote above from the technique doesn't suggest changing the pressure depending on the part of the body (I don't believe) -it seems to be a broad standard when you use this particular method. Whether it is the best method, I don't know?
But this sounds like a good 'reasonable starting point' and something which can be practised. The squares should/might just make it that bit easier, especially if you have to apply the bandage to yourself.
I suppose you need some human volunteers and all the first aiders to be applying first aid identically on a good sized sample. Minimising potential extraneous variables and the likliehood of confounding variables referred to-can't see it happening.

Lamont wrote:"The bandage
should be firm and tight, you should be unable to easily slide a finger between the
bandage and the skin." ENVENOMATION - PRESSURE IMMOBILISATION TECHNIQUE --In splarker's article.

It was this aspect of PIT stated in the article linked by splarker that I was referring in my comment above. The possibility of using it as a starting point and perhaps using the squares ('beyond the square' or whatever is required based on some trial/practise to get an understanding) to help determine something like this level of tautness, referred to above.

Everything is very subjective in these articles. How big is your little finger and what is 'easily' ??? Until there is quality research that gives a range of bandage tension then there can be no criticism of the applied bandages - as there is no standard to comply with.

And then there is if the start is at the top or the bottom of the limb. Or start at the snake bite and go up or down and then finish the rest of the limb either start or finish at the snake bite. Lots of variations there.

At the moment there is no definitive answer as there are possible problems what ever way you go. Possibly the correct answer will depend on the patient (age, fitness) and time between snake bite and treatment.

But it is best to do something rather than nothing - so go with what suits

Personally - I'd go a little beyond the square and start at, or a bit below the snake bite and go up the limb.
How many practice their first aid at least every 6 months?

Great discussion and thanks again slparker for the information.

For my setopress Ive decided I'l be using slightly more pressure than is indicated by the brown square (the strongest setting).

Id be keen to hear more about bandaging technique. Logic says start at the bite and work upwards towards the heart. But what if the bite is mid thigh? Start at the bite and go up and then all the way back down to the foot? Would that double bandage = twice the amount of pressure?

If i start below the bite am i not squeezing toxin upwards?

I can even see logic in starting at the top of the limb and working downwards even if the bite was in the calf. (to keep toxin in the effected limb)

EDIT. Just browsing some first aid sites.

- St Johns Australia https://stjohn.org.au/assets/uploads/fa ... kebite.pdf. This concerned me..

Apply the bandage as tightly as possible to the limb

So essentially a tournique? Be unfortunuate enough to have someone very strong follow that advice and your likely to have your leg amputated

- St John NSW - https://www.stjohnnsw.com.au/secure/dow ... id=1004638

apply tightly without stopping blood supply to the limb ;
DO NOT use a tournique

Two branches of the same organisation cant event agree on the advice!

They both agree that you need two bandages though.. one small length for the bite site and then another long length starting from the bottom of the limb(fingers/foot) and working upwards. So seems I will need to buy myself an extra setopress and then reduce its length so it works for the small (site only) bandage.

wildwanderer wrote: you need two bandages though.. one small length for the bite site and then another long length starting from the bottom of the limb(fingers/foot) and working upwards. So seems I will need to buy myself an extra setopress and then reduce its length so it works for the small (site only) bandage.

The smaller one can be a crepe bandage (or a bit of their shirt from their backpack).. I was advised to put a pad between it and the wound.

I was also advise to mark the site of the wound - 2 dots representing a snake be seemed the best, and a time as to when the bite occurred (best estimate). Both marked on the outside of the bandage.

wildwanderer wrote:Great discussion and thanks again slparker for the information.

For my setopress Ive decided I'l be using slightly more pressure than is indicated by the brown square (the strongest setting).

Id be keen to hear more about bandaging technique. Logic says start at the bite and work upwards towards the heart. But what if the bite is mid thigh? Start at the bite and go up and then all the way back down to the foot? Would that double bandage = twice the amount of pressure?

