Severe
bleeding, known in medical circles as ‘uncontrolled hemorrhage’, is the
largest cause of preventable mortality in trauma. Remember that over 50% of all penetrating
injury deaths are caused by exsanguination, or bleeding out, and that this happens
when you lose more than 40% of your total blood volume, between 4 and 5 pints
(2 to 2.4 liters). For adults with
severe bleeding this can take anywhere between three to five minutes
Wound
Packing 101
Medical
experts recommend that direct pressure be used first for bleeding control, however
when that is ineffective or impractical, such as in wounds of the junctional areas,
they advise wound packing, with a hemostatic agent, should be used if
hemostatic gauze is available.
Wound
packing is the process of filling a wound with clean cloth material to control
bleeding. This can be done with gauze, hemostatic
gauze dressings or other types of emergency bandages. The purpose of wound packing is to apply
direct pressure to the source of bleeding, helping to slow or stop the bleeding. This can be
particularly useful in situations where compression bandages or tourniquets are
not appropriate or available.
Wound
packing is a crucial emergency first aid skill that can prevent a victim from bleeding out. In an emergency where advanced medical
equipment is not always available, controlling bleeding through wound packing
is a lifesaver.
Hemostatic
dressings are specialized bandages containing agents like chitosan, kaolin or oxidized
regenerated cellulose (ORC) that rapidly stop severe bleeding by accelerating
the body's natural blood clotting process.
Wound
packing by tightly stuffing or packing, deep or heavily bleeding wounds with
gauze, either plain or hemostatic, stops bleeding by putting direct pressure onto
the bleeding source. It is often
followed by putting a compression dressing over the wound to maintain pressure
until medical care is available.
Studies
of combat wounds have shown that less than 25% of the wounds packed by combat
medics were junctional injuries, the rest were wounds of the extremities, back
and head. The study further showed that everywhere
hemostatic gauze was used, there was an approximately 90% chance of successful hemorrhage control.
When and
Where to Pack...
First,
if there’s only minimal bleeding, then the wound doesn’t need packing. Wound packing is used in cases of severe
bleeding from deep wounds of the extremities and junctional areas, such as the
groin or armpit, where tourniquets can't be applied.
Direct
pressure will usually suffice for bleeding neck wounds and aren’t packed, because
of the risk of compromising the airway. And
bleeding from a back wound will typically not be profuse and may be controlled
with a simple pressure dressing, although in Israeli combat experience, wounds
of the back can be packed successfully.
How to Pack
a Wound
Expose
and assess the wound by cutting away or removing enough clothing and scoop out pooled
blood with your fingers or gauze, so that you can see the wound's depth and the
location of the bleeding vessel.
Place
your gloved fingers, either with or without, a dressing into the wound to apply
direct pressure to the bleeding vein, artery, or both.
And
remember, while applying direct pressure to the wound, you must also do a
complete assessment of the victim, so that you don’t overlook other
life-threatening injuries.
Applying as much pressure as possible
to the bleeding vessel. The packing must
be tight enough to put pressure on the bleeding vessel; this is what controls
the bleeding.
That is why plain gauze or cloth,
when tightly packed, is as effective as gauze impregnated with a hemostatic
agent.
DON’T
BE SHY! You will not harm the victim by
deeply packing a wound, you can only help them.
The biggest mistake in wound packing is being timid.
· When
available use hemostatic gauze, otherwise use any clean cloth.
ü Hemostatic
gauze which contains agents to accelerate clotting is preferred.
ü Plain
gauze is also effective when packed tightly.
ü Any
clean cloth, t-shirt strip or handkerchief is an acceptable substitute, if
medical supplies aren't available, since stopping the bleeding is the main concern.
3) Apply
pressure, using firm, continuous, direct pressure on the packed material for at
least 3 to10 minutes to compress the damaged vessel.
· longer
time is required for plain gauze; less time is needed for hemostatic gauze.
ü Important
consideration -- don't stop applying continuous pressure until medical help
takes over or the dressing is secure.
4)
Apply a snug pressure dressing or bandage
over the packed wound to secure it, maintain pressure, and free your hands.
