It is a well-known fact that bleeding is one of the biggest killers of trauma patients. Those from a military medical background will also know that extremity bleeding is the #1 preventable cause of death on the battlefield.
But what happens when a wound is not amenable to a tourniquet? Or is a large cavity? This is where wound packing comes in!
Wound Packing is a basic but critical skill that will stop that vital red stuff (blood) from leaving the body. It has been taught to military medics around the world for a number of years but for some reason hasn't been widely adopted by our Ambulance Services or First Responders. Especially here in Australia.
When to wound pack:
- Heavily bleeding junctional wounds ie wounds too high on a limb for a tourniquet such as a Neck, Armpit and Groin.
- Large wounds with a deep cavity. This includes wounds that may have been already treated with a tourniquet (a TQ has to come off eventually).
When NOT to pack a wound:
- Chest & abdominal wounds. Bleeding in these areas are not compressible and wound packing won't work. You'll simply be burning time and consumables. Get the patient to a trauma centre (ie surgeon).
- I have packed a couple of stab wounds to the posterolateral neck with very good effect, however, care must be taken when packing a neck wound so you don't compromise the airway. Don't wrap your bandage around the patient's neck after packing (don't laugh.... I've seen it).
- A wound/cavity with minimal bleeding. Packing REALLY hurts and the patient won't appreciate you packing a wound that's unnecessary.
What to pack with:
- Haemostatic gauze, such as QuikClot, is ideal as it will speed up the clotting process and stop the bleeding faster.
- Gauze bandage. Any standard gauze roller bandage will work. As they come rolled up, the technique is just a little harder as you have to unroll as you pack.
- Packing gauze, such as the S-Rolled Gauze from North American Rescue, is specifically designed for efficient and effective wound packing. The gauze is 6-ply which means more surface area for blood platelets to attach to and clot.
What NOT to pack with:
Tampons. This has been covered in great detail by our friends at CTOMS. See a great article on it HERE.
How to Pack:
See below for a short video on wound packing.
Whilst it is certainly not as common to require wound packing in a civilian context compared to the combat environment, it is a skill set that is very basic but effective in controlling bleeding in certain wound types. Remember, haemorrhage control is about pressure and not absorption. Big dressings and towels will only cover and absorb blood.
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