If i start below the bite am i not squeezing toxin upwards?

I can even see logic in starting at the top of the limb and working downwards even if the bite was in the calf. (to keep toxin in the effected limb) .......

I was taught on different first aid courses that bandaging starts at the end of the limb and moves toward the body. This prevents fluids being forced into the extremities where they can cause pain, swelling and possible tissue damage.

With short fangs or a scrape wound as per Aussie snakes, the venom may seep in and disperse in any direction under the skin.
Wraping around the wound site (with a shorter bandage) then wrapping the whole limb with a long compression bandage seems to be the common method. From the end/extremity in.

Yes, two bandages for a adult limb like a leg. The darker tan coloured ones are OK.

My mini kit is kinda split and I have a larger group FAK too. Need to check I'm carrying two good bandages at any time! Other main useful bits are bandaids, alcohol swabs or teatree oil, tweezers and a mirror incase of something in the eye.

Other multiuse items onboard that may help with first aid are water, knife & stone, stove, buff, food, phone, now a PLB, UL puffy etc. It's all for comfort and survival

slparker wrote: [edit]
AVRU at Monash UNi recommend the setopress bandage (i.e. as an elastic bandage) but do not recommend using the coloured squares but do restate the correct pressure required to limit lymphatic fluid (and thus venom) movement.
https://biomedicalsciences.unimelb.edu. ... G_AVRU.pdf
When I get back to work I will contact them and clarify their position on the setopress.

Conclusion: There is nothing wrong with the setopress bandage it is an excellent snakebite bandage but using the coloured squares as a guide does not develop the pressure required to limit envenomation in treating a snakebite on the legs.

Thank you, slparker, for the extra information in this post and subsequent ones on this issue.

Getting out my Setopress bandage for another practice session, I see that the brief instruction sheet suggests that, when used on a leg, it should reach from the foot to just below the knee. The AVRU link suggests enveloping the whole limb. The Setopress seems to be of sufficient length to get to the top of the leg at the required tightness (whatever that may turn out to be), so I guess I'd use that approach, unless otherwise advised.

At only 100 wide the bandage is a little narrow for bigger legs so I have to assume it is the extra length that makes it work. So what is the difference between the Setopress and the AeroForm Snake Bite Bandage?
Apart from cost that is.
What do you do with all the excess bandage when using the Setopress on a small child? Keep wrapping and use all of it?

peregrinator wrote:

slparker wrote: [edit]
AVRU at Monash UNi recommend the setopress bandage (i.e. as an elastic bandage) but do not recommend using the coloured squares but do restate the correct pressure required to limit lymphatic fluid (and thus venom) movement.
https://biomedicalsciences.unimelb.edu. ... G_AVRU.pdf
When I get back to work I will contact them and clarify their position on the setopress.

Conclusion: There is nothing wrong with the setopress bandage it is an excellent snakebite bandage but using the coloured squares as a guide does not develop the pressure required to limit envenomation in treating a snakebite on the legs.

Thank you, slparker, for the extra information in this post and subsequent ones on this issue.

Getting out my Setopress bandage for another practice session, I see that the brief instruction sheet suggests that, when used on a leg, it should reach from the foot to just below the knee. The AVRU link suggests enveloping the whole limb. The Setopress seems to be of sufficient length to get to the top of the leg at the required tightness (whatever that may turn out to be), so I guess I'd use that approach, unless otherwise advised.

The instructions on the setopress relate to its intended purpose - venous ulcers on the lower leg. Just follow the PIT method using the setopress as an elastic bandage for the entire leg. I recommend exceeding the tension suggested by the setopress for the reasons outlined above.

Moondog55 wrote:At only 100 wide the bandage is a little narrow for bigger legs so I have to assume it is the extra length that makes it work. So what is the difference between the Setopress and the AeroForm Snake Bite Bandage?
Apart from cost that is.
What do you do with all the excess bandage when using the Setopress on a small child? Keep wrapping and use all of it?

