Bleeding Control

Discussion in 'Bush Medicine' started by Medic17, Dec 18, 2014.

  1. Medic17

    Medic17 Supporter Supporter

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    I have noted more discussions on the use of tourniquets and bleeding control, I decided to post 4 really good articles that deal with that topic. They were published by the JEMS magazine, a research based trade magazine that specializes in Prehospital Medicine.

    Fact not Fluff for the persons interested in taking the time to educate themselves.

    10 Hemorrhage Control Myths
    http://www.jems.com/articles/print/volume-39/issue-12/features/10-hemorrhage-control-myths.html

    Tampons and MaxiPads Use In Injuries-Myths
    https://www.personaldefensenetwork.com/article/severe-bleeding-first-aid-misconceptions-tampons/

    Stop The Bleeding- History
    http://www.jems.com/article/patient-care/stop-bleeding

    Point Care Hemorrhage Control- Bleeding Control
    http://www.jems.com/article/patient-care/point-care-hemorrhage-control

    JEMS Bleeding Control
    http://www.jems.com/articles/print/...l&utm_source=facebook.com&utm_campaign=buffer

    Tourniquet First-Use of Tourniquets
    http://www.jems.com/article/major-incidents/tourniquet-first

    Tourniquet Effectiveness*
    Buyer Beware: Selecting Your Everyday Carry Tourniquet
    (*Original Link Dead See Post #32 Below for a copy of the article.*)

    Wound Packing
    http://www.jems.com/articles/print/...l&utm_source=facebook.com&utm_campaign=buffer

    Specific Models of Tourniquets
    Without Reading all of the studies...

    Bottom Line

    A commercial tourniquet was much more effective than a improvised one.

    Evaluation Criteria - How Effective They Were and The Ease of One Handed Use.
    (Some were easier to use, while others were better at occluding arterial leg bleeds and what not...)

    "Really Good"
    CAT
    SOF-T Wide

    "Good"
    SWAT-T
    TK-4L

    Remember If you decide to purchase a tourniquet, buy two. One for training and one reserved for emergency use.
     
    Last edited: Apr 26, 2017
  2. Mr.Black

    Mr.Black WILDEROXEN Tracker Pack #1 Bushclass I Bushclass Instructor

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    Check...
     
  3. John_Rourke

    John_Rourke Scout

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    Good links:dblthumb:
     
  4. oldsoldier

    oldsoldier Guide Bushclass I

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    Its refreshing to see someone here post valid medical stuff. Not that others havent-but, theres a lot of misconceptions out there. I have know people who have medical kits that are more diverse than an operation auditorium-yet have never even taken a first responder course. I've said it a million times, and its worth repeating: the absolute BEST field medicine is evacuation to a hospital. At best, all you can do is manage an injury, and manage pain, until qualified medical personnel can address the problems. I have a decent amount of training, first responder, wilderness first responder, EMD for work, etc-but, I honestly carry very basic stuff to the woods. Bandaids, a cravat, some gauze, some tape, tweezers, some alcohol wipes. I also keep a whistle in there. Thats it. In my jeep, I carry some more extensive stuff (trauma bandages, clotting stuff, CPR mask, etc), but I will likely never need that stuff either.
    I also carry a modified IFAK when I go to the range, which is two trauma bandages, 2 quickclot packages, 2 TQs, and trauma shears. This is strictly for, god forbid, something happens on the range, and its needed ASAP until help arrives. But, again-the greatest thing you can do, is dial 911, and get help there as fast as possible.
     
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  5. ok bowhunter

    ok bowhunter Tracker

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    Great post
     
  6. Knight

    Knight Supporter Supporter

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    I would not settle for anything less than a SOFT wide or a CAT and in that order.
     
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  7. GreyOne

    GreyOne Elder Lifetime Supporter

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    Well, not always possible. I have been places where we had a four day hike out, and no cell phone or other coms.

    My current main relaxing place is about 130 acres, on a gravel road, off a paved road, out of the nearest "town" about 18 miles. No phone, and no cell phone reception most of the time. (get high enough at the right time of day on a very rocky boulder strewn mesa and you _might_ get a one or two bar signal).

    If you are on the back side of the place, a good 20 minutes to 30 minutes to get to the cabin, and another half hour to drive through the gates and get to town. That is assuming you are not trying to move the injured party. Try to carry some one out and all bets are off.

