The couple times I have seen someone apply direct pressure to a wound to stop bleeding, they improvised and used some sort of cloth. A beach towel one time, and I think a blanket the other.

What is the official thing to use? Gauze? I tend to think of gauze as a wound dressing, being absorbent, and maybe a little hard to handle for a big bleeding wound. Are there better options? Or is gauze just the obvious answer?

Thanks!

David

The absolutely best thing would be a sterile gauze pad, but if the bleeding is severe and copious, anything will do. I generally EDC a cotton bandana which could be used for this purpose if the bleeding is really significant. Hopefully you will have a glove or some sort of blood barrier on your hand if you are dealing with a situation like this.

My first EMT instructor, a Navy medic, once rode along to the ER with an accident victim, clamping a major blood vessel in her neck all the way. This was in the days before gloves were in common use.

... and make sure not to remove the "dressing" - leaving that to medical professionals.

Use what you have. Gauze is the official thing - yes it absorbs, but by holding the blood it allows it to start clotting. Blood that flows doesn't clot ...

Combat gauze is the new and greatest in the military. Gauze impregnated with a hemostatic agent.

As to the 'how,' I use my hand and push really hard.

+1 on what they said. My FAK has lots of 4x4 and 5x9 gauze pads. Could one of the more experienced here comment on cleaning the wound.

As I recall, once the major bleeding has stopped, the wound can be cleaned of any foreign material and irrigated with lots of drinkable water -- an irrigation syringe is useful. Then the wound can be covered with a clean dressing. Comments?

I keep a clean hanky and a microfiber towel in my bag. Both will serve in a pinch. no reason to carry gauze at all IMO.

Never done that. The emphasize was on stopping the bleeding,doing a thorough survey, ABC, etc, and stabilizing the victim. The victim was on his/her way to the ER pronto. WE did remove large boulders and tree branches from the wound, however. I can't recall ever irrigating. It would certainly be different if you were a long time from definitive care.

I carry a small FAK in my backpack which includes nitrile gloves, 4x4 & 5x9 gauze, an irrigation syringe and other goodies. The microfiber towel is for me to clean up. That said, a clean T-shirt or towel can be used in a pinch.

I s'pose that's one of the differences between Red Cross first aid and wilderness first aid. The irrigation syringe was high on their list of things to have. I've had a syringe in my FAK but really didn't understand why until the WMI FA course.

I see valid responses all over the board here from different contexts:

almost any absorbent cloth will do for direct pressure when you have EMTs and an ER in the near future. This includes home and auto accidents, SAR extractions etc. In fact in a pinch direct pressure without gauze or bandana will do, although really recommend gloving up first. Cloth can help with comfort for the patient with a bleeding wound you're pressing down on, and I believe it can promote clotting. FWIW I can't imagine not going in without some sort of cloth in my hand, my t-shirt even, and only rethink if the bleeding is excessive in which case I'm focusing on direct pressure or nearby pressure points to control bleeding. TQ is also an option then, though my gut is most bleeds will respond to pressure.

in WFA 24 hrs+ from the trail head and ERs and EMTs, they teach using gauze and direct pressure, and when one pad gets full put another pad on top (don't remove the soaked gauze, as some clotting may have occurred), and keep the pressure on, repeating as necessary. At a certain point there may be a decision to move to or supplement direct pressure with pressure points, or add or replace with a TQ but the most likely outcome is direct pressure reduces the bleeding sufficient to bandage up. You still work through your options in order - direct pressure, pressure points, then TQ if wound is on a limb. If you don't have an EMT or ER in the immediate future, control bleeding, irrigate wound, bandage, and continue wound care until you evacuate to medical assistance.

The key is the pressure. The bare hand is just as good as anything else. The problem is that you will probably want your hand back at some time or another. In my early days on an ambulance (before the EMT existed) I often used my hand directly. It is lots better to use something else, mostly because as the bleeding slows you can wrap the gauze, towel, etc. without removing the pressure. Most of the time we used gauze pads or kotex and Ace wraps. Hold the pad while you apply the Ace. The big advantage of combat wraps (before clotting agents) was that you could apply pressure without keeping your hand in place (you might want it for other reasons).

The sterile pad is also good because it doesn't add anything undesireable to the wound.

Respectfully,

Jerry

I'm not sure how effective the clotting agents are. I was watching a cooking show and one of the chefs chopped off the tip of her finger. They put a powder on it, presumably a clotting agent, and it still squirted. Eventually they resorted to bandaging and the show continued.

Perhaps it was not a clotting agent (or a GOOD clotting agent), or perhaps fingertips don't have enough surface area for it to work well.

Of course, just because it was on TV, even a 'reality' show, does not mean it was a reliable source of information...

What I have been told by a paramedic and former combat medic is that Combat Gauze saves lives. I've never used it myself.

