5.7 Bandaging, Dressings, Improvisation & the Ship's Medical Stores
Key Takeaways
- STCW Table A-VI/1-3 requires the ability to improvise bandages and use the materials in the emergency kit, so improvisation is an assessed competence and not a fallback.
- Distal circulation, motor function and sensation must be checked before and after every bandage or splint, and a bandage that has become a venous tourniquet is loosened, not reinforced.
- A bandage is secured with a reef knot rather than a granny knot, tied flat and away from the wound so it cannot press into the injury.
- The triangular bandage is the most versatile item in the kit: as an arm sling, an elevation sling, a broad or narrow fold, a head covering, or a pad retainer.
- The Maritime Labour Convention 2006 requires every ship to carry a medicine chest, medical equipment and a medical guide, and ships carrying 100 or more persons on international voyages of more than three days must carry a qualified doctor.
5.7 Bandaging, Dressings, Improvisation & the Ship's Medical Stores
Core Principle: Column 2 of Table A-VI/1-3 ends with improvise bandages and use materials in the emergency kit. On a ship four days from a hospital, the quality of a dressing and the discipline of the medical locker are not administrative details — they decide whether a wound heals or becomes a diversion.
1. Dressings: Getting the Right Thing onto the Wound
| Dressing | What It Is | Use |
|---|---|---|
| Sterile non-adherent pad | Low-adherent absorbent pad | The default for a clean wound; will not tear the healing surface off on removal |
| Gauze swabs / rolls | Woven or non-woven cotton | Cleaning, packing, padding, absorbing |
| Trauma / field dressing | Large absorbent pad with attached bandage | Major wounds, one-handed application |
| Emergency (Israeli) bandage | Pad with an integral pressure bar and elastic wrap | Direct pressure without a second pair of hands |
| Haemostatic gauze | Kaolin- or chitosan-impregnated gauze | Deep and junctional wound packing (Section 5.4) |
| Hydrogel burn dressing | Water-based gel sheet | Cools and covers a burn; a clean plastic film is an acceptable substitute |
| Eye pad | Sterile pad with a shield | Eye injuries; pad both eyes if the injured eye must be immobilised, since the eyes track together |
| Adhesive island dressing | Small pad with adhesive border | Minor cuts on clean, dry skin |
Never remove a dressing that has become soaked through. Removing it strips the clot. Add another dressing on top and increase the pressure.
2. Bandages and How They Are Used
Types
- Roller (conforming) bandage — the general-purpose wrap, sized by width for the body part: about 2.5 cm for fingers, 5 cm for hands, 7.5 cm for arms, 10 cm and up for legs and trunk.
- Elasticated (crepe) bandage — supports joints and provides mild compression.
- Triangular bandage — the most versatile item in any kit, described in detail below.
- Tubular gauze — retains dressings on fingers and toes without adhesive.
The Golden Rules of Bandaging
- Check distal circulation, motor function and sensation (CMS) BEFORE and AFTER. Feel the pulse beyond the bandage, check capillary refill under 2 seconds, ask the casualty to move fingers or toes, and confirm normal sensation.
- Bandage from distal toward proximal — start away from the heart and work toward it, so venous return is assisted rather than obstructed.
- Firm, not tight. You should be able to slide a finger under the edge. Blue, cold, numb or tingling digits mean loosen it, never reinforce it.
- Leave the fingertips and toes exposed wherever possible so circulation can be watched.
- Tie with a reef knot, not a granny knot — left over right, then right over left. A reef knot lies flat and does not slip; a granny knot rolls, digs in and works loose.
- Place the knot away from the wound, and away from bony prominences and the back of a limb the casualty will lie on.
- Re-check after 10 minutes and then regularly. Injured tissue swells, and a bandage that was correct on application can become a tourniquet within the hour.
Common Techniques
- Spiral turns — for a limb of even thickness; each turn overlaps the previous by about two thirds.
- Figure-of-eight — for joints such as the ankle, knee, wrist or elbow; the crossovers allow movement without the bandage rolling.
- Arm sling — a triangular bandage supporting the forearm at roughly a right angle, used for forearm and wrist injuries.