    Serious accidents out in the dry country are often hours from even notifying a "first responder", much less having them get there and find you.

    Lot of stuff just gets taken care of on the ranch that would be emergency room business in a populated area.

    Just how it is.
     
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  8. ra2bach

    ra2bach Supporter Supporter

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    the veterinarian in my home town has delivered several babies...
     
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  9. Medic17

    Medic17 Supporter Supporter

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  10. JAY

    JAY Scout

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    I do agree that if injured, the hospital is the place to go. I do hike alone, and with no cell towers to be found in the area, I find myself looking for info on how to stay alive if I were to be injured. I guess for me the best thing i can do is be very observant, and don't do things that might be a danger to myself. I'm sure not a rambo, and not sure if the average person can even buy suture needles, ect, for ones kit.
     
  11. Butler Ford

    Butler Ford Supporter Supporter

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    Thanks! Tag for more time.

    BF
     
  12. Gruntinhusaybah

    Gruntinhusaybah Supporter Supporter Bushclass I

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    This is good stuff.

    We have completely disproven the "tourniquets with kill the limb" myth in the last 14 years or so of war, many tourniquets have been applied in that time, and many of those absolutely saved the life of the person they were put on.

    There is no danger in using a tourniquet, and with a severe bleed, there are only positives to using a TQ.

    The SOFTT-W is the best tourniquet I have experience with, with the CAT right behind it.

    Be careful when buying TQs as there are many companies who cater to the airsoft crown who make replicas, that look almost identical to the real thing, but will break when used. Rule of thumb, if its less than $30, do not buy it. And please, please do not apply "it's just as good as" with a TQ. They are not. And the TQs that have proven themselves are more expensive because of the research that went into them and the process of manufacturing them.

    When applying a TQ, the further proximal the better, example: if someone severs their brachial artery, you would want to get the TQ all the way to the top of the arm into the armpit. If they sever the tibial artery or vein, a blow to the shin with an axe could easily do this, all the way into the crotch.
    Keep in mind, that is for SEVERE bleeds, if it is a smaller bleed slightly above the affected area can work.

    Apply pressure until bleeding STOPS.
     
  13. Sandcut

    Sandcut Bushmaster Vendor

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    Thanks for posting! Some of this info just might happen to find its way into my FA/CPR class this weekend during discussion time.

    I'll need to keep up with JEMS.
     
  14. Sandcut

    Sandcut Bushmaster Vendor

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    BTW, I forgot to mention. This is the all-time greatest understatement that I've read in awhile.


     
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  15. Swarvegorilla

    Swarvegorilla Scout

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    All bleeding stops in the end.......

    Back in wwII with supplies critically short in Berlin, kids were sent out to forage shepherds purse to help stop bleeding.
     
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  16. gila_dog

    gila_dog BCUSA Friend Bushcraft Friend

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    Not 100% true. This from one of the links in the OP:

    Ischemic complications from tourniquet use have been found to be related to the amount of time the tourniquet is left in place.4,5 Extensive experience with operative tourniquet use has demonstrated that the incidence of injury is very low with tourniquet times of two hours or less; military experience has confirmed the safety of this two-hour limit in the field.


    I know from personal experience that a tourniquet can save a life. But if it can't be removed or replaced with a pressure dressing within a couple of hours, it can result in limb loss. Our EMS crew had to deal with a guy who had been shot thru the leg. Fortunately for him a nearby resident applied an improvised tourniquet and stopped the bleeding. But it took about 4 hours to get him to a hospital. He survived, but lost his leg.
     
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  17. Crazysanman

    Crazysanman Supporter Supporter Bushcraft Friend Bushclass II

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    Good thread.

    I had to break out my trauma kit last night. Somehow my dog sliced off the tip of his ear and it wouldn't stop bleeding. Puddles all over the kitchen floor, every time he shook his head he'd sling blood high up the walls and even on the ceiling. The wife and I were both covered in blood trying to treat him. I used several small packets of a blood clotting powder with a total of 6 gauze pads (he kept bleeding through) before we got the flow of blood to stop. Then I sacrificed an Israeli bandage to pin the ear against his head and hold the gauze firmly in place.

    Luckily I have recently been building an EDC blowout kit and had just received a lot of supplied in the mail in the last few days so I had what I needed for him.