Fingertips are tough cuz the shape makes it hard to get good pressure on the wound, and the injury is often an avulsion rather than a laceration-a piece is missing, and lots of little vessels are bleeding. There is a product called tubegauze that permits good pressure and an esthetically pleasing finger dressing. Sometimes it is little too effective, and the resultant pressure can cause damage to healthy tissue. The most elegant solution to big vessel bleeding is to reach in with a hemostat-that little locking forcep that emt's and nurses clip to their uniforms- to reach in and clamp the vessel. That's how the device got its name hemo/blood+ stasis/halt= hemostat. Usually followed by tying off the vessel with a suture. Usual disclaimers: don't try this at home, use only those techniques for which you have training...

My experience has been almost all before clotting agents were available. Mostly in backwoods/wilderness settings, we saw mostly trauma generated from falls, plane and auto crashes, etc. I do recall some gunshot wounds. One of the bloodiest incidents98 was a virtual arm amputation (the victim walked into a spinning rear rotor).

Direct pressure always worked; I can't recall even using pressure points. Never even thought of applying a tourniquet. Battlefield injuries are a different kettle of fish, and it does seem that clotting agents are useful. For what i might face going into the woods, i am confident that I can get along without clotting agents.

Browsing in REI the other day, I read the directions on a packet of Quik-Clot. Basically, it said to apply the product to the wound and then apply direct pressure (!). For my likely situations, I am comfortable packing more gauze pads and ace bandages, omitting clotting agents. Versatility is highly desirable in a backwoods FAK.

I use gauze pads, sometimes many, but the bigger the bleed the more you need. I have a few individually wrapped sterilized gauze pads in all my FAKs, but I also carry bandanas and maxi pads in all my kits, not only for their intended purposes but also for big bleeds. (They work great for splints as well.)

I got a pretty good cut this on my thumb webbing this summer, and the first thing I had on hand (LOL!) was my bandana. Worked great for immediate pressure!

The missing fingertip is a tough one for hemostatic agents. I've taken my fingertip off a couple times, pretty much direct pressure and let it bleed til it wants to clot. As a PA buddy of mine likes to say, "all bleeding stops." Of course, he has a dark sense of humor!

A comment on gloving before applying direct pressure. Do It!
I was working on an open heart team in Georgia roughly 25 years ago and went to a blood born pathogens talk. The infectious disease doc speaking told of a nurse who applied direct pressure to a spurting wound in a local E.R. She later was diagnosed with HIV. She apparently contracted the virus through unbroken skin. She had no other risk factors for HIV.
I was walking down the hall of a telemetry nursing unit a couple of years ago and saw an elderly woman sitting on the side of her bed. She was naked, had pulled her Foley catheter, surgical dressing, and I.V. out and was smearing the blood from her arm on her body, face, hair. I ran in and applied direct pressure to her arm with her discarded gown while calling for help. Before the nurses got there, she managed to scratch my knuckle with her fingernail and break the skin. We both had blood drawn for antibodies and, fortunately, she was negative for anything of significance. If I had gloves available and wore them, I would have been saved the worry.

+1 on gloves. Since taking the WFA course I've started to EDC a pair of nitrile gloves loose in my right thigh pocket -- very accessible. My various FAK''s all have 2 pair. In a first aid situation the gloves will be on before first contact.

What is the risk (to the patient) of using non-sterile gloves?

Sorry if I was misleading and hijacked the thread.

I totally agree with wearing gloves, my statement was to indicate that pressure is pressure. The gloves protect you, they (and the gauze) do not help the pressure, they are for other reasons. The bare hand works just as well for the pressure, but it does not protect you (or the patient). I keep gloves in all my kits and in my EDC bag.

Do remember to replace gloves, on a regular basis. Especially those subject to heat and light. They do deteriorate, especially latex ones but nitrile as well.

JHertig,

Unless you carry sterile gloves packaged in sterile packaging, there is no difference. It depends on how and where you have been carrying them. Outside the operating room I have seen very few sterile gloves. The patient is probably better off if you carry non-powereed gloves, but in an emergency I would use them over no gloves.

Respectfully,

Jerry

In a non-sterile situation, which is just about anything you will run into short of an OR, there is no way to get anything else sterile so clean is probably far more than adequate.

Yep, what ILBob and JerryFountain said. The initial use of the gloves is to check the person's pulse and then for bleeding which may not be apparent. By the time that check is complete the gloves will be much more contaminated than the inside of my relatively clean pocket.

Didn't read through the replies so if I'm duplicating....sorry.
ACE bandage. Sorry.....elastic bandage. Whichever one.... it is good.

I'll have to check out different gauze pads. I always pictured them being sort of flimsy and maybe too absorbent, rather a firm fluid barrier. But I'm sure there are good options out there.

