Wound Packing and Hemostatics: The Next Line of Defense

When a wound is not on an extremity or is in a location where a tourniquet cannot be applied, the next critical skill in the M.A.R.C.H. algorithm is wound packing. The fundamental technique of packing and explains how modern hemostatic agents have supercharged this process, directly integrating the specific gauze products curated by ViTAC Solutions.

The Art of Wound Packing: Step-by-Step

Wound packing is the primary technique for controlling compressible hemorrhage that is not amenable to a tourniquet. This includes junctional wounds in the groin or axilla, or deep lacerations on the torso. The principle is simple: apply pressure directly to the source of the bleeding inside the wound.

The technique, often called the "feed and stuff" method, must be performed aggressively.

First, identify the source of the bleeding within the wound cavity, if possible.

Then, using your fingers, feed the gauze directly onto that point.

Continue to systematically stuff the gauze into the wound, packing it as tightly as possible, until the entire cavity is filled.

The goal is to create enough internal pressure to overcome the pressure of the bleeding vessel.

Once the wound is packed flush with the skin, the job is not done. You must then apply firm, direct pressure to the top of the packed wound with both hands for a minimum of three minutes for hemostatic gauze, and longer for plain gauze. This sustained pressure is critical for allowing a clot to form. It is a simple but physically demanding skill that is essential for every responder.

QuikClot Combat Gauze: How Hemostatics Supercharge Packing

Hemostatic agents are substances that accelerate the body's natural clotting process. QuikClot Combat Gauze® Z-Fold from North American Rescue is a TCCC-recommended hemostatic dressing that is the standard in the U.S. military. It is a soft, pliable gauze that is impregnated with kaolin, an inert mineral.  

The science behind QuikClot is that kaolin works as a catalyst, activating Factor XII in the body's coagulation cascade. This rapidly speeds up the natural process of forming a strong, stable blood clot. This means that when used correctly, QuikClot can stop life-threatening bleeding faster and more effectively than plain gauze. It does not generate heat and is safe to use.  

The "Z-Fold" packaging is a tactical advantage. Unlike traditional rolled gauze which can become unwieldy and roll away if dropped, Z-folded gauze is packed back-and-forth in a small, vacuum-sealed pouch. This allows the responder to feed it directly from the pouch into the wound, maintaining better control of the material in a stressful, chaotic environment.

Pros and Cons of QuikClot Combat Gauze

• Pros:

  • Accelerates Clotting: The kaolin-impregnated gauze works with the body's own clotting cascade to stop bleeding faster than standard gauze.

  • Familiar Technique: It is applied using the same wound packing technique as standard gauze, making it easy to use for those with basic training.  

  • Safe and Recommended: It does not generate heat, is non-allergenic, and is the first-line hemostatic product recommended by the CoTCCC.  

• Cons:

  • Requires Compression: Still requires a minimum of three minutes of firm, direct pressure after packing to be effective.

  • Relies on Clotting Cascade: While effective, its mechanism depends on the body's natural ability to clot, which can be compromised in severely hypothermic or coagulopathic patients.

Celox™ RAPID: Another Powerful Hemostatic Option

Celox™ Rapid Hemostatic Gauze Z-Fold from Celox Medical is another leading hemostatic agent that uses a different active ingredient to achieve the same goal. Celox is impregnated with chitosan, a natural polymer derived from shellfish shells.

The science of chitosan is different from kaolin. Chitosan carries a strong positive charge, while red blood cells have a negative charge. This strong electrostatic attraction causes red blood cells to bind to the chitosan on the gauze, creating a gel-like plug or "mucoadhesive" seal over the bleeding vessel. This process is independent of the body's natural clotting cascade, which means it can be effective even in patients who are hypothermic or on anticoagulants (blood thinners).  

Both QuikClot and Celox are proven, effective hemostatic agents. The choice between them often comes down to institutional preference or specific patient factors. Having a high-quality hemostatic gauze from a trusted brand like QuikClot or Celox in your kit significantly increases your ability to control massive hemorrhage, making it a non-negotiable component of any serious trauma kit.

Pros and Cons of Celox™ Rapid

• Pros:

  • Works Independently of Clotting Cascade: The chitosan-based technology does not rely on the body's own clotting factors, making it highly effective in patients who are hypothermic or on blood thinners.  

  • Fastest Acting: It is the only hemostatic cleared by the FDA to require only one minute of compression, significantly reducing treatment time and blood loss compared to competitors.  

  • Proven High Survival Rate: In DoD testing, Celox technology demonstrated a 90% survival rate, higher than that of Combat Gauze in the same study.  

• Cons:

  • Shellfish Origin: The active ingredient, chitosan, is derived from shellfish. While there have been no reported allergic reactions, this remains a theoretical concern for some users.

  • Different Texture: Some users find the texture of Celox gauze to be different from standard gauze, which could potentially affect their packing technique if they haven't trained with it specifically.

Be prepared. Be Confident.