# Wound Packing Training Methods and Adjuncts



## policemedic (Dec 6, 2012)

What's the best way you've found to practice packing?  What simulators, tools, or other adjuncts have you found to be useful?


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## ProPatria (Dec 6, 2012)

We've used the biggest beef roast we could find at the store.


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## Muppet (Dec 6, 2012)

policemedic said:


> What's the best way you've found to practice packing? What simulators, tools, or other adjuncts have you found to be useful?


 
D, there is a 15K "dummy" out there that bleeds and everything. I used it for USAR training a few weeks back. Able to apply T.Q.'s, pack wounds, everything. I have a flash drive that has the dummy on it and you watch it bleed from a junctional wound (groin) and the medics on there pack the wounds. Stop by the squad (143's) and I will give it to you to watch. Of course, there are other ways that I am sure people with more training that I have may tell you.

F.M.


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## policemedic (Dec 6, 2012)

I'll stop by.  I'm looking for something cheap, or even better something I can source on-site.  I may be teaching out of the area and will need to supply something we can use for packing practice.


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## policemedic (Dec 6, 2012)

ProPatria said:


> We've used the biggest beef roast we could find at the store.


 
That's what I was thinking of.  How did it work out?


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## ProPatria (Dec 7, 2012)

Pretty good. Someone would cut deep holes in the meat and place an IV tube in with fake blood in the bag. To simulate stopping the bleed someone would squeeze the bag so the 'blood' would pour out and they wouldn't stop until another person packed the wound properly. It was some pretty good training.


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## policemedic (Dec 7, 2012)

That's easy enough.  Dead cow that donated its body to science + knife + 1000cc IV bag with food coloring bolus.  

That's much better than some of the commercial simulators I've seen in terms of expense.  The simulators are ideal, but they're damn pricey.


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## Muppet (Dec 7, 2012)

So, I will ask this here since we are on the subject but I will preface it by a story: I recently had to take a TCCC course, for con-ed, taught by non-military SWAT medics. In one scenerio there was an active shooter following an IED in a night club. It was not my patient but the other EMT that was treating packed an abd. wound with combat guaze / kerlex. Now, when I took TCCC multiple times in the past 3 years, I was taught to never pack abd. / chest wounds, only junctional wounds (groin) ETC.... When I brought this up to the instructors (professionaly I might add) I was blown off and told you needed to control the bleeding no matter what. So, my question is: Do you pack abd. wounds or not? I was just thinking about this even though the class was last week after watching Blackhawk Down on t.v., again.

F.M.


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## RustyShackleford (Dec 8, 2012)

I'd say the instructors took some aspects of TCCC and "made it their own." How does packing an abdominal wound allow you to control bleeding may have been a better question.


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## pardus (Dec 8, 2012)

How can you pack an abdominal wound? Where is the bleeding coming from? You could put a ton of gauze and kerlix in and never touch the bleed. I'm just a 68W but I've never been taught anything but contain an abdominal wound.


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## surgicalcric (Dec 8, 2012)

pardus said:


> How can you pack an abdominal wound? Where is the bleeding coming from? You could put a ton of gauze and kerlix in and never touch the bleed. I'm just a 68W but I've never been taught anything but contain an abdominal wound.


 
Clamp or ligate (remembering the leave the tails hanging way outside the wound edges after closing) the bleeeder(s); cut to fit and utilize the plastic backing from a HALO chest seal dressing as a backing inside the wound and use the HALO to close the wound or staple it closed (pending your SOPs.)
,


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## pardus (Dec 9, 2012)

surgicalcric said:


> Clamp or ligate (remembering the leave the tails hanging way outside the wound edges after closing) the bleeeder(s); cut to fit and utilize the plastic backing from a HALO chest SEAL dressing as a backing inside the wound and use the HALO to close the wound or staple it closed (pending your SOPs.)
> ,


 
Thanks mate.


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## Pacer (Dec 15, 2012)

Surgicalcric...

I have great respect for you per your various contributions on this and other boards...

And my standing here is civi doc/nurse/medic only...

Wouldn't your description be most useful for a 'wall bleed', rather than an internal organ perf? Yes, damage control surgery goes much like you state, but the packing is done around the bleeding organ, not just the cavitary entrance.