David

I carry compressed gauze, triangular bandages, and a tourniquet. The tourniquet can be used to maintain the pressure without actually tightening it enough to cut off circulation. It helps to free you hands while you get more gauze or dial 911!

"She apparently contracted the virus through unbroken skin"

that's troubling. first time I've heard that.

Pete2

"that's troubling. first time I've heard that"
Yes, that was troubling to many of us. The I.D. doc couldn't come up with any other means of transmission.

Maybe a little off-topic, but what would you guys recommend to stop major bleedings:

"Chemical" solutions like Quikclot and other clotting agents, or rather "physical" ones like the Israeli bandage or tourniquets, that work by applying pressure?

I could imagine that the "normal" bandages are more rugged when still wrapped, and even if their expiration date is up, they should still be sterile and thus usable as long as the packaging is intact.

Chemical agents, on the other hand, might really not be as effective when they expire (I have no idea), and I guess extreme storage conditions like in a dark backpack under direct sunlight might have negative effects on them (again, no idea).

I know that most kits have a combination of both types, but what if you had to choose?

Cody, I can count on having my hands with me and don't need instructions on their use. If I have a sudden Major bleed to handle, I'll apply direct pressure; with my bare hand if necessary, while I look around for something to protect me and better control the bleeding. If the bleed is not major, I'll move a little slower and grab something such as a glove or glove/gauze pad to use. If what I have to use requires I read instructions, I'll probably go with the glove/gauze pad.

Depends on the expected us. I never had to use such bandage. Just lots of gauze or gauze rolls will take care of all common injuries. The Israeli bandage or quickclot are more for gunshots or other very large wounds/bleeds. Tourniquets are not for directly on a wound and wrongly used can cause more harm than good.

Time is of the essence, especially with copious bleeding - use your hands and clamp down (glove up first, if possible). I have worked a fair number of accident scenes with major bleeding, and DP has always worked quite well.

What instruction did you receive in FA class? That is always good to follow.

Now that I reread my own question, I noticed that I didn't really make clear what I wanted to know:

Let's say you have limited space in your pack but you want to add something to treat massive bleedings. Would you pick "chemical" or "regular"?

But I don't want to highjack this thread, so back on topic:

Hikermon, in first aid class (a course especially for basic life support in car accidents) we learned this to apply pressure: Put the dressing of your bandage on the wound, roll some of the gauze around and then put another (still wrapped) bandage on top of the dressing. Then wrap tightly until it stops bleeding, maybe even by adding another wrapped bandage on top of the first one.
Actually, you have to roll in a special way to better not completely restrict the bloodflow of the extremity (if the wound is on the upper arm, for example).

Some wounds may be best treated by blood stopping agents, such as deep penetrating wounds that are bleeding profusely and don't lend themselves to being stopped by a tourniquet. If you don't have blood stopping agents (or you have a sponge type that won't fit in the wound) you may need to pack gauze into the wound instead.

Other wounds may be best treated with a tourniquet, such as a lost limb.

A pressure bandage might not work given the wounded person's position; for example you may not be able to apply the pressure bandage without extricating the victim but the bleed is such that treatment can't wait for extrication.

Don't use tourniquets for head wounds. Otherwise I don't think there's a one-size-fits-all answer to your question.

I have some extremely small kits with both. A pack of Combat Gauze doesn't take up much space. Nor does a SWAT-T -- while not the best tourniquet or pressure bandage, it's inexpensive and can be used for either purpose. Great for a small kit, like the one I have in my laptop bag.

I'll just throw out another possible option to the toolbag, er, first aid kit. Basically, it's the use of a cling wrap type bandage to apply hands-free pressure. Not just directly on the wound, but also a more generalized compression that slows the blood flow to the area which could be preferable to direct pressure. For example, for a wound with underlying fractures where traditional direct pressure would be excruciating for the injured person. Sort of an alternative to a tourniquet, but less extreme.

Some of you might remember me asking about it in this old post:

ELAD--The other Israeli bandage

Does anyone know if this idea ever became commercialized and put into the field? I've never heard it mentioned anywhere else.

It would be quite simple to replicate the general idea of the ELAD. It would be helpful to take a "normal" 12-18" wide cling wrap you can buy at the supermarket and cut in half or even smaller. Narrower would seem to be more convenient for wrapping an arm or head wound than a foot-wide roll. But a foot-wide roll could be handy for other hard-to-compress sites like an abdominal wound.

Cheap, doesn't stretch when soaked with blood like an elastic bandage might, sticks to itself, and being transparent, it allows some degree of checking on the condition of the wrapped area without having to unwrap the bandage.

Cody - i would carry bandages impregnated with QuickClot.

Pete2

Looks like it would be good for larger areas like abrasions after a fall. Wish I'd known about it six years ago.