So I packed a roast with gauze today in training

[BehindBlueI's]

During a 2 hour refresher on our blowout bags we were introduced to wound packing. We were told to pack wounds in the arm pits, pelvis, and in limbs if two tourniquets failed to stop the bleeding. For practice we had some roasts that were shot with .40 hollowpoints. I was rather surprised how much gauze I got into the wound channel. The roast was not screaming at the time, which likely helped.

Supposedly we're one of the first PDs to get this within our scope of training. It's already been used unofficially by former combat medics on the department on at least two incidents so I guess they figured since some guys were doing it anyway, it worked, and the local ER docs were cool with it we might as well make it official. There's things I bitch about on my department, but the training isn't one of them.

[jnc36rcpd]

I'm apparently the new TECC instructor for my department. I confess that I found the concept of stuffing gauze or a hemostatic agent into another person's body rather gruesome. That said, we don't have to like it. We just have to do it. During our last TECC training, the instructor sprayed red food dye on us as we worked on downed officers. I think the roast idea is excellent.

[HCM]

We did wound packing in TCCC training provided via HIDTA and the TX ANG. They used a wound simulation dummy which 'bled' water with red food dye. For the final excecise it also moves. They're not cheap but in the long run I think roasts could get expensive.

[Duelist]

Interesting technique. Messing around with large amounts of real meat grosses some people out. Any special type of gauze?

[BehindBlueI's]

Interesting technique. Messing around with large amounts of real meat grosses some people out. Any special type of gauze?

Regular roll of gauze for training, this for real: http://www.celoxmedical.com/usa/products/celox-gauze/

[Wayne Dobbs]

Interesting technique. Messing around with large amounts of real meat grosses some people out. Any special type of gauze?

So...if they get grossed out by "real meat" how do you think they'll do on "real" human meat when hard times come?

[SLG]

I'm happy to say that we have been doing this for many years here, though mostly (only?) for the tac guys. 10 years ago the pig labs became popular, and they are really excellent. I agree with your point BBI, that if the roast was screaming, things would be harder. The pigs that I have seen are almost bled out, so there seems to be less screaming and kicking then there might be. How about intubating a conscious person? :-)

[Failure2Stop]

I'm happy to say that we have been doing this for many years here, though mostly (only?) for the tac guys. 10 years ago the pig labs became popular, and they are really excellent. I agree with your point BBI, that if the roast was screaming, things would be harder. The pigs that I have seen are almost bled out, so there seems to be less screaming and kicking then there might be. How about intubating a conscious person? :-)

I just take my shirt off and hook up a catheter.

[SLG]

I just take my shirt off and hook up a catheter.
This isn't a job interview...:-)

[Nephrology]

I'm happy to say that we have been doing this for many years here, though mostly (only?) for the tac guys. 10 years ago the pig labs became popular, and they are really excellent. I agree with your point BBI, that if the roast was screaming, things would be harder. The pigs that I have seen are almost bled out, so there seems to be less screaming and kicking then there might be. How about intubating a conscious person? :-)

I *definitely* would not want to intubate a conscious person... fortunately that's why they have etomidate and roc. I would not try to place an ET tube if you don't have the training/don't have RSI drugs. NPAs are probably much easier/more appropriate for field use.

re: Wound packing that's not something I've ever seen our EMTs do. Wonder what it would be indicated for.

[SLG]

I *definitely* would not want to intubate a conscious person... fortunately that's why they have etomidate and roc. I would not try to place an ET tube if you don't have the training/don't have RSI drugs. NPAs are probably much easier/more appropriate for field use.

re: Wound packing that's not something I've ever seen our EMTs do. Wonder what it would be indicated for.

We used to shove nasal airways up each other's noses for fun at training. not so much fun...

Packing is for penetrating trauma that you cannot tie off. Hips, groin, underarms etc..

I don't know of the doc is messing with us or not...if I missed the sarcasm, forgive me.

[BehindBlueI's]

I *definitely* would not want to intubate a conscious person... fortunately that's why they have etomidate and roc. I would not try to place an ET tube if you don't have the training/don't have RSI drugs. NPAs are probably much easier/more appropriate for field use.

re: Wound packing that's not something I've ever seen our EMTs do. Wonder what it would be indicated for.

EMS is so heavily regulated, it often takes the a looking time to do new things.

[JCS]

Wound packing in the field is going to be very messy. There are some really cool videos out there of celox and other clotting agents and the difference they make. Our ems chief once told us a story of some training he did a long time ago. It's obviously not allowed anymore because of peta etc but they were split into teams and given a goat. someone stabbed to goat in front of them and they had to keep it alive for as long as possible. Most realistic training you could get. It's just hard to simulate it but it's a critical skill to know.


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[BehindBlueI's]

Wound packing in the field is going to be very messy. There are some really cool videos out there of celox and other clotting agents and the difference they make. Our ems chief once told us a story of some training he did a long time ago. It's obviously not allowed anymore because of peta etc but they were split into teams and given a goat. someone stabbed to goat in front of them and they had to keep it alive for as long as possible. Most realistic training you could get. It's just hard to simulate it but it's a critical skill to know.


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Well, I wouldn't say it's not allowed. I would say the places that do the "goat hostage rescue" are smart enough to maintain a veterinary license and to not advertise it much outside the circle of those it's intended for.

[Hambo]

For practice we had some roasts that were shot with .40 hollowpoints. I was rather surprised how much gauze I got into the wound channel. The roast was not screaming at the time, which likely helped.


You guys shoot a lot of roasts in the streetz? ;)

Sorry I couldn't resist the dickish remark. You're getting training, which is cool.

