Last week we discussed why learning to pack a wound is an essential skill for stopping life threatening bleeds. If you haven’t seen it yet, I recommend giving the article a read so you’ll better understand what we’re talking about in this one.
Tourniquets save so many lives due in part to how simple they are to apply. Wound packing is equally simple and arguably just as important as TQs.
In this article, we’ll be looking at how to pack a junctional wound for maximum effectiveness. Since wound packing is always used in conjunction with a pressure dressing, we’ll take a close look at gear like the Israeli Style and OLAES bandages, and how to apply them in next week’s article.
Expose the Wound!
If you can’t see the wound, you’re going to have a hard time packing it. I’m not saying it can’t be done, emergency medicine happens in rough conditions all the time and sometimes you just need to suck it up and push through.
But, if you can, get eyes on what you’re working with so you can make the best decision. Once the severity is known, we can make a judgement call of its lethality.
The more information we have about the situation, the more efficient (and more correct) we can be in our decision making. Ask yourself, and anyone listening (especially the casualty) these questions:
- How was the casualty injured? In EMS, this is known as the “mechanism of injury.” If you know this and understand basic trauma medicine, you have a wealth of information available to you. The Emergency Trauma Response Training Course is short, free, and a great place to start.
- Where is the wound located? Over an artery location like the neck, or inside of the thigh should be taken seriously. If the wound is on an arm or leg, consider using a tourniquet first.
- Is there blood? How much? Not every life-threatening wound will bleed, others will bleed so bad you’ll think someone turned on a faucet. The average human body contains about 5 liters of blood, but that can be hard to visualize and if you don’t understand what shock is, you’re at a disadvantage. The course linked to above goes into all this in more detail than I can get into here, so please check it out.
- What type of wound is it? This can change how you decide to pack the wound.
If you’ve determined this wound is best treated with packing and have access to a trauma kit, medical gauze or even better, hemostatics, work best but if you don’t have any a strip of t-shirt or something similar will work in a pinch.
Make a “Power Ball”
Some people like to the roll the end of the gauze into a ball, but I prefer to tie quick simple knot in the end for my power ball. This ball is useful for getting additional pressure right on top of the bleeding artery. Look into the wound and try to identify the exact location of the bleed so the ball can be placed right on top.
Good technique here means that you need to “Pack Towards the Heart.” This is because the severed end of the artery closest to the heart is where the bleeding needs to be controlled.
Pack the Wound
While maintaining continual pressure, firmly pack as much gauze into the wound as you can get into the cavity. Long lacerations might require you to taco fold the gauze into the wound then hold firm pressure with finger tips.
The size of the wound determines how much gauze you’ll use. Large wounds might require multiple packages of gauze so having extras is good.
Pile the remaining gauze on top of the wound and hold firm, direct pressure over the wound for at least 3 minutes if you’re using a hemostatic like ChitoGauze or QuikClot, or for at least 10 minutes if you aren’t.
Secure with Pressure Dressing
Wrap the injury snug, but not tight, this is a pressure dressing, not a TQ. If you need a TQ, you should use that instead.
With nothing at all, just continue to hold direct pressure over the wound until EMS arrives. If there are other casualties who need your help, you are authorized to delegate this to the casualty or a bystander when possible and if they can be trusted.
Continue to check on the wound often until EMS can arrive to take over. If you see blood seeping through the bandage, the bleeding is uncontrolled and you should upgrade to a tourniquet immediately, if you have one.
Don’t remove the pressure dressing or pull out the gauze to check to see if bleeding is controlled, or for any other reason. If you do, you risk pulling out the clot you worked so hard to put there. Just let the trauma surgeon deal with that, your job is done.