Wound packing is an effective hemorrhage control technique used to manage severe bleeding from deep wounds that cannot be controlled with direct pressure alone and are not appropriate for tourniquet application. Common locations include the groin, axilla, shoulder, buttocks, and other junctional areas where major blood vessels may be injured.

The goal of wound packing is to place material directly onto the source of bleeding, creating pressure within the wound cavity and promoting clot formation.

Wound packing should be considered for:

• Deep wounds with significant bleeding
• Junctional hemorrhage
• Areas where tourniquets cannot be effectively applied
• Bleeding that persists despite direct pressure

Providers may use either hemostatic or non-hemostatic gauze when packing wounds:

• Hemostatic Gauze: Gauze impregnated with agents that promote clot formation and help control severe bleeding.
• Non-Hemostatic Gauze: Standard compressed gauze used to fill the wound cavity and provide direct pressure to the bleeding source.

Key wound packing principles include:

• Expose the wound and identify the source of bleeding.
• Pack the wound tightly, layer by layer, directly onto the bleeding source.
• Continue packing until the wound cavity is completely filled.
• Apply firm direct pressure following packing.
• Maintain pressure according to local protocols and manufacturer recommendations.
• Secure the packed wound with an appropriate pressure dressing.

Following wound packing, reassess for continued bleeding and monitor the patient for signs of shock or ongoing blood loss.

Remember: Pack the wound completely, apply pressure, and secure the dressing.