5) After
securing the packing, check to see if the bleeding has stopped.
If
bleeding continues add more packing material if possible. If it is not possible to add more packing, you
must decide whether to remove the hemostatic gauze and start over or simply
apply as much direct pressure to the wound as possible and get the patient to a
medical facility quickly. This decision should
be during transport, DO NOT delay transport for extensive packing and repacking
of the wound.
If
it is an extremity wound, consider using a tourniquet.
6) Once
bleeding is controlled, consider splinting or otherwise immobilizing the area
to prevent the packing from being dislodged during transport.
Continue
to monitor the wound and dressing during transport to a medical
facility.
If
a tourniquet is initially placed on an extremity wound, it may later be
replaced with a pressure dressing or with packing, which may be more
comfortable for the patient and will allow a moderate amount of distal
circulation.
Don’t forget to come back next week and read “Severe Bleeding, STOP
the Bleed – Tourniquets Part Four©”.
Disclaimer:
All content and media on The Woodsman’s Journal Online is created and published
for informational/educational purposes only. It is not intended to be a substitute for
professional medical advice and should not be relied on as health or personal
advice. Use of the information on this
site is AT YOUR OWN RISK, intended solely for self-help, in times of emergency,
when medical help is not available, and does not create a doctor-patient
relationship. Always consult with a
medical professional for proper diagnosis and treatment of injuries.
I
hope that you continue to enjoy The Woodsman’s Journal Online and look for me
on YouTube at BandanaMan Productions for other related videos, HERE. Don’t forget to follow me on both The
Woodsman’s Journal Online, HERE,
and subscribe to BandanaMan Productions on YouTube. If you have questions, as always, feel free
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That
is all for now, and as always, until next time, Happy Trails!
Sources
Aggressive Medicine; “Wound
Packing in Tactical Medicine: A Vital Skill for First Responders”, [© 2026,
Aggressive Medicine], https://aggressivemedicine.com/en-us/blogs/news/wound-packing-in-tactical-medicine-a-vital-skill-for-first-responders,
accessed January 7, 2026
Austin Texas Government; “Medical
Directive 17-07 Wound Packing for Penetrating Junctional and Extremity Trauma”,
https://www.austintexas.gov/sites/default/files/files/Medical_Director/Medical_Directive_17-07_Wound_Packing_for_Penetrating_Junctional_and_Extremity_Trauma.pdf,
accessed January 10, 2026
American
Red Cross; “Bleeding, Life-Threating External”, © [2025 The American Red Cross],
https://www.redcross.org/take-a-class/resources/learn-first-aid/bleeding-life-threatening-external?srsltid=AfmBOoruukIMCkbnGCNWGd3QY5C2xHdip6lYe1NlsTuzRMF7j7trgnYI,
accessed December 6, 2025
Bolleter,
Scotty, BS, ET-P, Heightman, A.J., MPA, EMT-P, and Taillac, Peter P., MD, FACE;
“Wound Packing Essentials for EMTs and Paramedics”, April 1, 2017, [© 2025
Clarion Events North America], https://www.jems.com/patient-care/emergency-trauma-care/wound-packing-essentials-for-emts-and-paramedics/,
accessed January 7, 2026
DHA,
“Deployed Medicine”, January 2024, [© 2024 Primal Survivor™], https://books.allogy.com/web/tenant/8/books/a30c619d-7270-4bfe-be4f-eb4d27adc783/,
accessed December 6, 2025
Shertz, Mike, MD; “Clamshell
Direct Pressure: A Simple, Hands-On Hemorrhage Control Technique When
Tourniquets Aren’t Available”, [©2025 Crisis Medicine], https://www.crisis-medicine.com/clamshell-direct-pressure/?srsltid=AfmBOopsv8B-c8iZd8We8JIfkUlBULjWi5-BfPjislJqLFPq5I-rUtHC,
accessed December 13, 2025
Vuković,
Diane; “How to Treat and Pack a Bullet Wound in the Wilderness”, September 11,
2023, https://www.primalsurvivor.net/treat-gunshot-wound/,
accessed December 6, 2025