It doesnt matter what you do with the excess - you can tie it off or cut it or keep wrapping back down the limb.

The important point is to compress the limb with sufficient pressure and immobilise the limb with a splint and immobilise the casualty under shelter.

wildwanderer wrote:Great discussion and thanks again slparker for the information.

For my setopress Ive decided I'l be using slightly more pressure than is indicated by the brown square (the strongest setting).



Id be keen to hear more about bandaging technique. Logic says start at the bite and work upwards towards the heart. But what if the bite is mid thigh? Start at the bite and go up and then all the way back down to the foot? Would that double bandage = twice the amount of pressure?

If i start below the bite am i not squeezing toxin upwards?

I can even see logic in starting at the top of the limb and working downwards even if the bite was in the calf. (to keep toxin in the effected limb)

EDIT. Just browsing some first aid sites.

- St Johns Australia https://stjohn.org.au/assets/uploads/fa ... kebite.pdf. This concerned me..

Apply the bandage as tightly as possible to the limb

So essentially a tournique? Be unfortunuate enough to have someone very strong follow that advice and your likely to have your leg amputated

- St John NSW - https://www.stjohnnsw.com.au/secure/dow ... id=1004638

apply tightly without stopping blood supply to the limb ;
DO NOT use a tournique

Two branches of the same organisation cant event agree on the advice!

They both agree that you need two bandages though.. one small length for the bite site and then another long length starting from the bottom of the limb(fingers/foot) and working upwards. So seems I will need to buy myself an extra setopress and then reduce its length so it works for the small (site only) bandage.

The Australian Resuscitation Council recommends using one bandage over the bite site for immediate compression and venom stasis and then another one extending from the base of the toes or fingers upwards to the groin or armpit.

I carry a coban bandage for general use in my FA kit they are really lightweight and compressive and also a heavier wider bandage like a setopress for snakebite if I feel that the risk is there.

If i am leading a walk or am a nominated first aider for a group i will carry a couple of 15 cm wide elastic bandages for large limbs or for if a snake bit someone on more than one leg (always check the other leg on a snakebite casualty).

You could improvise with, say, a buff/thermals etc cut and wound tight over the bite site and tjen use your setopress over the limb as recommended. But using two bandages is easier if you have them.

Remember that snakebites are uncommon and bandages are heavy and bulky. Its tempting to 'just in case' your way to a 5 kg first aid kit but most FA kits can be very minimal depending on your individual risk assessment of the walk.

Thanks slparker. Gold mine of information

Agree that one can go overboard with a FA kit (and most gear). Im fairly good, I mainly include drugs, some tape, a snake bite bandage packaged in a ziploc and thats it. Now I will include with the main bandage a chopped second one (should be about 15% bulk/weight of the main).

Went all the way to a Chemist Warehouse, got some tapes and completely forgot to pick up some extra bandages! Doh!

Ordered two Setopress yesterday at 3pm, arrived this morning at 10.30!! Country Victoria to country Victoria.
$32.50 plus $5.50 post.
https://www.firstaiddistributions.com.a ... 0cm-x-3-5m
Following The Australian Venom Research Unit at Melb. Uni's Department of Pharmacology and Therapeutics Advice for snake bite in Australia and PNG, I will be bandaging the limb from "the toes(hand) regardless of where on the limb the bite has occurred, commence just above the toes (fingertips) over the entire limb using two bandages if necessary".
I want everything I might need, to hand, in one place.
Splint, call phone/Inreach and hope for the best-probably never see a snake again.
Hope not, beautiful animals unless they are trying to fang your calf.

Tip to hip, thanks for the chip

I travel with S2S Quagmire gaiters so my plan is a single compression bandage, hit the button on the PLB and then jury rig the gaiter with some cord.

Good luck Lamont with not bumping into another snake. I'm 100kg+ so the earth shakes when when I'm coming down the track and I still catch them unawares. Funny though watching them freak out and doing the runner, or should I say high speed slither.

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