Tampons and Maxipads for first aid...

[TGS]

http://privatebloggins.ca/?p=1026

I've made these same arguments here before, but some were resistant to listen......I guess the old maxim holds true about not being an expert unless youre from outside the company...

So here is a good explanation on why using tampons and maxipads for hemmorhage control is a bad idea.

[RoyGBiv]

Thanks for the pro-tip.!! "Surface area" makes sense.

Ida gone with a tampon in a pinch. Mindset changed to "bamboo or cotton shirt".

[Suvorov]

Thanks for the timely information. I was actually thinking about adding them to my blow out kit and vehicle first aid kits.

[Drang]

I'd read that elsewhere, thanks for providing the link.

Anyone else thinking "Oh, John Ringo, no!"

[ST911]

When someone advocates tampons or pads for a GSW/BOK/FAK, ask them how well they worked the last time they used them on a bleed. Note response, or lack thereof.

[DocGKR]

I shoved Combat Gauze into the last soft tissue GSW we had here--worked pretty well, almost like it was designed to stop bleeding...

[Odin Bravo One]

I shoved Combat Gauze into the last soft tissue GSW we had here--worked pretty well, almost like it was designed to stop bleeding...

I've tossed CG to some of the women in my life when I noticed they were ultra-bitchy.

Did not work as well as I had anticipated.........

[jc000]

Wouldn't it be better to bleed out than lug around a bunch of pads???

[ST911]

I shoved Combat Gauze into the last soft tissue GSW we had here--worked pretty well, almost like it was designed to stop bleeding...

Quackery.

[45dotACP]

Well thought out article. Thanks for the link TGS!

[Hambo]

Wouldn't it be better to bleed out than lug around a bunch of pads???

Worse yet, you lose your man card posthumously when your buds find Tampons in your gear.

[TGS]

I think one of the reasons this myth persists is because of cost.

A high quality SOFT-T, chest seal and package of combat gauze can easily run you near $100, not to mention a cool bag, and all the other stuff. On the other hand, you can take your wifes tampons or maxipads for free.

You dont need this stuff to effectively treat a range GSW, though.

Pick up a $5 TourniKwik TK4, or two, and some fluffy gauze rolls from CVS.

A chest seal can be improvised from the plastic packaging the gauze is in....or the ziplock you carry the stuff in instead of a ridiculously expensive bag.

The plastic can be sealed using duct tape. Either put a roll in the bag, or even better: next time you have something packaged in that hard, clear plastic that is a PITA to open, keep the plastic. Cut it into a rectangle and round the corners. Take two long straps of duct tape and wrap them neatly around the plastic. When you get to the end, make a tail so its easy to grab.

Boom. You now have a no-shit effective GSW kit for $20 or so.

[ST911]

I think one of the reasons this myth persists is because of cost.

A high quality SOFT-T, chest seal and package of combat gauze can easily run you near $100, not to mention a cool bag, and all the other stuff. On the other hand, you can take your wifes tampons or maxipads for free.

You dont need this stuff to effectively treat a range GSW, though.

Pick up a $5 TourniKwik TK4, or two, and some fluffy gauze rolls from CVS.

A chest seal can be improvised from the plastic packaging the gauze is in....or the ziplock you carry the stuff in instead of a ridiculously expensive bag.

The plastic can be sealed using duct tape. Either put a roll in the bag, or even better: next time you have something packaged in that hard, clear plastic that is a PITA to open, keep the plastic. Cut it into a rectangle and round the corners. Take two long straps of duct tape and wrap them neatly around the plastic. When you get to the end, make a tail so its easy to grab.

Boom. You now have a no-shit effective GSW kit for $20 or so.

We make throwable/drop-kits along those lines. Variations contain a TQ of some sort, roll of ace and gauze, and tape folds for a chest seal using the packaging. Depending on the TQ selection, they run a few dollars to ~$20-something.

[Chance]

Thanks for posting this! I have heard this from numerous places, and always thought it didn't seem sound, but wasn't qualified to pass judgement.


I shoved Combat Gauze into the last soft tissue GSW we had here--worked pretty well, almost like it was designed to stop bleeding...

Is Combat Gauze even covered in basic first aid/CPR/AED classes? I haven't had a class in years, and, for a while, was actually under the impression that quick clot was dangerous until I talked with a paramedic friend - in retrospect, I don't even know where I got that piece of misinformation from.

[DocGKR]

BLS typically does NOT cover penetrating wounds; TCCC does.

[DNW]

Thanks for posting this! I have heard this from numerous places, and always thought it didn't seem sound, but wasn't qualified to pass judgement.



Is Combat Gauze even covered in basic first aid/CPR/AED classes? I haven't had a class in years, and, for a while, was actually under the impression that quick clot was dangerous until I talked with a paramedic friend - in retrospect, I don't even know where I got that piece of misinformation from.

Early formulations of Quick Clot produced an exothermic reaction (heat) that ended up creating further damage to the wound site. Current formulations do not produce heat.

