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Wound Packing is a pre-hospital procedure used in massive hemorrhages. The use of direct pressure and tourniquet for bleeding is the most intuitive,relatively simple and frequently performed procedure. In the case of bleeding from the extremities, the standard is the use of an external dressing or tactical stasis or an improvised tourniquet.
However, the situation is more difficult when the wounds are located at anatomical junctions of the limbs with the torso, i.e. groin, perineal area, armpit, shoulder, and areas too high for a tourniquet or within the joints.
In these areas, we are unable to effectively place a tactical stasis or apply an external tourniquet.
Massive bleeding from wounds in these areas is most often associated with damage to large caliber deep blood vessels. e.g. common iliac artery, femoral artery, subclavian artery. External pressure in these areas is often ineffective.
In these areas where a tourniquet cannot be applied, the solution is the Wound Packing technique.
1. Immediately apply direct pressure to the wound. You can use your fingers, hand, elbow or knee to apply pressure depending on the area of the body. While applying pressure, prepare wound packing materials from the first aid kit.
2. Once you have the wound packing materials you need, gather a few inches of dressing under the index finger of one hand and insert it into the wound by feeling the bottom , while maintaining direct pressure with the other hand. Continue packing the wound until you can't insert any more dressing into the wound.
3. After packing is complete, apply very firm pressure to the wound for ten minutes.
4. After three minutes, apply a pressure dressing to the wound and brace the injury site to make sure the packing does not move during transport.
5. If the wound continues to bleed after reassessment, and hemostatic agents are available, it is recommended to remove the bloody dressing and insert a fresh one coated with hemostatic agent into the wound. The reason for the congestion of the first dressing can be attributed to a wound that is not properly filled with a dressing that is not inserted deep enough.
Remember, however, that injuries: chest, abdominal and pelvic should not be packed! These injuries are usually very deep and cannot be reached from the outside. Most of these types of injuries require surgical intervention, so the wound should be superficially tended by a pledget dressing ( chest wounds) or a moist dressing (evisceration , abdominal cavity) and the victim should be transported to the operating theater as soon as possible.
