The use of manual pressure to stop bleeding is one of the most immediate ways to control hemorrhage and save a life. With this technique, manual compression is applied directly to the wound. Pressure must be applied firmly and consistently to help blood clot formation. If something is being used to compress the wound, such as gauze or cloth, and it becomes soaked with blood, pressure can be briefly halted in order to add more items for compression. Pressure should be quickly resumed. Pressure can be applied inside larger wounds directly on the site of bleeding. It is important to apply pressure directly onto the bleeding vessel, if identifiable, as this is the most effective way to control blood loss.
If holding pressure does not stop or sufficiently slow the bleeding, packing the wound can also provide direct pressure to sites that may not be as easily accessible or amenable for adequate pressure application with one’s hands. With large, deep wounds, the cavity can be packed with clean gauze or cloth. When introducing packing material into the wound, it is important that the wound is packed as tightly as possible for adequate compression. Even when it does not seem as if more packing material can fit into the wound, continue to try adding more. Try to keep count of how many individual pieces of packing material are packed into the wound, so that at the time of definitive management and removal of packing material, individual pieces are not unintentionally left behind. Once all of the packing material has been placed, more manual pressure can be added on top of the packing with one’s hands. Firm packing and pressure significantly help with stopping bleeding.
Why pressure and packing?[edit | edit source]
Secondary prevention, which is defined as the reduction of the impact of an injury after it has already occurred, is one of the key aims in teaching prehospital providers how to provide precise and adequate hemorrhage control given that hemorrhage is such a widespread cause of potentially preventable early trauma deaths. The impact of secondary prevention on external hemorrhage is evident in the fact that hemorrhage is often first identified at the scene of the injury, and prehospital personnel with a variety of skills in hemorrhage control techniques can prevent ongoing blood loss leading to hemorrhagic shock that is irreversible by the time of arrival to hospital. Early interventions without increasing transfer time to a hospital are the keys to increasing the success rate of the other strategies used in damage control.
Pressure and packing training is not provided in Guatemala for first responders, as is any other bleeding control training. Since pressure and packing are often used as first measures to stop the bleeding and, if done correctly and when sufficient, can avoid the need to place a tourniquet, we added it to our integrated module of ways to cease hemorrhage in pre-hospital care and potentially avoid unnecessary, avertable deaths in low- and middle-income countries.
References[edit | edit source]
- Davis JS, Satahoo SS, Butler FK, et al.. An analysis of prehospital deaths: Who can we save? J Trauma Acute Care Surg 2014;77:213–8. 10.1097/TA.0000000000000292
- Valdez C, Sarani B, Young H, Amdur R, Dunne J, Chawla LS. Timing of death after traumatic injury: a contemporary assessment of the temporal distribution of death. J Surg Res. 2016;200:604–609
- Butler FK, Holcomb JB, Giebner SG, McSwain NE, Bagian J. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007;172 (suppl):1–19
- Bleeding Control Using Hemostatic Dressings: Lessons Learned Brad L. Bennett, PhD, EMT-P, FAWM WILDERNESS & ENVIRONMENTAL MEDICINE, 28, S39–S49 (2017)
- Meléndez-Lugo JJ, Caicedo Y, Guzmán-Rodríguez M, Serna JJ, Ordoñez J, Angamarca E, García A, Pino LF, Quintero L, Parra MW, Ordoñez CA. Prehospital Damage Control: The Management of Volume, Temperature… and Bleeding! Colomb Med (Cali). 2020 Dec 30;51(4):e4024486. doi: 10.25100/cm.v51i4.4486. PMID: 33795898; PMCID: PMC7968431