    A lot of us go on outings with dogs but I think few of us actually prepare for animal first aid as well. You can't use band aids or medical tape on a dog...
     
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  18. arleigh

    arleigh Guide

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    What are your thoughts on using turmeric ?
     
  19. Harper

    Harper Guide

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    Turmeric usually slows clotting. That is not a good idea for this purpose. Later, after bleeding is controlled to promote healing, prevent infection, reduce inflammation, etc.-- possibly. Turmeric is a great spice. It has many, many, many healing properties. But, again, I personally wouldn't use it initially.

    Did you mean Cayenne? Cinnamon? http://bushcraftusa.com/forum/showthread.php/145545-Spices-That-Can-Serve-Multiple-Purposes?highlight=spices



    The preceding information was presented for educational purposes. It is not meant to diagnose, prescribe, treat, heal, cure, etc. Consult a physician for medical problems.

    It's a damn shame I feel it necessary to even say this.


    ETA: I'm not talking about small cuts. For that, turmeric may be okay since it is in a powder form and the powder itself may help with clotting. I read this thread as pertaining to more severe bleeding and my answer is based on that.
     
    Last edited: Jan 12, 2016
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  20. Butler Ford

    Butler Ford Supporter Supporter

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    This is not necessarily correct, I respect the training and skills of the original poster of this; but, my retirement job is a 911 dispatcher, my only medical training has been First Aid/CPR/AED, First Responder, Army's Lifesaver course, and Emergency Medical Dispatch(allows me to give prearrival instructions). In the last decade I have received less than a dozen callers in a medical emergency that were calm and collected enough to give me the information needed without hesitation. 99% of the time in a true emergency, dragging the info out of distraught caller is akin to pulling teeth. I HAVE to know WHERE you are, many don't know or can't think of the address much less the Lat/Long. Most of the time it's "just past where Joe Brown use to live", I know 4 Joe Browns and they have each moved a half dozen times since I've known them. I HAVE to know WHAT your emergency is. "Get an ambulance out here NOW!" just doesn't get'er done. We have the capability to triangulate your cell phone, IF you aren't so remote that there isn't three cell towers, to within usually 500 feet. That is of no help in a city! Our standard is 2 minutes max and many times, we're pushing that limit. The ambulance drivers (I say that tongue-in-cheek) are NOT sitting in the truck with the engine running. Usually sitting in the lounge filling out run sheets, or fixing a meal, or sitting in a restaurant mid-meal when I give them the call. They too have a two minute response time. Then there is the drive time. I hope that you're starting to understand my point. If you are talking about a serious bleed, the patient could have died before you get EMS on scene.
    The greatest thing you can do is take a quality First Aid/CPR course, keep it current and stay proficient. Stop or at least control the blood loss then call 911.

    BF
     
    Last edited: Jan 12, 2016
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  21. The Bruce

    The Bruce Scout

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    Interesting, they always used to insist that if you were alone, you call for help first, then proceed. But that was back in the day when you didn't put little blue gloves and a mask on before getting bloody.

    Navy FMF Corpsman for 8 years, sometime back in the dark ages.
     
  22. arleigh

    arleigh Guide

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    In an ideal situation
    1. get facts= how what when where and why and who.
    2.make the call ,deliver the facts
    3. start with ABCs assessment .
    4.bleeding under control.
    5.airway & breathing
    6.assess for other injuries
    7.assess for transport and evacuation strategies .
    8.make sure first responders can see you /victim.
    communicate with first responders/
    If there is time take pictures of the event the person and their affects (preferably on a SD card you can hand to the first responders)
    IMO
     
  23. Medic17

    Medic17 Supporter Supporter

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    It has no place in emergency medicine.
    Stick with the tried and true.
    When in doubt do a net search for an accredited medical study.
     
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  24. Mazer

    Mazer Scout

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    Invaluable information
     
  25. Doubles

    Doubles BCUSA Friend Bushcraft Friend

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    Good thread, thanks
     
  26. Sandcut

    Sandcut Bushmaster Vendor

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    Good news.

    The Red Cross just issued a new First Aid/CPR/AED manual two days ago. New revisions include use of commercial tourniquets consistent with the emergency medicine journal articles in the OP. Teaching the use of commercial tourniquets is now a mandatory lecture/skill (it was previously an optional lecture) and is now taught to be used prior to CPR under certain circumstances (for severe, life-threatening bleeding with mass casualties, trapped extremity, unsafe scene, etc.)

