Wound Packing

mycrofft said:
Yeah, the compress was included in the clot (deep traumatic incision into the bicep near the shoulder), and it was basically office surgery to get it out. But the emergent bleeding had been stopped.
Click to expand...

To me, this seems like a good thing. Presumably by the time somebody's going in to debride the site, they're in a position to enact more definitive control of the bleeding.
 
I think the "Everybody stops at the Emergency Room" deal is an outgrowth of triaging civilain ills, and the practice in the old days of MASH that once incoming were triaged, those headed for surgery needed some fluid resuscitation or a chest tube or such to be able to survive anesthesia and surgery. This allowed them to pace their entry into Surgery, and any iffy cases would die and not waste their time.


Not exactly the goal of modern civilian ED's!
 
Regular kerlix is 80% as effective as hemostatic gauze.

Also consider that if the ENTRANCE is high inquinal, theres a good chance that the wound tracked into the pelvis.

Not saying it does no good to pack it, but if you're gonna do it, don't do it half a$$ed. Either pack it or dont.

Don't mess around with it in lieu of getting them to bright lights and cold Steel though.
 
Amen.
 
Resurrecting an old thread here I know, but I'm seeing some faces in here whose opinions I would like to hear.

http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2011.01036.x/full

That is a link to a study on wound packing using some commercially available hemostatics, and the results are quite interesting. We used Z-fold Celox gauze when I was last in Afghan, as well as CAT tourniquets, Israelis pressure dressings and a few different types of chest seals.

I've see how successful hemostatic gauze can be on non-compressible and 'junctional' bleeds first hand.

So my point is thus- in light of current operational success with hemostatics and wound packing, what is the civilian consensus? Do we have a better way of managing catastrophic bleeding when urgent evacuation isn't possible?
 
Im no expert by any means (military CLS is all) but the first rule we are taught is any primary artery severance typically causes death within 5 minutes of inital trauma, with that in mind, what are the odds of a ambulance arriving within 5 minutes of a i flicted wound? Applying an exterior bandage with pressure wont stop the bleeding of those cavities of the wounds being described.
Theres alot of room to bleed into. Applying a bandage on the inside forcing the artery to stay in place were pressure can be applied will keep it from moving, and then applying more gauze to fill the cavity will create a "wicking" effect, giving the moisture some where other then the insides of the body to travel to. A little statistics from a field surgeon from my division, nearly 87% of axillary and inguinal wounds that are treated by packing gauze and improvising a pressure dressing are livable wounds.
Alas thats not the actual civilian world, thats military, but if you are intrested in "field expedient" medical care, try getting in touch with a military componet and ask them about it, 9/10 times they have a wealth of knowledge and personal experience of matters of this sort.
 
Dr. Nicholas Senn (Previous president of the AMA and Founder of the Association of Military Surgeons of the United States said in 1898 "The fate of the wounded rests in the hands of the one that applies the first bandage". 120 years later patients are still dying of hypovolemic shock from wounds treated with big bulky dressings. I think the quote should be updated to "The life of the wounded rests in the hands of the one who applies the correct tools to actually stop the bleeding".

We are currently carrying Quick Clot Z-Fold gauze for wound packing at my service, and will often use it in conjunction with an H bandage for wound compression. We also have tourniquets but like others have pointed out they will not be effective for a groin wound. Quick hemorrhage control, rapid admin of our blood products, and get the patient to the OR as quick as we can...We have seen alot of success deploying the Z-fold gauze with the H bandage on both scene and IFT flights where hemorrhage is still uncontrolled when we get to patient side.
 
Just to confirm, (excluding commercial hemostatic agents), wound packing is still not part of the national paramedic educational curriculum, nor is it standard practice in civilian EMS scope of practice for most state certifications (excluding regional protocols) correct?
 
ExpatMedic0 said:
Just to confirm, (excluding commercial hemostatic agents), wound packing is still not part of the national paramedic educational curriculum, nor is it standard practice in civilian EMS scope of practice for most state certifications (excluding regional protocols) correct?
Click to expand...

Couldn't find it in the Instructional Guidelines on the EMS.gov site. Seems like it's PHTLS/TCCC/TECC-approved. Also, looks like it's DHS-sanctioned: https://www.amr.net/solutions/feder...nces-and-resources/dhs-tactical-ems-guide.pdf see page 71
 
We were taught into my medic class but there wasn't any sort of reference for it.
 
I took ITLS last year, there was no mention of it in the class. No mention it of it under the national paramedic scope of practice model, nor any of the states procedural scope of practice models I am certified in. It would appear that this is still an "up and coming" thing for civilian EMS and still regional and agency specific. However, if it was in your PHTLS class I am really surprised it has not became more main stream.
 
