Oswald in the doorway: the blog of the Oswald Innocence Campaign, by Ralph Cinque

This is from the Army Study Guide website about dressing open abdominal wounds. You'll notice that it says nothing about applying a dressing over clothing.

APPLY A DRESSING identify proper procedures for treating a casualty with an open abdominal wound

Lesson 6
APPLY A DRESSING TO AN OPEN
ABDOMINAL WOUND

INTRODUCTION

An open abdominal wound can be caused by the muscular abdominal wall being penetrated by a bullet, by a stab from a knife, by an object blown from an explosion, or by falling on a sharp object.

APPLY A DRESSING TO AN OPEN
ABDOMINAL WOUND

TASK
Identify proper procedures for treating a casualty with an open abdominal wound.
CONDITION
Given multiple-choice items pertaining to open abdominal wounds.
STANDARD
Score 70 or more points on the 100-point written pretest.

POSITION A CASUALTY WITH AN OPEN
ABDOMINAL WOUND

Position the casualty on his back with his knees up (flexed). This position helps to prevent further exposure of the abdominal organs, lessens pain, and controls shock.

DRESS AN OPEN ABDOMINAL WOUND

Locate and Expose Open Abdominal Wound(s)
Check the abdominal region for entry and exit wounds. Check the back using your hand to feel for wounds. Look for a pool of blood.
If more than one open abdominal wound is found, treat the more serious wound first.
Expose the area around the open abdominal wound by removing, cutting, or tearing the clothing around the wound.

DRESS AN OPEN ABDOMINAL WOUND

If clothing is stuck to the wound, cut or tear around the stuck clothing rather than removing the stuck clothing.
Do not probe, clean, or remove foreign objects from the wound.
If you are in a chemical environment, dress the wound without exposing the wound.

DRESS AN OPEN ABDOMINAL WOUND

Position Dislodged Organs, If Applicable
If part of an intestine or other organ has been forced through the wound, use clean, dry material to gently lift the organ. Then position the organ on top of the casualty's abdomen.
Do not touch the exposed organ with your hands or try to push the organ back into the body.

DRESS AN OPEN ABDOMINAL WOUND

Dress the Wound
Open a field dressing and place the white side of the dressing over the wound and any protruding organs.
If the field dressing is too small, use clothing, part of a blanket, elastic gauze bandages or similar clean materials as a dressing.
If an object is protruding from the wound, stabilize the object with clean, bulky material and bandages.
Hold the dressing in place with one hand to keep it from slipping.
Grasp one tail and slide it under the casualty.

DRESS AN OPEN ABDOMINAL WOUND

Reach down on the other side of the casualty, grasp the tail under the casualty, and pull.
Bring the tail up the casualty's side, over the dressing, and to the other side.
Wrap the other tail in the opposite direction.
Tie the tails in a nonslip knot on the outer edge of the dressing toward the casualty's side. Do not tie the knot over the wound site.
The bandages should be tight enough to keep the dressing from slipping. You should be able to insert two fingers between the knot and the dressing. Elastic gauze bandages over exposed abdominal organs (especially intestines) should be moistened with I.V. solutions using the appropriate tubing.

DRESS AN OPEN ABDOMINAL WOUND

Dress Other Abdominal Wound(s)
If other abdominal wounds are present, dress and bandage the wounds.
Reinforce Dressings
If the situation allows and materials are available, cover the dressing(s) with cravats or strips of cloth. Tie the tails of the reinforcing bandages over the other edge of the field dressing (not over the field dressing knot).
Do not tie any knots over the wound site.

MONITOR A CASUALTY WITH AN OPEN
ABDOMINAL WOUND

Keep the casualty in the knees-up position.
Evacuate the casualty as soon as possible.
Do not give the casualty anything to eat or drink.
If the casualty asks for water, moisten his lips with a damp cloth.
If you leave the casualty, tell him to stay on his back with his knees up.

APPLY A DRESSING TO AN OPEN
ABDOMINAL WOUND

CLOSING

The abdominal cavity contains the stomach, intestines, liver, kidneys, spleen, and several large arteries and veins. An object that punctures the muscular abdominal wall can injure organs, cause severe bleeding, and cause massive infection. The casualty must be treated at a medical treatment facility as soon as possible.