    Unfortunately, they revised a large portion of the manual information and flow. Now I have to go relearn what I was just starting to become comfortable teaching.
     
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  27. Medic17

    Medic17 Supporter Supporter

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  28. Ol Grizz

    Ol Grizz Scout

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    Thanks for the info, Medic17. I'm not sure I ever even thought about carrying a tampon for anything other than it's intended purpose (I used to plan and lead 3 to 5 day college tour trips for high school students). I did use a maxipad once for a student with a severe nosebleed but that's different than an actual wound. If there is a wound, I'm using standard wound care items, especially for someone who is not my family. Good Samaritan laws only go so far.
     
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  29. mainewoods

    mainewoods Maine Supporter Supporter Bushcraft Friend Bushclass I

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    For some one on blood thinners this is a great post! I carry my CAT and Israel bandaid and a Quikclot combat gauze .
    those and my basic Sm FAK
     
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  30. RobOz

    RobOz Scout

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  31. Bitterroot Native

    Bitterroot Native Guide

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    When I was in the Army we used a chitosan dressing for hemorrhage control. Substance synthesized from shellfish shells I believe. Amazing how quick it would stop a bleed.
     
  32. Medic17

    Medic17 Supporter Supporter

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    [​IMG] Buyer Beware: Selecting Your Everyday Carry Tourniquet

    With the increase in Active Violent Incidents (AVIs) over the last few years and the shared lessons learned (LL) from the U.S. and Canadian militaries’ experience in Afghanistan and Iraq, there has been an explosion of life-saving devices hitting the market. Nothing has become a larger issue than hemorrhage control. Hemorrhage is the leading cause of preventable death in both the civilian and military setting. It also happens to be one of the easiest to treat.

    Private Military Contractor during the rescue operation
    The extremity tourniquet saves lives.
    Manual pressure has been shown to be as quick and effective in a manikin model for junctional hemorrhage as several commercially available products that are currently being used by the U.S. Army.1 However, it is the resurgence of the extremity tourniquet (TQ) that has saved thousands of lives.

    The Committee on Tactical Combat Casualty Care (CoTCCC) has thoroughly studied and approved of three TQs for use in combat, 1) the Combat Application Tourniquet (C-A-T) (North American Rescue, Greer, SC), 2) the SOF Tactical-Tourniquet Wide (SOF®TT-W) (Tactical Medical Solutions, Anderson, SC), and 3) the Emergency and Military Tourniquet (EMT) (Delphi Medical Innovations, Vancouver, BC). Their civilian counterpart the Committee on Tactical Emergency Casualty Care (C-TECC) follows similar guidelines.

    In response to AVIs, groups and initiatives like the Hartford Consensus, Stop The Bleed, and C-TECC have called for more bystanders training in hemorrhage control.2 Many of these are successful and are being taught using similar if not the same TQs recommended by the CoTCCC and C-TECC. However, there is still an overall lack of uniform guidelines for TQ application3, which may be cause for inadequate TQs being used throughout the country.

    There are several commercially available TQs being sold that do not have scientific data to support its effectiveness or are being marketed in a manner that has the appearance of being recommended by such groups as the CoTCCC. Still others promote the use of improvised TQs.

    Some articles support the use of improvised TQs, when they are properly applied.4,5 Though, other data suggest that improvised TQs are not nearly effective as commercially available TQs.4,6 This may be for any number of reasons. A vital reason is the inverse relationship between the TQ width and the pressure needed to stop arterial bleeding.

    Many improvised TQs and other commercially available TQs simply do not have the ability to stop the arterial hemorrhage due to this width/pressure relationship. Pneumatic tubing or other elastic/rubber material was a popular TQ in World War II and can be effective.

    Nevertheless, data suggests that they inadequately occlude arterial bleeding and only stop venous bleeding, both of which can worsen hemorrhage.7 They can also be extremely painful and pressure difficulties can result in excessive pressure.8 In the event a novice applies a rubber TQ, will they be able to apply it in concentric wraps to ensure there is adequate pressure to stop arterial bleeding?

