Tag Archives: Wound Packing

More on public access hemorrhage control

Views are my own, and do not represent my employers in any way.

There is ample evidence that tourniquets work in controlling hemorrhage from extremities, and now various public bodies, including the White House, are adding their voices to a push for public access hemorrhage control:

“…make tourniquets as commonplace as heart defibrillators in U.S. schools, stadiums, airports, malls and other public places, to reduce fatalities from mass shootings and terror bombings.”

Department of Homeland Security and NAEMT have all added their voices to the call for public access hemcon and public training in hemcon techniques.

If you don’t know how to use a tourniquet, if you can’t apply one to yourself quickly, efficiently, and effectively, you are exposed to an easily controlled risk.  It’s not just hybrid targeted violence of the sort we’ve seen in Paris, Mali, Kenya, London, Madrid, but any exposure to a traumatic injury that warrants no-fail hemorrhage control measures!

More (well, some!) evidence to back up hemostatic dressings.

Unlike tourniquets and TXA, both of which have  a robust and growing body of literature to support their use, hemostatic dressings such as Quickclot, Combat Gauze, WoundStat etc have had limited published field experience to support their use.
EMS1 on Hemostatics

Blowout Kit

Blowout Kit


In US DoD studies, Combat Gauze was chosen as the agent of choice, but that decision was largely based on animal models, which are great, but provide limited value and don’t always translate well to clinical practice. Some suggest they are about 30% more effective than good wound packing with regular materials.

But here’s a study from Israel that supports their effectiveness in the field about 90% of the time!  Keep in mind that this is a small study, but it’s pretty reflective of this authors experience with hemostatics in the military setting, includes extremity and junctional injuries, and acknowledges where there are gaps in the data.

Hemostatic agents in their current form seem to be a potent addition to the hemorrhage control arsenal, and have lots of cheerleaders in the military health care community, but are not a silver bullet that will stop every source of bleeding.  Here’s hoping one of the many gels, foams, CO2 delivered TXA interventions is THE answer to the bleeding patient!

One Step Closer to our Tactical Emergency Casualty Care Course

For the past several days I’ve been working the phone lines and email tree trying to nail down a venue for our next course offering, and I think we’ve found it.  I’ll be stopping by tomorrow to ensure that it meets our needs and is cost effective for our clientele.

Our Tactical Emergency Casualty Care Course is open to paramedics, law enforcement, and Canadian Armed Forces members.  TCCC and TECC teach the same material, but to different target audiences, in a slightly different format.  While sending the 9-Liner CasEvacReq is an essential skill for a deployed soldier, there isn’t much need to teach it to a street level paramedic or police member.

What each of them does have to know is how to handle themselves if they’re injured; how to apply a tourniquet to themselves, their patient, or their partner quickly and efficiently and get back to the job at hand.  How to control hemorrhage with wound packing, direct pressure, and with a variety of bandages.  How to place an airway, on the floor, in the dark, by touch. How to move someone by themselves over smooth terrain, over rough terrain.

Tomorrow, at 1300, I find out if we’ve got our venue!

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.