Massive Hemorrhage continued, Wound Packing (no not tampons)

In the last post, we had performed the blood sweep looking for any injuries in the junctions or on the extremities that we would have to either pack or place a tourniquet. Well once you’ve identified a wound, you are going to need to do something to it. I did not say treat it and that’s for a reason. Nothing we do in TCCC is actually a treatment. Our whole goal in TCCC is not to treat wounds, but to stabilize anything in order to allow them to get to a higher level of care (people with letters after their name). But that’s a diatribe for another post.

If the wound is in a junction or too high up on the extremity to properly place a tourniquet we are going to have to pack the wound. Packing is not an easy skill by any means, but it’s not actually a hard skill. To dumb it down to the very basics, we are filling the wound with gauze starting at the source of the bleeding and going out and towards the surface from there. We want the gauze to allow pressure applied from the top of the wound to be redistributed to the source of the bleeding in the bottom of the wound. But to just leave it at that would be a bit of a disservice.

Notice how we aren’t just placing the gauze on top of the wound. We aren’t trying to prevent blood from spilling out of the wound, we are trying to keep blood from coming out of the damaged blood vessel.

First, we’ll start with a discussion of packing materials. In class, I talk about how hemostatic impregnated gauze is definitely better than just plain cotton gauze. There is something to keep in mind though, cost. Plain cotton gauze is anywhere from $2-$5 depending on who makes it and if it is rolled, s folded, or compressed. Quickclot is $45 brand new. That is a big price difference. I will never tell anyone that cotton gauze is better because it simply isn’t. But it is less expensive. Medical equipment is already ridiculously expensive. That is why I don’t have any in the IFAK. If you feel like purchasing quickclot that is awesome, but I think for storing deep, you’d be better off with purchasing plain cotton gauze.

Now that discussion is out of the way, we can continue on to packing. Packing is very technical and is different from the type of packing that most may be familiar with. This is going to be different than packing an abscess or cyst that has been drained. The overall goal is different. We aren’t trying to encourage healing from the inside, we are trying to prevent our casualty from bleeding the fuck out. So we are going to stuff as much gauze as possible into this wound space. But again, not just however we can get it to fit, but very specifically. This does not change if we are using hemostatic impregnated gauze.

Notice the zig zag pattern of the gauze. Notice how the severed vessel is packed from both ends.

Once the gauze has all been packed into the space we are going to hold pressure for three minutes. Once that is complete we are going to pull at the edges of the wound to see if we can see any pooling blood or pink-tinged gauze. If we do see any of that, we need to remove that gauze and start over because we didn’t stop the bleeding. Even if you used hemostatic impregnated gauze if you see pooled blood or pink-tinged gauze it is not going to save you from a shitty packing technique. If you don’t see any of that then you packed correctly. Now we can move to the pressure bandage.

The pressure bandage not only applies continual pressure, it covers the wound to keep further debris from getting into it. There are several options for a pressure bandage from the Israeli, the Olaes, to simply an Ace Wrap. I prefer ace wraps from larger bags like my aid bag or my vehicle kit. But if it’s an IFAK, I just use a pressure bandage. In larger bags, I may have to use it for more than just a pressure bandage, but an IFAK that is all it is going to be used for. Once the pressure bandage is applied, you’re good. Tape to secure it and take a look at it occasionally to make sure the gauze hasn’t become dislodged.

For practicing this skill there are a few options out there. For the class, I like to keep it cheaper to show you what you can do with a simple budget. I use a yoga block that I’ve dug a hole in to give a space to pack. It’s not the most realistic compared to the other options, but it works.

Next up we’ll talk about the deliberate tourniquet.

To learn how to wound pack and how to handle the rest of the MARCH algorithm come on out to class.