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## Yoshi (Dec 17, 2012)

I am curious about ya'lls professional opinion on this - http://www.shadowspear.com/special-operations-medicine/106233-darpa-wound-statis-system.html

It seems like an amazing breakthrough for combat trauma if it works correctly. Although to my extremely untrained eye it seems as though the foam could wrap around organs. Any thoughts? *Back to lurking *


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## policemedic (Dec 17, 2012)

Yoshi said:


> I am curious about ya'lls professional opinion on this - http://www.shadowspear.com/special-operations-medicine/106233-darpa-wound-statis-system.html
> 
> It seems like an amazing breakthrough for combat trauma if it works correctly. Although to my extremely untrained eye it seems as though the foam could wrap around organs. Any thoughts? *Back to lurking *



Tagged for later. Just saw a presentation on this at SOMA in Tampa.


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## TLDR20 (Dec 17, 2012)

surgicalcric said:


> Clamp or ligate (remembering the leave the tails hanging way outside the wound edges after closing) the bleeeder(s); cut to fit and utilize the plastic backing from a HALO chest SEAL dressing as a backing inside the wound and use the HALO to close the wound or staple it closed (pending your SOPs.)
> ,



This is a good method that I second, what I teach is to clamp, then create a vapor barrier(plastic bag) then a good ole fashioned ab dressing sans tails, then a double cravat around the body. Works well. 

Ligation is a good thing if you plan on being the one who comes back to it later.


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## 8654Maine (Dec 17, 2012)

That wound stasis looks good.  Quick perusal of the stated ingredients remind me of that "Great Stuff" insulating foam.  

Better be ready to control the airway and monitor ventilation:  the diaphragm may have a hard time moving against the foam mass.

Wonder if it's flammable?


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## surgicalcric (Dec 17, 2012)

Pacer said:


> Surgicalcric...
> 
> Wouldn't your description be most useful for a 'wall bleed', rather than an internal organ perf? Yes, damage control surgery goes much like you state, but the packing is done around the bleeding organ, not just the cavitary entrance.



Actually it is meant as a means of treating mesenteric or other and organ bleeders not abd wall or cavity bleeds.  The treatment for each, while varying based on exact location of offending vessel and organ as well as the tactical situation, is based in the principles cback0220 and I noted.  Rarely in the field will we "pack" the abdomen unless we can locate the bleeder and then it's packing the bleeder, not the cavity.

OMMV, but this has been the standard in SOF medicine for quite a few years.  I would love to hear your thoughts on the topic if you have used other methods in TAC/field settings.


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## policemedic (Dec 17, 2012)

8654Maine said:


> That wound stasis looks good. Quick perusal of the stated ingredients remind me of that "Great Stuff" insulating foam.
> 
> Better be ready to control the airway and monitor ventilation: the diaphragm may have a hard time moving against the foam mass.
> 
> Wonder if it's flammable?


 
LTC King, MD presented findings from his research on this product at this year's Special Operations Medical Association Symposium.  It is essentially a binary product that is provided to the soldier in a device that looks like a dual chambered caulking gun.  The medic introduces a trocar into the peritoneal cavity and injects the two precursors simultaneously (I can't remember the total volume, but it was somewhere between 100-200cc).  Once mixed, the two precursors react and expand to something like 4.2L inside the cavity, thus creating mechanical pressure and tamponading bleeding.  

Up to this point, research has been conducted using anesthetized swine with severely lacerated livers.  The _n _is low; however, 100% of the pigs survived to 60min with no other intervention and 80% survived to 180min.  The product doesn't absorb blood, and doesn't truly stop bleeding i.e. it's not fix-a-flat for trauma patients.  However, bleeding is slowed exponentially.

The foam is able to be easily removed in the OR and has minimal effect on diaphragmatic excursion.

All in all, pretty interesting stuff.  Of course, much more work needs to be done before we'll see human trials.  I'll be following this stuff in the literature.


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## 8654Maine (Dec 17, 2012)

Sounds promising.


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## pardus (Dec 18, 2012)

Very, very interesting.


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## DoctorDoom (Jan 4, 2013)

I'm a pessimist so I can forsee a lot of problems, but it might be useful.


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