    More recent anecdotal data from the Boston bombing found that that six of the rubber and improvised type TQs had to be replaced with CATs.9 Furthermore, the most common EMS tourniquet consisted of rubber tubing and a Kelly clamp.9

    The idea of one-handed tourniquets are often marketed as a simple solution in the case you have one healthy extremity. Again, data suggests, it is difficult to employ with varying degrees of success in stopping arterial blood flow.10,11 Finally, the American College of Surgeons Committee on Trauma, recommended against “use of narrow, elastic, or bungee-type devices.”7

    Medical endorsements of a product are not equivalent to scientific evidence of its effectiveness and can often be misleading for the bystander or novice.

    It must be understood that, first and foremost, tactical medicine is medicine. This means it is governed by conventional practice for implementing the employment of new equipment. The standard of care in modern medicine is built on a foundation of good evidence and scientific analysis.

    This is called Evidence Based Medicine (EBM). In the broad strokes, a new medicine, medical device or technique must be tested in a research or laboratory setting before being used on actual patients or casualties. If an acceptable level of efficacy can be established in these controlled settings then patient trials are attempted to gather data in real world applications. This data is analyzed, collated and studied to examine the success or failure of the drug, device, technology or technique.

    If all goes as planned a new standard of care is accepted by the medical community. If there is no improvement over the existing standard of care, then the idea is usually shelved until some innovation takes place. If there is a lack of positive outcomes than the existing treatments, then the findings are published as a warning to the industry.

    Medical professionals used EBM to compliment clinical judgment and common sense. Tactical medicine is no different. Tactical operations require a tiered medical response centered on matching an appropriate intervention to the level of threat and gear available. The CoTCCC and C-TECC guidelines are based in science to promote a high standard of care within this specific environment.

    Clinicians will not prescribe a new medication with a proper monogram to include understanding the possible side effects and adverse effects. The same goes for new technology and techniques. No medical professional would use an unproven medical device as part of his or her regular practice. The outcomes can be unpredictable. This could be considered malpractice and negligence. Again, there is no difference between tactical medicine and clinical medicine.

    So, what does this mean to the bystander or non-medic that wants to carry first-aid gear including a tourniquet on their person? Simple, your choices of medical devices (aka tourniquet) must be based on science and evidence; not dogmatic brand loyalty or slavish following of tactical fashion icons.

    Even with CoTCCC approved TQs, there are many instances where TQs are not applied correctly.12 Why would one believe non-TCCC recommended TQs could be applied correctly to stop arterial hemorrhage?

    Only recently, two non-TCCC TQs were evaluated against the CAT. The Rapid Application Tourniquet System (RATS) and the Tactical Mechanical Tourniquet (TMT) did not show any improvement over the CAT, and further, the RATS resulted in greater blood loss and slower application time when compared to the CAT.13 Both the RATS and TMT were able to stop arterial hemorrhage in the manikin model, but were inferior to the CAT. It should be noted that these evaluations were completed under controlled laboratory conditions.



    Would you want your paramedics or doctors working on your family to use a device that has questionable effect? Of course not.

    Would you go into battle with an unproven weapon? Not a chance. So, why would you carry an inferior tourniquet to use on yourself or your family?

    Why leave your decision in the life-saving equipment you carry to the judgment of a misleading brand ambassador or snazzy social media campaign? There is only one logical answer. Follow the evidence. Carry a proven tourniquet with proven results in combat and at home.


    http://havokjournal.com/fitness/medical/tourniquet/#
     
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  33. Medic17

    Medic17 Supporter Supporter

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    http://www.jems.com/articles/print/...l&utm_source=facebook.com&utm_campaign=buffer

    Wound Packing Essentials for EMTs and Paramedics
    Sat, Apr 1, 2017
    By Peter P. Taillac, MD, FACEP , Scotty Bolleter, BS, EMT-P [P] , A.J. Heightman, MPA, EMT P
    [​IMG]
    A wound that's deep and bloody, with bleeding that doesn't respond to direct pressure, is a good candidate for wound packing.


    One of these documents, The Hartford Consensus III: Implementation of bleeding control, recommends that direct pressure be used primarily for hemorrhage control, whenever possible.3 When direct pressure is ineffective or impractical, the application of a hemostatic agent to junctional wounds is suggested. The evidence-based guideline specifically suggests that the hemostatic agent be "delivered in a gauze format that supports wound packing."2

    Although physicians and military medics have long been trained in wound packing techniques, traditional EMS training programs haven't typically included this skill, because it's not currently included in the national scope of practice published by the National Highway Traffic Safety Administration/Office of EMS (NHTSA/OEMS).

