The dressing does not change in the flat pack — what changes is whether it fits the pouch you actually wear.
At a glance
10 things to know about the Flat ETD
What the flat fold changes, what it does not, and how to get the pressure right.
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01
Same dressing, half the depth
The Flat ETD is the standard ETD — resilient elastic wrap, sterile non-adherent pad, durable securing device and Quick-Grip Roll Control — folded flat and vacuum-sealed to cut its diameter and footprint in a kit.3,4 Both sizes pack 0.875 in. deep, against 1.75 in. for the rolled 4 in. ETD and 2.1 in. for the rolled 6 in.4,5
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02
Two sizes
4 in.: 56 × 4 in. wrap, 6 × 4 in. pad, 2.6 oz, packaged 4.25 × 2.75 × 0.875 in. 6 in.: 56 × 6 in. wrap, 6 × 6 in. pad, 4 oz, packaged 6 × 3.5 × 0.875 in.3,4 Same weights as the rolled versions — only the package changes.5
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03
Built for where depth decides
Plate-carrier panels, belt IFAKs, pocket kits and vehicle door panels are limited by depth more than by area. A dressing that will not let the pouch close stays out of the kit; at 0.875 in., this one goes in. It matters because the pressure dressing is what responders reach for most: in the DoD Prehospital Trauma Registry it was the most common intervention by battlefield first responders with no medic in the chain of care.13
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04
No pressure bars, no hooks
NAR left out pressure bars and hooks to reduce the fine motor skill the job takes, and the Quick-Grip tabs keep the bandage from unrolling during application — an application simple enough to remember under combat or survival stress.3,4
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05
One product, one job
A complete bleeding kit carries four products for four jobs: a tourniquet, packing gauze, a pressure dressing and a chest seal. The Flat ETD is the pressure dressing. The TCCC Guidelines also use pressure dressings when a trained provider converts a limb tourniquet — only when the casualty is not in shock, the wound can be watched and it is not an amputation.1
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06
Where it comes from
NAR marks the Flat ETD TAA compliant; it is sterilized by irradiation (STERILE R on the label).4,7
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07
Class I, sterile, latex-free
FDA lists it as an elastic bandage (product code FQM, 21 CFR 880.5075): Class I, exempt from 510(k). It is sterile, single use and labeled as not made with natural rubber latex.6 A GS1 label on the back carries the GTIN, the lot number and the expiration date.7
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08
No NSN — order by item number
NAR lists no NSN for either flat size.4 When a contract or kit list calls for an NSN, the rolled ETD is the NSN item: 6510-01-558-4108 (4 in.) and 6510-01-558-4114 (6 in.).5
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09
Firm pressure — not a tourniquet
NAR's direction: firm pressure, but never so tight it creates a tourniquet effect.9 Too tight, and the wrap closes the veins while the artery keeps pumping in — a venous tourniquet that can end in compartment syndrome.8 Feel is not a gauge: in 116 measured applications by EMS providers, pressures ran from 50 to 412 mmHg and did not match how tight providers thought they were.11 In cadaver legs, high-stretch wraps raised compartment pressure the most.12
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10
More than a bandage
Like every ETD, it also slings and swathes an arm, secures a splint, and does any other job that needs an elastic wrap.3,4
How to apply the Flat ETD
In doctrinal order — the tourniquet and packing decisions come first, the dressing last.
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1Tourniquet first on a limb. Life-threatening limb bleeding a tourniquet can control gets a tourniquet. Hasty: high and tight over clothing, under threat or when you cannot see the source. Deliberate: on bare skin 2–3 in. above the wound once it is exposed. Never across a joint.1
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2Pack a wound that is deep. Deep wounds and junctional wounds — groin, armpit, neck — are packed first: the power ball goes in first, directly on the bleeding vessel, and every corner is packed tight. Never pack the chest or abdomen. The neck can be packed with care without compressing the airway; the lower neck above the collarbone is acceptable.
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3Hold pressure. Hemostatic gauze: at least 3 minutes, or the time on its label.1 Plain gauze: at least 10 minutes. In every case, until the bleeding stops — best practice is to keep holding until someone relieves you.
