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?