Page 18 - JSOM Winter 2025

Plastic Packaging Wrap for Patient Packaging

Patrick Thompson, MSc *; Anthony Hudson, MBBS, MA ;
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Timothy J. Irvine-Smith, LLB, CCP, BA 3

ABSTRACT
Bandages have been used in hemorrhage control since at least South Africa’s first registered ambulance service in the West-
ancient Egyptian, Greek, and Roman times. The design re- ern Cape. There are no descriptions of packaging wrap being
mained unchanged until the fifth century BCE, when gauze used for improvised bandaging prior to this. This material was
was introduced. Modern bandages are relatively expensive used because it is cheap, clean, widely available, and has many
and heavy and are not widely available in low-resource envi- uses aside from improvised bandaging. Widely known as plas-
ronments. Packaging wrap, sometimes called Saran wrap, cling tic packaging or pallet wrap, linear low-density polyethylene
film, cling wrap, or Glad wrap, is widely available in many (LLDPE) has unique properties that allow it to stretch and
countries. It is used commercially with handheld dispensers to adhere to other layers of the same material using the attraction
bind goods to pallets for secure transport. In austere settings, of static charge generated when the material is unwrapped and
packaging wrap has a large number of improvised medical electrons transfer between layers. LLDPE is used commercially
uses. It can be used as a dressing to apply pressure to wounds, to bind loads to pallets for transportation, but so far it seems
as covering for burns, to splint limb fractures, to occlude bowel not to have been recognized as having medical applications.
evisceration, and to ensure the security of casualty cards. It can When used in wound care, the plastic packaging wrap does
also be used to create an endotracheal tube tie, an improvised not go inside the wound nor make contact with open tissue, so
intravenous fluid pressure infuser, an improvised pneumatic it is not being used as a medical dressing but rather a patient
limb tourniquet, or a head immobilizer for spinal immobiliza- packaging adjunct for the austere, remote, and tactical envi-
tion. Large numbers of dressings can be created from a single ronment. Like any other bandage, it can be incorrectly applied.
dispenser, making this a cheap and light alternative to con- Therefore, practice applying as well as regular reassessment
ventional dressings. Packaging wrap is not intended as a re- after application is required to ensure the bandage is not too
placement for commercially available, approved products but tight. If the handheld plastic packaging wrap has an applicator,
rather to assist in packaging and for use in austere, remote and tension control can be improved.
tactical environments, where space and weight are limited.
Uses for Improvised Dressings
Keywords: wilderness medicine; dressings; packaging wrap; and Securing Devices
bandage; hemorrhage; austere settings
Pressure Dressings
Current TCCC Guidelines recommend 3 minutes of direct
pressure after wound packing to promote clotting at the in-
Background
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jured vessel. After this, a pressure bandage is applied circum-
Since ancient times, bandages have been used for hemorrhage ferentially to keep the wound dressing in situ and to maintain
control and to secure dressings and splints. These uses have pressure on the wound to prevent further bleeding. It is im-
evolved, and recent conflicts have led to the development of portant that this bandage exerts sufficient pressure to main-
a wide variety of bandages and hemostatic agents to manage tain hemostasis but is not so tight as to impair distal tissue
injury. While many of these products are highly effective, they perfusion. Hence, frequent reassessment is necessary. Plastic
can be expensive, bulky, and relatively heavy. Moreover, their packaging wrap can be used as a pressure bandage but, as with
availability to front-line clinicians can often rely on sophisti- other pressure dressings, must not be applied too tightly and
cated supply chains. In austere settings or when tactical con- must be reassessed after application.
siderations dictate how many bandages can be carried, there is
often a need to improvise with alternative materials. We pres- Burns
ent the novel use of a cheap, widely available material that, in Packaging wrap can be applied loosely to cover burns; the use
certain circumstances, can be used for improvised bandaging. of nonsterile cellophane for burn treatment has been widely
established. A clean plastic wrap field can be improvised by
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Novel Use of Plastic Packaging Wrap wrapping the material around two outstretched arms, as illus-
as a Pressure Bandage trated in Figure 1, and then cutting to provide a flat piece of
material for loose application to a burn. Care must be taken to
South African paramedic Timm Irvine-Smith first introduced use the outside area of the wrap (which should remain clean)
the use of plastic packaging wrap as improvised bandaging in for application to the burn surface and not the inside that
2004 for use by the Generic Paramedics Ambulance Service, has been in contact with the care provider’s skin or clothes.
*Correspondence to ATEM, 6 Verity Square, Cricketers Way, Andover, Hampshire, England, SP10 5EB or pat@atem.org.uk
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1 Patrick Thompson is affiliated with THOR and ATEM Ltd., Hampshire, England. Dr. Anthony Hudson is a physician affiliated with the Pen-
insula Trauma Network and Royal Devon University Hospital, Exeter, UK. Adv. Timothy J. Irvine-Smith is affiliated with Ronin, South Africa.
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