The ability to pack a wound is an essential skill for the tactical medic. While a tourniquet is an excellent tool for controlling hemorrhage in extremity trauma, there are many areas that do not allow proper application of a tourniquet. The video on wound packing was produced to show the fundamentals of wound packing.
A. Identify the bleed
B. Pack into the bleed
C. Pack tightly to the bone if possible
A. Identify the bleed-
It is essential that the medic identify the source of the serious hemorrhage. Simply stuffing gauze into a cavity is not always effective. Often times the pressure is not applied where it is needed and the gauze only acts as a sponge. What makes packing a wound effective is that is provides focused pressure directly on the damaged vessel. By occluding the lumen of the vessel with the gauze you get hemorrhage control. If it is not completely controlled it at least slows the hemorrhage to a point where the body’s natural clotting factors can interact with the gauze to form a clot. There are three main methods to identify the location of a bleed.
Visualization is the preferred method, but it is often unrealistic due to ballistic patterns, flooding of cavities and tissue movement. Excess blood filling the cavity can be scooped out to give a quick look, but on high pressure bleeds and blast injuries this can be very difficult.
2. Tactile assessment
Feel works well if you are in a relatively calm mental state and have complete awareness of your senses. It is not a reliable source when you have been carrying heavy loads, firing weapons for long periods of time or participating in any activity that has caused your hands to fatigue. It’s also unreliable if you are wearing multiple layers of gloves.
A basic understanding of the vascular structure of the human body goes a long way in this situation. It isn’t as good of an indicator as visualizing the bleed, but if you are pressed for time it can be a good solution. It is best when used in conjunction with the other methods. It is also helpful when determining the best angle to pack from.
B. Pack into the Bleed
Notice what the section is titled, “Pack into the bleed”. It does not say pack into the wound. Your first few sections of gauze should go directly to the source of the major hemorrhage. After that hemorrhage has been staunched, the remaining gauze should be packed tightly around it to keep it in place. Your goal is NOT to create a sponge inside the wound, but a solid mass that applies pressure where it is needed. This is a very important point. An often-asked question is, “how much blood does the Olaes bandage absorb?” The answer is this: hopefully none. The purpose of bandages is not to absorb the most blood, it is to STOP bleeding, in order to keep blood where it needs to be: in the body. You don’t put bandages on to keep your vehicle clean.
C. Pack to the bone
The major vessels of the body are not inside muscular tissue! Most vessels run near the major bones in the body. If the wound is in a location that allows you to use the bone as a rigid object to maintain pressure on the damaged vessel, use it. Start by packing into the bleeder, and then use the gauze to squeeze the vessel between it and the bone. This creates the same effect as a vascular tourniquet, or simply holding pressure with your finger.
Educating medical directors and command surgeons in the importance of wound packing is essential. The ability to pack wounds is a necessary skill in an environment with the potential for delayed evacuation times and limited manpower. The idea that you will hold direct pressure for 3-5 minutes during a fire fight is ridiculous. Packing a wound reduces the need for this and frees the medic’s hands up to engage more important things, like the enemy. When used in conjunction with hemostatic agents, it is even more effective. We will cover how these two work together in a future entry.