4 ms·

Yeah, the current technique (which, IMO, is still the way to go) uses gauze, which the clot will form around. It's difficult/impossible to remove that gauze wit

Yeah, the current technique (which, IMO, is still the way to go) uses gauze, which the clot will form around. It's difficult/impossible to remove that gauze without removing at least some of the clot and causing some bleeding. At that point though, they're already in the OR, and that bleeding is generally fairly easily managed w/ the right equipment.

ineedasername 5y ago
is still the way to go According to the writeup, that is less effective for some wound locations. I'm no expert to be able evaluate that claim though. Otherwise the main advantage here seems time-to-deploy, as it may be faster than wound packing, and it may be more user-friendly for police first on the scene before paramedics show up. That said, this is far from a finished product. It's only a partial prototype, and it looks like there will need to be a lot of testing on a different wound shapes & depths & locations to calibrate the appropriate pressure in each case.
- JshWright 5y ago
  I haven't seen any data on how effective this is, or if it would be more effective than wound packing. I'd be very surprised if it worked any better for abdominal wounds (it has the same problem... there is nothing to compress against, and the abdomen can just keep expanding and organs can shift out of the way). I would also be suspicious of any "net" time-to-deploy improvements. Z-Fold gauze is small and light enough that it lives in the trauma bag, and I will definitely have it with me upon arrival to a stabbing patient. Given the relative rarity of stab wound where this would be useful (even simply as a percentage of all stab wounds), I think it's likely it wouldn't be grabbed by default, which means a trip back to the rig to get it. Obviously, take my opinion with a grain of salt... All the info I have about this is from this single article, and EMS is notoriously suspicious of change and "new shiny".
  - ineedasername 5y ago
    Is gauze packing like this something that a typically trained police officer could do? If not, that might be the main benefit of the device. Otherwise, yeah, I guess an EMS that deals with these issues regularly may have the process down well enough that speed isn't the issue. Also curious, because I know nothing about trauma wounds like this. I know I'm wrong, but I don't know why: Could you use tissue glue to seal the edges? It seems like that's what would happen in surgery for a permanent "fix" anyway, so doing it temporarily in the field, with the edges adhering to themselves, would reduce the need for compression.
    - JshWright 5y ago
      Yeah, cops (at least around here) generally know how to pack a wound. It's not terribly hard (you're just repeatedly shoving your finger in the hole, stuffing a bit more gauze in there each time). The external wound isn't the issue, and that's really the only thing that you could practically "glue" in the field. The issue is the artery inside that's spurting blood (and even if none of that blood actually escapes the body, there's more than enough room to lose enough blood inside the body to kill someone. The surgical intervention will involve opening up the area of the wound a bit further so that you can actually find the hole in the artery and have room to work. Once the specific location of the bleed has been found, generally a clamp will be applied "upstream" of the bleed, which will then be stitched closed (ideally reattaching it to the other end if it was severed completely). Glue isn't going to hold up against arterial pressure.
hnick 5y ago
In my first aid course in Australia the teacher told us we are not allowed to be taught wound packing and that if anyone asks we didn't learn it - before telling us about it. He'd been in the military where it might see some use and apparently wound packing is also recommended in the US, but over here I guess it's needed rarely enough that teaching everyone might cause more harm than good.
- jackson1442 5y ago
  It might also be because it was a part of a "first aid" course and not a more professional course or certification. In my lifeguard certification here in the states, for example, they explicitly don't train on tourniquets because we had an on-site EMT that would do the more dramatic procedures like that before an ambulance arrived. Tourniquets are definitely a last-resort measure and an untrained provider using one can certainly cause more harm than good, so it was omitted from training at our level. The same might apply to wound packing- knowing _when_ to use it is harder to teach than _how_ so many people don't understand when it is appropriate, which could be dangerous.
  - hnick 5y ago
    It was accredited, the type of course you get told to do if you have certain responsibilities like volunteer teaching a class where it might be necessary, or the sort of thing you need a few people per floor to have at work for OHS. I assume people who make a career about it get more into the advanced topics. Being in Australia, we covered snakes, spiders, and jellyfish more than some countries would, while gunshot trauma wasn't really mentioned in a large amount of detail.
  - JshWright 5y ago
    > Tourniquets are definitely a last-resort measure and an untrained provider using one can certainly cause more harm than good This is a bit of a stigma that is starting to get cleared up. Tourniquets should be a "first resort" for significant bleeding in a limb that can't be easily controlled with direct pressure. Protocols used to involve all sorts of additional things to try (elevate the limb, use pressure points, apply more dressings/pressure, etc). Now it's "Squeeze the wound with gauze and a gloved hand. Did it stop? No? Apply a tourniquet." Assuming someone gets to a hospital within a reasonable period of time (where "reasonable" is "within a couple hours"), there is very little risk in applying a tourniquet.

ineedasername 5y ago

is still the way to go According to the writeup, that is less effective for some wound locations. I'm no expert to be able evaluate that claim though. Otherwise the main advantage here seems time-to-deploy, as it may be faster than wound packing, and it may be more user-friendly for police first on the scene before paramedics show up. That said, this is far from a finished product. It's only a partial prototype, and it looks like there will need to be a lot of testing on a different wound shapes & depths & locations to calibrate the appropriate pressure in each case.

