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February 23, 2016

How to pack a severely bleeding wound

DALLAS — Proper use and application of hemostatic gauze was presented to EMS providers and medical directors at the 2016 Gathering of Eagles XVIII EMS State of the Science program by Peter Taillac, MD, Utah medical director.

The 2014 Evidence-Based Prehospital Guidelines for External Hemorrhage Control directs application of hemostatic gauze in wounds that can't be controlled with direct pressure or tourniquet. But the guideline doesn't include specific details on the training provided to paramedics to pack a wound with gauze.

Taillac described a five-step wound packing process that can be used with plain gauze or gauze treated with a hemostatic agent.

Memorable quotes on wound packing

"Paramedics are not actually trained to use hemostatic gauze. This needs to be remedied."

"Push in as much packing into the wound as you can and pack in even more."

"Medics can learn to pack the $h!t out of wounds with gauze as an additional step to stop profuse bleeding."

Key takeaways proper use of hemostatic gauze
Taillac's five-step wound packing process.

1. Apply direct pressure to the wound
Use your hand, gauze, knee, rag, or whatever it takes to "stem the flow while you get your supplies."

2. Get in the wound
Next put your hand or finger in the wound and push hard to begin stopping the bleed.

3. Pack, pack, and pack some more
Pack gauze into the wound and keep packing gauze into the wound until no more goes in. Then pack some more gauze into the wound.

4. More pressure
After packing as much gauze and more into the wound apply very firm pressure for three minutes. The combination of gauze packed into the wound and more direct pressure "will stop bleeding in almost every case."

5. Reassess, immobilize and transport
After three minutes reassess the wound for bleeding. If the bleeded has stopped start transport, obtain intravenous access and immobilize or splint the injured area. If the wound is still bleeding pack in more gauze, apply more pressure and transport emergently.

Taillac also added these important points:

  • A topical hemostatic agent is recommended to be applied in the form of a gauze and not as a powder applied directly to the wound.
  • Gauze without a hemostatic agent may be just as effective for wound packing as gauze treated with a hemostatic agent
  • Large wounds may require multiple gauze dressings to fully pack the wound. Pack in as much gauze as will fit into the wound and push in even more if you can.
  • Wound packing training needs to be incorporated into initial and ongoing EMS provider training.

Visit GatheringofEagles.us to view the presenter's slides.

Watch this video for a demonstration of wound packing with gauze.

About the Author

Greg Friese, MS, NRP, is Editor-in-Chief of EMS1.com. He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by emailing him at greg.friese@ems1.com.
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