- Elevation sling — the hand is placed on the opposite shoulder, used for hand injuries, bleeding and collarbone fractures, because elevation reduces both swelling and bleeding.
- Broad fold (triangular bandage folded twice) — for securing splints and for a swathe binding the arm to the body.
- Narrow fold (folded once more) — for securing dressings and for figure-of-eight ankle support.
3. Improvisation from Shipboard Materials
This is assessed, so treat it as a skill rather than a last resort.
| Need | Improvised From |
|---|---|
| Sterile-ish dressing | The clean inner surface of a freshly laundered sheet, pillowcase or T-shirt; a clean handkerchief |
| Bandage | Torn strips of sheeting, a triangular bandage cut from a pillowcase, clingfilm for a burn |
| Sling | A shirt front pinned up over the forearm; a jacket sleeve pinned to the chest; a belt |
| Splint | A rolled magazine or chart, a broom handle, an oar, a length of batten, a boat hook, a SAM splint, or the casualty's uninjured leg (anatomical splinting) |
| Padding | Towels, blankets, life jackets, foam from a fender, bubble wrap |
| Burn cover | Clean clingfilm laid on in flat sheets, never wrapped circumferentially around a limb |
| Amputated part | Sterile gauze moistened with saline, sealed in a clean plastic bag, placed in an ice-and-water slurry — never directly on ice |
| Stretcher | A blanket rolled onto poles, a door or hatch board, a Neil Robertson stretcher for vertical work |
| Eye shield | The bottom of a clean paper or plastic cup, taped over the eye without touching it |
Improvisation rules: cleanest surface toward the wound; nothing fluffy (cotton wool sheds fibres into a wound); pad every rigid splint against bony points; and never improvise where a proper item is available three metres away in the medical locker.
4. The Ship's Medical Stores
What the Law Requires
The Maritime Labour Convention 2006, Regulation 4.1 and Standard A4.1 require every ship to carry:
- A medicine chest appropriate to the ship's type, voyage and complement.
- Medical equipment proportionate to the ship's operation.
- A medical guide — in practice the WHO/ILO/IMO International Medical Guide for Ships.
It also sets the staffing thresholds:
| Situation | Requirement |
|---|---|
| Ships carrying 100 or more persons and ordinarily engaged on international voyages of more than 3 days | Must carry a qualified medical doctor |
| Ships not required to carry a doctor | Must carry either a person in charge of medical care who has completed approved medical-care training, or at least a seafarer trained in medical first aid |
| Ships carrying dangerous goods | Must carry the Medical First Aid Guide (MFAG), used with the substance's UN number |
Many flag States and the EU also categorise medicine chests as Category A, B or C according to voyage length and area, with a defined contents list for each.
Maintaining the Locker
- Inventory it monthly against the flag State's required contents list.
- Check expiry dates every month and land expired stock ashore for disposal — never over the side, and never into the general garbage.
- Restock before the voyage, not after something has been used.
- Controlled drugs are held in a separate locked safe, with a register that records every issue, the reason, the quantity, the time, and the signature of the officer in charge of medical care.
- Keep the locker cool, dry and locked, and keep the key accessible to the designated person at all hours.
- Grab bags — a portable first-response bag, the oxygen set and the AED — are checked weekly and stowed where they can reach any part of the ship quickly.
- Record every treatment in the ship's medical log: date, time, casualty, complaint, findings, treatment given, medication and dose, and the TMAS reference if advice was taken.
Exam Watchout: the medical log and the controlled-drugs register are official records. They support the casualty's later medical care, any port State or flag State investigation, and any claim under the shipowner's liability provisions of MLC Title 4. Retrospective or approximate entries are worth very little.
Ten minutes after a roller bandage is applied to a forearm laceration, the casualty's fingers are cold, pale and tingling. What is the correct action?
Why is a bandage secured with a reef knot rather than a granny knot?
Under the Maritime Labour Convention 2006, which ships must carry a qualified medical doctor?
A crew member has a partial-thickness burn across the forearm and the ship has no hydrogel burn dressings left. What is the best improvised covering?