- March 27, 2020
So your buddy has a puncture wound and you can’t apply enough external pressure so you pack it with gauze and the bleeding has been controlled. What would be the most appropriate ensuing steps to clean and bandage the wound if you do not have immediate access to professional medical help?
Tom RaderStaff - March 27, 2020
Great question! The reason we are packing a wound is to stop life-threatening bleeding in an area where a tourniquet is ineffective. Your buddy will ultimately need a higher level of care because there is a significant risk of infection.
While immediate professional help is preferred, your buddy would have a few hours until the risk of infection is high enough to be worrisome. That time could be extended if they have some antibiotics in their IFAK.
If there is no access to higher care, or that care would be delayed for a day or more, as you surmise, you would need to consider cleaning the wound and repackaging it. We have an article on that topic here: https://theprepared.com/survival-skills/guides/clean-wound/.
In this case, you need to be extra careful since the original injury was a life-threatening bleed, and you do not want to restart that bleed after you have controlled it. Fortunately, the areas that we would pack are relatively shallow, so after cleaning you could repack with fresh gauze if needed. In any case, I would wait as long as I could before attempting to clean to allow the wound to clot as best as possible.
Lowell - April 24, 2021
When to use a pressure/Israeli dressing?
From the article, “You can think of Israeli dressings as a middle-ground combo between plain dressings and a tourniquet.” Then there’s also hemostatic dressing also!
The First Aid for Severe Bleeding Online (Red Cross) course I just took advises a TQ for severe bleeding on an extremity, and a hemostatic dressing for severe bleeding elsewhere.
For non-severe bleeding, I figure I’ll just use regular gauze.
Where does this leave pressure/Israeli dressings? When would these be a better choice than the others?
Apologies in advance if the article answered this and I just missed it!
I’ve seen on TP and that Red Cross course that a second TQ may sometimes be necessary — would a second TQ be a better use of bulk for my FAK than a pressure dressing? That Red Cross course mentioned that an elasticized wrap tourniquet is more appropriate for children, so perhaps one of those for a second TQ?
Tom RaderStaff - April 24, 2021
Hi Lowell, bleeding is stopped by the body’s clotting process. Our job as a first responder is to lower the pressure at the site of the bleed so that clotting process can work. That could be a TQ above a massive hemorrhage, gauze packed in a wound in a junction along area, direct pressure (or a pressure bandage) directly over the bleed, etc. The goal is to use the quickest and most direct method to stop the bleeding.
Hemostatic agents are expensive “one-trick” ponies. Technically you must still reduce the pressure at the source of the bleed. What these agents do is help speed up the clotting process from whatever the active chemical is—you still have to apply pressure—just not as long. Most only speed up the process by around 30%. So if needed to hold for 10 minutes, it would just save you 3 minutes.
Pressure dressings still maintain utility. I would use them where Red Cross says to use hemostatics. You can also use pressure dressings to secure remaining gauze after packing a wound. Pressure dressings can be used as a regular elastic bandage. They are one piece of gear that can do many things. Plus if you carry the TacMed OLAES, you get the pressure dressing, wound packing gauze that can be removed from the absorptive pad, an occlusive piece of plastic that can be used for a hasty chest seal, and an eye cup. You can buy several OLAES bandages for the cost of one package of hemostatic.
A second TQ gives more flexibility with larger limbs or repositioning an existing TQ.
It is false information that CATs, SOFTT-Ws, and other Committee approved tourniquets cannot be used on kids. They can be used on any limb that the backing can wrap around. TQs are not needed on babies. And dogs have tapered limbs that need a different shape.
I hope this helps. You may want to look into a “Stop the Bleed” class as well—that material is based on the current recommendations from the committees that define policy for combat/tactical medicine.
Lowell - April 24, 2021
Thank you for your response Tom!
It’s concerning that the Red Cross course had misinformation about TQs on children.
Would you be able to link me to the OLAES bandage that you use? I’ve got this one for $10, and have this QuikClot for $15, which doesn’t line up with being able to buy several of the former for the cost of a single of the latter.
Tom RaderStaff - April 24, 2021
My bad, I thought you were talking about a full gauze pack like https://www.amazon.com/dp/B009EJUFDA/
Even so, at TacMed, the OLAES is $6.95: https://www.tacmedsolutions.com/OLAES-Modular-Bandage so you could get two for $15.
There are a lot of variables to consider when stopping a bleed. Depth of wound. Location. Severity of bleed. Co-morbidities (diabetes, hypertension, clotting disorders, etc). In actual use on bleeders, we still teach to hold for 10 minutes—no reason not to and a shorter time encourages the rescuer to “peek” which involves releasing the pressure.
Also the instructions on the package still say to wrap the wound after the three minutes—so you still need other materials… The pressure bandage does all that for you… 😉
It looks like the use case for that specific QuikClot is a small uncomplicated wound that is not bleeding severely. The one I linked above is more appropriate for a severe bleed.
Lowell - April 25, 2021
Oh no, I thought I grabbed this QuikClot from some TP guide! I’ll review my kit and re-evaluate.
Thank you again for your time Tom
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