Wound Packing - A Basic Guide
It's your worst nightmare. A friend, a family member, or a stranger has fallen prey to a terrible accident. The wound is gushing with blood and you have no idea what to do beyond the basic method of covering the injury and putting pressure on it. Still, you jump into action, grab whatever you have at hand, and try to control the bleeding. It slows but it doesn't stop. Or even worse, it's not slowing at all, and you feel like you're trying to hold back a geyser. The ambulance is on its way, but will it arrive in time to save the patient's life?
Sadly, the largest cause of preventable deaths during or after trauma is uncontrollable bleeding. Deaths that could have been avoided by the application of simple yet effective hemorrhage-control techniques. Thanks to educational programs such as Stop the Bleed, these techniques are becoming more familiar to the average layperson, but many remain ignorant of what to do during an emergency. Two important methods to remember, are the use of tourniquets and wound packing.
Tourniquets are basically a type of dressing that you tie around the limb and tighten until all bleeding stops and should be used if direct pressure on the wound isn’t enough. Or, if there are multiple wounds or victims to attend to, holding pressure on one injury is not feasible. Anything that is suitable can be used: A bandage, a belt, or a tie. Any type of strap that can be tied around the limb a few inches above the wound and tightened sufficiently will work.
When there is no or minimal bleeding, the wound does not require packing. Direct pressure to the site should be applied first in an effort to stem the bleeding. If that doesn't work, wound packing is the next step. Especially for wounds of the limbs. Tourniquets can be used to control the bleeding at first and replaced by wound packing and a pressure dressing. This will allow for a modicum of circulation to the limb or area.
Wound packing is best used on limbs, junctional areas such as the groin and armpit, places where tourniquets can't be applied, and injuries of a challenging nature where the bleeding is deeper and maintaining pressure is difficult. Wounds in the chest, abdomen, or pelvis should NOT be packed and professional help sought immediately.
The material used for packing can range from bandages to hemostatic products designed to enhance clot formation, plain gauze is perfectly acceptable and a person could even improvise with clothing. Despite popular opinion, tampons are not suitable. They are too absorbent and the key to controlling blood loss lies with pressure, not absorption.
The technique is simple: Apply immediate pressure to the wound using gauze, bandages, a cloth, or even your knee or elbow to slow the bleeding while you grab your supplies. Place your gloved fingers inside the wound to apply direct pressure to the damaged vein or artery and compress the source of bleeding. Pack the wound with as much material as you can, folded into the gap hand over hand. Once the cavity is tightly packed, create a mound over the wound for three minutes to allow for clotting. Next, apply a pressure dressing over the injury and keep the site immobile. Any movement might dislodge the dressing and undo your best efforts.
When it comes to the actual packing, it's critical to pack as deeply and tightly as possible. This is not the time to hold back as the material should put direct pressure on the bleeding vessels. Big, loose dressings such as wads of cloth or towels will only absorb blood. If the wound continues to bleed and blood seeps through the dressing, it means that control has failed and should be addressed immediately.
One option is to pack more gauze into the wound, but if that isn't possible, you are faced with two choices: Start over, or apply as much direct pressure to the injury as possible and get the patient to the hospital as fast as you can.
The most important thing to remember in any emergency situation is to remain calm. Panicking will get you nowhere and won't help anyone around you either. Neither the patient, nor any family or friends nearby. So above all, keep calm, keep your cool, and use your brain. It's the most effective tool you possess.
A Blog Post by Baileigh Higgins