Combat gauze, since it has additives to the gauze to improve clotting, is not authorized under most medical control systems, the docs that approve agencies to work, or state EMS boards, unless they approve TCCC protocols. There are few traditional EMS providers in big systems that approve TCCC as a standard. Some are authorizing it for specific units or trucks that are designated to work directly with PD entry teams for active shooter type events.

Traditional gauze can be used very effectively for wound packing for GSWs, but like Doc says, usually not taught.

[TGS]

TCCC is becoming much more popular.

If you can't invest 2-3 days into the full NAEMT TCCC course, try the 1 day version.....Trauma First Response, LE First Responder, something like that.

Look into the background of where you take it, though. IMO, it's becoming diluted, because just like the black rifle craze brought on by GWOT and everyone wanting to live out their weekend warrior fantasy, I'm seeing a ton of people with zero experience in combat/tactical background get involved with TCCC and wanting to become instructors. It's the new cool thing to do.....everyone wants to be Ricky Recon without actually joining up. These courses will quickly be diluted to the point of "entertrainment", especially with the day 3 scenario training which will almost assuredly lose its value when taught by people looking to stroke their egos......especially people who've never done this stuff besides taking TCCC and becoming an instructor through their online self-study program.

1 of the primary instructors for our TCCC course, a good friend of mine, even said he would be suspect to take the course from us.

[Chance]

Combat gauze, since it has additives to the gauze to improve clotting, is not authorized under most medical control systems, the docs that approve agencies to work, or state EMS boards, unless they approve TCCC protocols.

That's interesting. I can understand why the TCCC protocols are not approved at large, but can combat gauze not be approved outside TCCC? Is the use of combat gauze ever contraindicated, or simply not seen as necessary?


If you can't invest 2-3 days into the full NAEMT TCCC course, try the 1 day version.....Trauma First Response, LE First Responder, something like that.

I plan to. Lone Star Medics is down the road. My girlfriend and I will be attending their Field and Tactical Medicine Conference in March, and we hope to follow up with several of their classes when money allows. She took their intro course recently, and spoke very highly of it.

[Dagga Boy]

Back before Quick Clot, Combat Gauze, and all the newer bleeding control stuff, Tampons were a very viable item to have. Small, cheap, easy to use under stress for non medical personnel, etc. One of the most experienced SARC medics around used to use them extensively with his Marines. Like anything else, we have newer better stuff. With that said, in a pinch, the old Tampon stuff for small penetration wounds is better than nothing if your well set up IFAK isn't available.

[TGS]

That's interesting. I can understand why the TCCC protocols are not approved at large, but can combat gauze not be approved outside TCCC? Is the use of combat gauze ever contraindicated, or simply not seen as necessary?

Civilian EMS is extremely hard to change. In this business there are lots and lots of undereducated people with huge egos that don't like to hear there's better way to do things. Even today, it's outright frustrating to teach simple things to 20+ year medics, like to not rush to the hospital with a cardiac arrest, even though every shred of evidence we have tells us to stay on scene and work the patient; cause if we cannot get them back in their living room, then they ain't coming back a half hour later in the ED anyway.

You've also got a bunch of political bullshit, as volunteer organizations are universally opposed to advancing, as it means they'll loose their social club due to tighter requirements and higher training levels.

[drjaydvm]

They have marketed a veterinary version of the quick clot and combat gauze- I got some samples at a conference and didn't really see the need for it. Standard gauze (or any clean absorbent fabric for that matter) packed into or covering a wound COMBINED with pressure (direct or with a bandage) will control most hemorrhage that can be controlled without definitive surgical repair or a tourniquet. Cohesive bandage is great for providing pressure- it is elastic and sticks to itself- much more useful than an ace bandage. As for tampons, my assumption was that as the tampon swelled, it wound provide direct pressure inside the wound- it doesn't appear that is the case. Can anyone explain the reasoning for attempting to cover and seal an open chest wound in the field? I would think that a collapsed lung would be preferable to a tension pneumothorax if there is leaking lung tissue and no exit for the air to leak out of the chest cavity. I know it isn't quite the same, but I have been an emergency veterinarian for 15 years and have treated thousands of penetrating wounds, including gunshot wounds.

[TGS]

They have marketed a veterinary version of the quick clot and combat gauze- I got some samples at a conference and didn't really see the need for it. Standard gauze (or any clean absorbent fabric for that matter) packed into or covering a wound COMBINED with pressure (direct or with a bandage) will control most hemorrhage that can be controlled without definitive surgical repair or a tourniquet. Cohesive bandage is great for providing pressure- it is elastic and sticks to itself- much more useful than an ace bandage. As for tampons, my assumption was that as the tampon swelled, it wound provide direct pressure inside the wound- it doesn't appear that is the case. Can anyone explain the reasoning for attempting to cover and seal an open chest wound in the field? I would think that a collapsed lung would be preferable to a tension pneumothorax if there is leaking lung tissue and no exit for the air to leak out of the chest cavity. I know it isn't quite the same, but I have been an emergency veterinarian for 15 years and have treated thousands of penetrating wounds, including gunshot wounds.