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4Open and orient. Tear the package at a red notch and unfold the dressing. The pad goes on the wound; the printed tag on the wrap reads OTHER SIDE TOWARD WOUND.3,4
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5Wrap with a little stretch. Pull a little stretch on each pass and wrap around the limb, covering the pad completely. The Quick-Grip tabs keep the roll from unrolling as you go.3,9
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6Secure the end. Fasten the end with the securing device's hook-and-loop, or tuck it under the last wrap so it sits tight.9
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7Check beyond the dressing. Color, warmth, sensation and pulse below the wrap, compared with the other limb. If the skin turns dusky, capillary refill slows, pain climbs or the pulse fades, take the dressing down and reapply it with less force — then keep reassessing.8
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8If blood comes through. On a superficial wound, or a wound under the dressing that is not deep enough to pack, leave the dressing in place and add gauze and pressure on top. That rule does not cover a packed wound: if a packed wound keeps bleeding, remove the packing and repack — find the source, power ball first, every corner tight.1
Where it fits
- Bleeding a pressure dressing can hold
- Holding hemostatic or plain gauze under pressure once a deep or junctional wound is packed
- A pressure dressing after a trained provider converts a limb tourniquet1
- Slim kits where a rolled dressing will not let the pouch close
- Slinging and swathing an arm, or securing a splint3
- Life-threatening limb bleeding a tourniquet can control — tourniquet first1
- An open or sucking chest wound — a vented chest seal, or a non-vented seal if no vented seal is available1
- Packing into the chest or abdomen — never
- Wrapping tight around the neck — the airway comes first
- A contract line that requires an NSN — order the rolled ETD5
The evidence
No peer-reviewed study of the ETD itself is indexed in PubMed. The studies below tested pressure dressings as a class, and the TCCC documents set the role.
| Study | Evidence type | What was studied | What it found |
|---|---|---|---|
| TCCC Guidelines, 1 May 2026 | Expert review · guideline | Massive hemorrhage, tourniquet conversion, open chest wounds | Tourniquet for limb bleeding it can control; hemostatic dressings ≥3 min of pressure; convert tourniquets to hemostatic or pressure dressings when three criteria are met; vented chest seal for an open chest wound |
| Evidence-Based Standard Devices & Adjuncts, 15 December 2021 | Expert review · device list | Devices recommended for combat casualty care | Limb tourniquets and hemostatic dressings and devices are named; there is no pressure-dressing category |
| Paulson et al., Med J (Ft Sam Houst Tex) 2021 | Human · combat registry | 29 casualties treated only by battlefield first responders, Prehospital Trauma Registry 2003–2019 | Pressure dressing was the most common intervention (12), ahead of limb tourniquets (4) |
| Brauckmann et al., Eur J Trauma Emerg Surg 2026 | Human volunteer · simulation | 124 EMS providers applying pressure dressings to one volunteer's forearm over calibrated sensors; 116 analyzed; ETD not among the materials | Peak pressure 169 ± 84 mmHg (range 50–412); 28% of Israeli-bandage applications exceeded 250 mmHg; self-assessed tightness did not match measured pressure |
| Kwok et al., Mil Med 2026 | Cadaver · synthetic model | Low-, moderate- and high-stretch circumferential dressings on a pressurized manikin arm and cadaver legs | High-stretch dressings raised compartment pressure the most (cadaver anterior compartment +10.7 vs +3.0 mmHg for low-stretch) |
Strongest to weakest: human registry data, then human-volunteer measurements, then cadaver and manikin work. The registry counts how often pressure dressings were used, not how well any one brand performed.
How it compares
The flat sizes against the rolled 4 in. and NAR's smallest dressing, the Mini Responder.
| Flat ETD 4 in. | Flat ETD 6 in. | ETD 4 in. rolled | Mini Responder 4 in. ETD | |
|---|---|---|---|---|
| NAR item | 30-0093 | 30-0094 | 30-0031 | 30-0179 |
| Elastic wrap | 4 × 56 in. | 6 × 56 in. | 4 × 56 in. | 4 in. wide, 42 in. unstretched |
| Pad | 6 × 4 in. (H × W) | 6 × 6 in. (H × W) | 6 × 4 in. (H × W) | 4 × 6 in. |
| Packaged | 4.25 × 2.75 × 0.875 in. | 6 × 3.5 × 0.875 in. | 4.5 × 2.5 × 1.75 in. | 5 × 3.5 × 0.75 in. |
| Weight | 2.6 oz | 4 oz | 2.6 oz | 2.4 oz |
| Closure | Securing device + Quick-Grip tabs | Securing device + Quick-Grip tabs | Securing device + Quick-Grip tabs | Hook-and-loop + C-Clip |
| NSN | No NSN | No NSN | 6510-01-558-4108 | No NSN |
| evidence-based standard | No | No | No | No |
Flat and rolled figures from NAR's product information sheets;4,5 Mini Responder figures from NAR's Mini Responder ETD product information.10 NAR gives the Mini Responder's pad as 4 × 6 in. without orientation.
Build the system
The tourniquet and gauze that come first, the rolled and mini ETDs, a compact chest seal, a wrap and the trainer.
Questions buyers ask
Package & specifications
Available Options:
- 6"
- 4"
Specifications coming soon. Contact us for detailed product information.
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