We went over it pretty extensively in TCCC and ITLS, but it may be instructor dependent. Its been utilized in the military for years, its silly to not adapt it if it works.
 
Army Medic here. We're trained and train all our guys on hemostatic dressings. Wound packing of all neck, axillary, and inguinal wounds. We don't pack groin wounds, no point normally but I suppose it would be case dependent to an extent. Pack as much quikclot in as possible, hold pressure for at least 3 minutes and then wrap it with a pressure dressing of some sort. ETB, ace wrap, etc.. Technique depends on the location of the wound and believe me packing wounds works.
 
Took PHTLS recert yesterday and they addressed hemostatic agents and wound packing as accepted practice.


Sent from my iPhone using Tapatalk
 
So for more so those who find this while searching, I came across this looking for wound packing slides in hopes I wouldn't have to make them -__- But anyways reading this thread I think most people are missing the fact that this is being taught for emergency intervention prehospital. In the hospital they may wound pack or utilize other means. When I deploy I always have several tourniquets on me to include a junctional, if I have uncontrolled bleeding, I would use one of those immediately, even stateside in ambulance services hands down. However, if I don't have a junctional tourniquet or I have a GSW to a weird place, then I would wound pack the hell out of it. the notion of holding pressure and elevating makes sense on paper but in an emergency or during care under fire (police too) your not gonna sit there with your hand on a wound waiting when you have other things that take precedence which is when wound packing becomes a great alternative. Idk about others but Civilian Paramedicine does talk about wound packing, at least the school I went to. Military PHTLS and TCCC go way more in-depth with it as well to include hemostatic agents. To properly do it, its best to use something like compressed gauze or kerlix so you don't have a bunch of pieces everywhere, but you use what you have. Also, just packing a wound wont do anything but act like a sponge, the idea of it is if you know your anatomy and can find the source of the bleeding, your initial packing will be on the vessel to help potentiate clotting and then pack the hell out of the wound to give it added pressure. I cant speak for hospital protocols, but if your teaching policemen or firefighters or medics this is what I've done and seen in my experience both stateside and deployed.
 
I've been a medic since 2006 and in EMS since 2002. I had not been taught wound packing until a couple of years ago. This class was only a "local in-service training" by a commercial hemostatic agent company representative that came to our ambulance HQ. I did ITLS in 2015, and my friend did his last month at a different agency, neither of our courses covered wound packing in the lectures or the practicals. I am shocked that it's not in the ITLS courses.
 
I cant speak on ITLS or much on the civilian side. I know Pima CC's paramedic program incorporates it sparcely, but it is taught pretty in depth in the military. I know the army paramedic program has it as a skill and so does the air force's medical technician as well. We go through PHTLS Military and TCCC which also discusses the uses of it and ATLS Military as well. Its also going to probably depend on the agency you work for too as our ride alongs on the civilian side at Baltimore that's also a skill set for EMT-B and EMT-P. I mean I haven't had to do it many times in my career I almost always used a tourniquet and if I have time ill pack the wound to prevent foreign matter to get into it. There are several skills that one agencies would use or teach versus others. As far as the teaching programs it would also depend on the curriculum as well. PCC had more certs and classes than other traditional EMT or paramedic programs I've researched.
 
@Alex07, very informative commentary - thanks!

Do you generally have hemostatic dressings available for wound packing in the tactical setting? Or are you limited to the standard fabric stuff?
 
EpiEMS said:
@Alex07, very informative commentary - thanks!

Do you generally have hemostatic dressings available for wound packing in the tactical setting? Or are you limited to the standard fabric stuff?
Click to expand...

Well...im deployed right now and im fortunate to have both. Combat gauze is amazing and i have compressed gauze too. my previous deployments ive only had compressed gauze ie the ones u get in IFAKs, it just depends. stateside in our ambulance service we have both available as well. I kno besides where im at now, its pretty standard for the military to use combat gauze. we no longer use the powdered quik clot with regular gauze anymore, only plane or hemostatic gauze due to safety hazards.
 
EpiEMS said:
@Alex07,Do you generally have hemostatic dressings available for wound packing in the tactical setting? Or are you limited to the standard fabric stuff?
Click to expand...
All of our tactical medics, both on the PD and FD side, have hemostatic agents in our kits. Each of our SWAT operators also have henostatic agents (as well as other equipment of course) in the IFAKs on their kits as well.
 
You must log in or register to reply here.
Back
Top