Occlusive dressing are used because if you monitor the patient, you can burp the occlusive dressing to prevent a tension pneumo from developing.

A tampon swelling will not develop enough pressure to overcome blood pressure from an arterial bleed......and if it does, your patient is in decompensating shock and is good as dead. Think about it....if a tampon could swell and cause enough pressure to tamponade an arterial bleed, do you think women would be able to go about their day with them? :eek:

In the presence of a nasty bleed, QuickClot has added benefits even though proper wound packing will do as you say. How quickly will it do it, though? With Combat Gauze......quicker. If I can keep my patient from losing less volume, then I want to do that. It lowers the risk of other bad things happening....like shock...lowers complications in definitive care as well as recovery.

Continuum of care, that whole thing.

[drjaydvm]

That makes sense about the occlusive dressing on a chest wound- I was just curious. Do they make an occlusive dressing with a one way valve? Like a flat sticky Heimlich valve? The Quick clot makes sense as well- doesn't someone make a tampon shaped clot forming expanding bandage? I guess when I put a bandage or pack a wound it is to buy me a little time until I can repair it- I'm not in the field but in a hospital environment.

[DocGKR]

I am not a fan of occlusive dressings or the use of needle thoracostomy in typical urban or suburban environments--simply not needed with the relatively quick transport times involved to an ED. Rural and field conditions are a different story.

Standard gauze with pressure works, but hemostatic gauze works better; there is no downside using it and potentially a lot of upside.

[Yute]

No disagreement here, but packing at the point of hemorrhage is key (even with Quickclot gauze).

I was recently in an ex-lap for a patient with abdominal compartment syndrome that was hemorrhaging out. My trauma attending had gotten some demo QC and kinda just placed it in the general location of the bleeding without any packing. And then removed it around 5 minutes later. No surprise bleeding was still active. My attending shook his head declaring that the stuff didn't work. When I informed him that packing was needed per instructions, he accused me of sounding like a product rep and that I should work for z-medica.

Eventually we packed the patient with surgicel and surgery sponges, but not before transfusing the patient a whole lot of blood.

[DocGKR]

He didn't choose to use the product as instructed and it didn't work. Amazing. That attending is surely a bright and shining light...

[drjaydvm]

http://www.popsci.com/article/technology/how-simple-new-invention-seals-gunshot-wound-15-seconds

[Street Survival]

TGS thanks for the enlightening post.

[RJ]

Great thread.

I bought the kit below last year for my range bag, thinking either I, or someone near me, might need it, sometime.

http://www.adventuremedicalkits.com/quikclot/trauma-pak-with-quikclot.html

[Clay]

Great thread.

I bought the kit below last year for my range bag, thinking either I, or someone near me, might need it, sometime.

http://www.adventuremedicalkits.com/quikclot/trauma-pak-with-quikclot.html

That kit along with a C.A.T. Tourniquet makes a great kit to have on hand. I have it in both vehicles and in my range bag as well. I also include a couple of TK-4 tourniquets as well for good measure.

[RJ]

Great thread.

I bought the kit below last year for my range bag, thinking either I, or someone near me, might need it, sometime.

http://www.adventuremedicalkits.com/quikclot/trauma-pak-with-quikclot.html

Forgot to add, I augmented the kit with one of these shears, seem to be part of other high-end kits I've seen. They are well made and food quality.

http://www.amazon.com/Prestige-Medical-Fluoride-Scissor-Black/dp/B002WJHE7E/ref=pd_sim_hpc_4?ie=UTF8&refRID=02CRNT3MXTVBNAK50HJM

My thinking (*) was one of the things I might have to do is get through tough fabric, hence the shears.

*I am no MD, or medic or First Responder; my training is from Boy Scouts, and a 2 day Wilderness First Aide Class prior to my last trek out west as a Scout Leader.

[PPGMD]

I am not a fan of occlusive dressings or the use of needle thoracostomy in typical urban or suburban environments--simply not needed with the relatively quick transport times involved to an ED. Rural and field conditions are a different story.

I was always taught that you only needle them if they present symptoms of tension pneumothorax, which I assume in an environments with 5-10 minute EMS response would likely be their responsibility.

[PPGMD]

Forgot to add, I augmented the kit with one of these shears, seem to be part of other high-end kits I've seen. They are well made and food quality.

http://www.amazon.com/Prestige-Medical-Fluoride-Scissor-Black/dp/B002WJHE7E/ref=pd_sim_hpc_4?ie=UTF8&refRID=02CRNT3MXTVBNAK50HJM

My thinking (*) was one of the things I might have to do is get through tough fabric, hence the shears.

*I am no MD, or medic or First Responder; my training is from Boy Scouts, and a 2 day Wilderness First Aide Class prior to my last trek out west as a Scout Leader.

I've used both shears, and a hook knife. The hook knives like the Benchmade seem to go through clothes faster.

[ST911]

I like these on my shears. Pretty handy. http://www.ripshears.com/ Otherwise, my shears are nothing fancy. Bright colored to find in bags or weeds, and disposable. I use pocket knife for straps, ropes, etc.