[Duelist]

So...if they get grossed out by "real meat" how do you think they'll do on "real" human meat when hard times come?

My point, which I'm sure didn't come out right, is that the training these guys are doing on real, bloody, shot-up meat instead of training dummies could de-sensitize people to the realities of sticking their hands into a bloody, chewed up mess of real flesh, so when the hard times come, they can deal with it and get the job done.

I had a buddy last fall all excited to come out and help me bring in a deer, but when it came time to do the cutting, all he would do was hold the antlers or the legs, or hold open the game bags. It was helpful, but would have been done faster if he'd been willing to get bloody, too.

My daughter doesn't like handling raw meat, and bones in cooked chicken makes her nauseous. It's weird to me. Maybe I should have done what my dad did, and butchered chickens and rabbits and pigs in front of her when she was small.

[MD7305]

I went through some training a couple years ago and the instructors used a roast with tubing ran through it. Using a pump bulb the pumped blood (fake, I think?) through the roast while you were packing the wound. It was to teach you to apply pressure to the artery while you pack. It really opened my eyes. Having blood ooze from the wound while was packing added a degree of stress. These instructors had all kinds of blood pumping moulage of various injuries. That added some stress in scenarios to have squirting blood, etc. The head instructor was a career PJ and he was a treasure trove of knowledge.

[Pennzoil]

Thanks for sharing this idea of using the roast.

I've been doing training with the family getting my young daughters (6&8) used to using the gear my wife and I carry. I'm going to use this in the near future with them. I've been using a bunch of fake blood when we train and they are used to it now but I didn't have a good way to do wound packing. All the simulation training kits for this are just to pricey in my eyes.

[ST911]

Wound packing for hemostasis is increasingly common curriculum, but there are still pockets of resistance and ignorance. Teaching it to public safety, citizen, and medical groups, many had never seen it before nor were aware that it was within the layman's scope of practice. It is the only answer for those junctional bleeds that can't be managed with direct pressure or a TQ. I also teach it as part of TQ conversion for groups wanting or needing that skill. Clinical providers often confuse packing for hemostasis with packing for long term wound management, which is commonly done by nurses or a higher level providers.

Packing can be quite messy, and students need as realistic practice as they can tolerate. Old meat, warmed to room temp or better, wooden dowel or PVC run through for bone, with lines hooked up to turkey basters or squeeze pumps is a great expedient tissue simulant. Purpose-built plumbed limb sections are commercially available, but there's no substitute for meat.

[Sir Guy]

Did the same thing a few weeks ago for some in-service training. Definitely good to maintain familiarity with the kits...even if it is at the expense of a good roast!

[TGS]

I'm glad to hear that med training and equipment is being disseminated throughout your guys' agencies.


I *definitely* would not want to intubate a conscious person... fortunately that's why they have etomidate and roc. I would not try to place an ET tube if you don't have the training/don't have RSI drugs. NPAs are probably much easier/more appropriate for field use.

re: Wound packing that's not something I've ever seen our EMTs do. Wonder what it would be indicated for.

The way its typically taught in military/LE is when tourniquet(s) fail to control bleeding, or a wound that cannot accept a tourniquet.

At least in an urban EMS setting, wound packing may be counterproductive for most situations. The trauma center is usually close enough that most GSWs can be treated with a gauze 4x4 or gloved hand...packing would waste time on scene, and also waste time for the trauma team. That whole team approach, thinking about the continuity of care thing. There was one particularly nasty chainsaw vs leg that was pretty big, so the guys packed it (I have no knowledge if it was properly packed). About 1 minute from hospital it turned into a code, and we all know how trauma codes turn out......

[Nephrology]

About 1 minute from hospital it turned into a code, and we all know how trauma codes turn out......

15 seconds of CPR followed by a miraculous ROSC and a touching scene between family and provider before the credits start rolling?

[45dotACP]

Lmfao, the only ones I've seen ended in death threats by "cousins" with face tattoos...

So glad I don't work in ER...especially now it's warming up in Chicago :D

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[Nephrology]

Lmfao, the only ones I've seen ended in death threats by "cousins" with face tattoos...

So glad I don't work in ER...especially now it's warming up in Chicago :D

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All of the ones I've seen end with emergent thoracotomies, pressure bags of blood via IO that are then followed by pronouncement in the OR.

[45dotACP]

All of the ones I've seen end with emergent thoracotomies, pressure bags of blood via IO that are then followed by pronouncement in the OR.
That trauma 1 life tho...If you like trauma, you'd love it here.

Last weekend 6 gsw cases and 2 MVAs rolled up within 30 minutes of each other...I was told at least one was a bilateral thoracotomy that had to be done in the trauma room....

[Nephrology]

That trauma 1 life tho...If you like trauma, you'd love it here.

Last weekend 6 gsw cases and 2 MVAs rolled up within 30 minutes of each other...I was told at least one was a bilateral thoracotomy that had to be done in the trauma room....

I'm already at an ACS Lvl1 Trauma Center for my preceptorship - though can't say I've ever seen 6 GSWs and 2 MVAs happen within 30m. We got a mass casualty event from a house fire a few weekends back - ET tubes flyin left and right.

[45dotACP]

Yeah, Chicago's southside is the mass casualty event of the Midwest lmao...but burns are hardcore dude...we don't even have a burn unit to take em as far as I know.

Off to shoot...Keep on doing good work man! Check your own pulse time to time :)

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[Duelist]

Bought a roll of Celox to stick in the kit today. Going on a week-long camp with the scouts next week, and saw it at the store, and said, I probably should have that.