Wound packing & Hemcon

Direct pressure is the mainstay of hemcon, but it’s one that isn’t necessarily well applied.

One of our local ERP used to accuse paramedics of using “pillow pressure” versus “pinpoint pressure.”

The difference, as the names imply, is one of location.  Pillow pressure is the tendency of responders to take a large dressing, abd pad, etc. and apply it over top of the wound, using something to hold it in place against the skin.  Pinpoint pressure, on the other hand, is to directly visualize the site of the bleeding and put pressure directly on the bleeding vessel.

Bodies don’t just spontaneously bleed.  Blood vessels are damaged or severed due to a mechanism, and bleed from the site of that damage. Putting pressure on the site of the bleeding is the way to stop it.  Putting pressure in the general vicinity of the bleed doesn’t really do much to stop the hemorrhage.

TCCC and TECC advocate the use of hemostatic dressings, but we need an understanding that the dressings (and the hemostatic agent) need to get down to the actual site of the bleeding in order for them to be effective.  Simply filling a hole with gauze isn’t going to do much.  Filling a hole with gauze that applies pressure to the vessel is going to be far more effective than a poorly placed hemostatic agent.

There is a huge amount of information on the internet about TCCC/TECC, some accurate, some not.  There are a million companies lining up to sell you a blowout kit.  There is no point in carrying a pouch stuffed full of things you don’t know how to use, especially if misuse can worsen your patients condition.

Wound packing is a simple skill, easily learned, quickly applied, and incredibly effective.  A skill everyone who may have to control hemorrhage should have.