JshWright 5y ago
I haven't seen any data on how effective this is, or if it would be more effective than wound packing. I'd be very surprised if it worked any better for abdominal wounds (it has the same problem... there is nothing to compress against, and the abdomen can just keep expanding and organs can shift out of the way). I would also be suspicious of any "net" time-to-deploy improvements. Z-Fold gauze is small and light enough that it lives in the trauma bag, and I will definitely have it with me upon arrival to a stabbing patient. Given the relative rarity of stab wound where this would be useful (even simply as a percentage of all stab wounds), I think it's likely it wouldn't be grabbed by default, which means a trip back to the rig to get it. Obviously, take my opinion with a grain of salt... All the info I have about this is from this single article, and EMS is notoriously suspicious of change and "new shiny".
- ineedasername 5y ago
  Is gauze packing like this something that a typically trained police officer could do? If not, that might be the main benefit of the device. Otherwise, yeah, I guess an EMS that deals with these issues regularly may have the process down well enough that speed isn't the issue. Also curious, because I know nothing about trauma wounds like this. I know I'm wrong, but I don't know why: Could you use tissue glue to seal the edges? It seems like that's what would happen in surgery for a permanent "fix" anyway, so doing it temporarily in the field, with the edges adhering to themselves, would reduce the need for compression.
  - JshWright 5y ago
    Yeah, cops (at least around here) generally know how to pack a wound. It's not terribly hard (you're just repeatedly shoving your finger in the hole, stuffing a bit more gauze in there each time). The external wound isn't the issue, and that's really the only thing that you could practically "glue" in the field. The issue is the artery inside that's spurting blood (and even if none of that blood actually escapes the body, there's more than enough room to lose enough blood inside the body to kill someone. The surgical intervention will involve opening up the area of the wound a bit further so that you can actually find the hole in the artery and have room to work. Once the specific location of the bleed has been found, generally a clamp will be applied "upstream" of the bleed, which will then be stitched closed (ideally reattaching it to the other end if it was severed completely). Glue isn't going to hold up against arterial pressure.

hnick 5y ago

In my first aid course in Australia the teacher told us we are not allowed to be taught wound packing and that if anyone asks we didn't learn it - before telling us about it. He'd been in the military where it might see some use and apparently wound packing is also recommended in the US, but over here I guess it's needed rarely enough that teaching everyone might cause more harm than good.

jackson1442 5y ago
It might also be because it was a part of a "first aid" course and not a more professional course or certification. In my lifeguard certification here in the states, for example, they explicitly don't train on tourniquets because we had an on-site EMT that would do the more dramatic procedures like that before an ambulance arrived. Tourniquets are definitely a last-resort measure and an untrained provider using one can certainly cause more harm than good, so it was omitted from training at our level. The same might apply to wound packing- knowing _when_ to use it is harder to teach than _how_ so many people don't understand when it is appropriate, which could be dangerous.
- hnick 5y ago
  It was accredited, the type of course you get told to do if you have certain responsibilities like volunteer teaching a class where it might be necessary, or the sort of thing you need a few people per floor to have at work for OHS. I assume people who make a career about it get more into the advanced topics. Being in Australia, we covered snakes, spiders, and jellyfish more than some countries would, while gunshot trauma wasn't really mentioned in a large amount of detail.
- JshWright 5y ago
  > Tourniquets are definitely a last-resort measure and an untrained provider using one can certainly cause more harm than good This is a bit of a stigma that is starting to get cleared up. Tourniquets should be a "first resort" for significant bleeding in a limb that can't be easily controlled with direct pressure. Protocols used to involve all sorts of additional things to try (elevate the limb, use pressure points, apply more dressings/pressure, etc). Now it's "Squeeze the wound with gauze and a gloved hand. Did it stop? No? Apply a tourniquet." Assuming someone gets to a hospital within a reasonable period of time (where "reasonable" is "within a couple hours"), there is very little risk in applying a tourniquet.