    [​IMG]
    Pack deeply into the wound, making sure to put the gauze
    into direct contact with the bleeding vessel at the base of the wound.

    However, given that wound packing has been recommended by the Hartford Consensus and the recent evidence supports this procedure, many training programs have begun including the procedure in their curricula.

    In fact, NHTSA/OEMS has convened an expert panel to review and update the national scope of practice and wound packing is on the agenda to be considered. If approved, this skill will then be integrated uniformly into standard EMS training curricula.

    Supporting Evidence
    When the ACS hemorrhage control guideline was published, there was little human evidence to support the recommendation for hemostatic gauze. The recommendation was primarily based on animal experiments in a laboratory. However, physicians have been using wound packing as a hemostatic technique for centuries, so the empirical evidence for the technique is strong.

    In 2015, the largest case series of prehospital hemostatic dressing use was published; it included 122 patients treated by the Israel Defense Forces Medical Corps. Study authors concluded that "hemostatic dressings seem to be an effective tool for junctional hemorrhage control."4

    Incidentally, only about a quarter of the wounds packed were junctional injuries, the remainder were wounds of the extremities, back and head. Nonetheless, the authors found that there was a high rate of successful hemorrhage control (approximately 90%) in all locations where hemostatic gauze
    was used.4
     
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  34. Medic17

    Medic17 Supporter Supporter

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    When to Pack
    Simply stated, if there's no (or only minimal) bleeding, the wound doesn't need packing. Wounds of the extremities and junctional areas are amenable to packing. If a tourniquet is initially placed on an extremity wound, it may later be replaced with a pressure dressing or with packing, which may be more comfortable for the patient and provide for a moderate amount of distal circulation.

    Direct pressure will usually suffice for bleeding neck wounds. Wounds of the neck aren't generally packed because of the risk for airway compromise.

    Although the bleeding from a back wound will typically not be profuse and may be controlled with a simple pressure dressing, in the Israeli experience, wounds of the back were packed successfully.

    [​IMG]
    Maintain pressure on the wound while packing, and pack the wound tightly.
    Wounds of the chest, abdomen or pelvis shouldn't be packed because bleeding from these wounds is generally from a very deep source that can't be reached from the outside. These patients must be rapidly transported to a surgeon for operative bleeding control. Packing of wounds in these areas should therefore be performed at the discretion of local EMS Medical Directors or the appropriate state agencies where applicable.

    Wound Packing Material
    There are many choices for packing material designed to control hemorrhage. The commercial hemostatic gauze products are impregnated with a variety of substances designed to enhance clot formation, including kaolin, chitosan and others.

    In its January 2017 update, the military's Committee on Tactical Combat Casualty Care (CoTCCC) recommended QuikClot Combat Gauze as the "hemostatic dressing of choice."5

    Alternatives approved by the CoTCCC include Celox Gauze, ChitoGauze and XStat. Military medics have the most experience with Combat Gauze, as it has been widely deployed for years.

    All the hemostatic products are highly effective when used properly. Interestingly, even plain gauze (without an impregnated hemostatic agent) has been found to be highly effective.6 It's nice to know you can use plain gauze if hemostatic agents are not available to you.

    Wound Packing Technique
    It's less important to the field provider which product is used; what's more important is how the product is used.

    Step 1: Stop the bleeding. Now! Immediately apply direct pressure to the wound, using gauze, clean cloth, elbow, knee-whatever it takes to slow or stop the hemorrhage-until you have time to get out your wound packing supplies.

    Place your gloved fingers-with or without a dressing-into the wound to apply initial pressure to the target area (with your target being the vein, artery or both) and compress the source of bleeding. Keep in mind that the body's anatomy presents with major vessels running close to bones. So, whenever possible, utilize a bone to assist with vessel (i.e., bleeding) control. This will also give you an idea of which direction the wound travels and you can insert the gauze accordingly.

    Step 2: Pack the wound with gauze. Tightly! Your goal is to completely and tightly pack the wound cavity to stop hemorrhage. Begin packing the gauze into the wound with your finger, while simultaneously maintaining pressure on the wound.

    [​IMG]
    When no more gauze can be packed inside the wound, hold direct pressure on the wound for 3 minutes.
    It's critical that the gauze be packed as deeply into the wound as possible to put the gauze into direct contact with the bleeding vessel. By doing so, you're simultaneously putting direct pressure onto the bleeding vessel and allowing the hemostatic agent to do work its magic.

    Step 3: Keep packing! The key to successful wound packing is that the wound be very tightly packed, applying as much pressure as possible to the bleeding vessel. This pressure against the vessel is the most important component of hemorrhage control. This explains why plain gauze (without an impregnated hemostatic agent), when tightly packed, is also quite effective.

    Step 4: Apply very firm pressure to the packed wound for 3 minutes. This step pushes the packing firmly against the bleeding vessel and aids in clotting.

    Step 5: Secure a snug pressure dressing and transport. After applying pressure for 3 minutes, place a snug pressure dressing over the wound. You may consider splinting or immobilizing the area, if possible because movement during transport can dislodge the packing and allow hemorrhage to restart.

    Continued Hemorrhage
    Should the bleeding continue, hemostatic gauze manufacturers recommend removal of the original packing and repacking with fresh gauze. The rationale for this is that they assume it wasn't packed properly the first time, or perhaps the packing didn't quite get to the bleeding vessel.

    Prior to repacking, another option is to pack more gauze into the wound, if possible. If no further packing is possible, you must decide whether to remove the gauze and start over or simply apply as much direct pressure to the wound as possible and get the patient to a trauma center quickly. This decision should be made during transport; transport shouldn't be delayed for extensive packing and repacking of the wound.

    [​IMG]
    Apply a tight pressure dressing to the packed wound. Once the bleeding is controlled,
    consider splinting or immobilizing the area to avoid
    dislodging the packing during transport.

    Don't Be Shy!
    EMS providers aren't typically trained to put their finger deeply into wounds, so a natural hesitancy by EMS personnel is understandable. However, please keep in mind that you won't harm the patient by deeply packing a wound, you'll help them.

    The biggest mistake in wound packing is being timid. Don't be shy! Be bold! Pack that wound tightly! And, remember to also perform a complete assessment of your patient so as not overlook other life-threatening injuries.
     
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  35. Bitterroot Native

    Bitterroot Native Guide

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    Great post @Medic17! Especially the part about not being shy/timid when packing the wound.
     
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  36. Sandcut

    Sandcut Bushmaster Vendor

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    Great info Medic17!

    The one complaint that I have about the Am. Red Cross WRFA curriculum is that it just glosses over this when covering hemoststic agents. It basically states "hemostatics are to be used for uncontrolled bleeding on the head, neck and torso.". That's all it really says. The NOLS class did the same thing. Apparently the scopeof practice recommendations haven't been updated to cover this for WFA.

    As such, after a little bit of research, I started adding a brief discussion on wound packing to the class "unofficially". I hadn't run across the information that regular guaze was almost as effective. That's great to know! And yes, people in classes get a little squeamish when you tell them that they have to get their fingers down into the wound to make contact with the bleed. But, better to have them confront that feeling in a quiet, controlled situation so that it imprints on the brain rather than have them get freaked out when they need to use it.

    Thanks for sharing this.

    PS. That's a hell of a leg wound in the photo.
     
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  37. rsnurkle

    rsnurkle Supporter Supporter Bushclass I Bushclass II

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    Thank you @Medic17 for this and other informative medical threads!

    I may have to drive Northeast for my next WFA recert.

    Is wound packing the kind of task that there is some sort of hands on training task for people at the WFA-level or are people likely to be figure it after discussing and visualizing the process?
     
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  38. Medic17

    Medic17 Supporter Supporter

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    @Sandcut @rsnurkle

    Wound Packing is a very simple and effective measure at controlling bleeding from deep tissue injuries. Unfortunately it is not adequately taught or given the attention it deserves.

    Practicing can be done on a old uncooked bone in ham.

    Z Medica offers a wound packing simulator for around $300.
    Its great for teaching how to bandage deep lacerations and GSW's.
     
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  39. Sandcut

    Sandcut Bushmaster Vendor

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    Since it really isn't part of the curriculum, it's only discussed. It really isn't that difficult of a concept to envision.
     
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  40. Sandcut

    Sandcut Bushmaster Vendor

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    Thanks! I've just been cupping my hand and demonstrating with some roller guaze to simulate. It seems to get the idea across. Like I said, I don't get too eleborate since it isn't part of the training. I'm hoping that this changes with the next five year review.
     

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