Wound packing, besides applying a tourniquet, is one of the most basic techniques of bleeding control in a pre-hospital environment. In theory, the concept is relatively simple: hold pressure on a wound, and after several minutes, the applied pressure will help to encourage the body’s natural clotting factors. This can vary from just three minutes of pressure if using specially manufactured gauze (i.e. Combat Gauze) impregnated with hemostatic agents, to 10 minutes if using standard gauze or other fabrics.
The trick to this technique, however, is that the correct pressure application point may be several inches down inside the muscle. Pressure is much more effectively generated once you reach a hard surface, such as a bone, to push against. Otherwise, trying to compress relatively squishy fat and muscle starts to feel like pushing rope.
The Wound Cube from Phokus Research Group is a new training tool to help teach this vital technique. We’re featuring it because it’s difficult to make a similar tool on your own, and even harder to make it for less money than its current retail price.
A layperson’s instinctual reaction when presented with a heavily bleeding wound is often to apply pressure directly on top of the skin, possibly with their hands. Even if they have gauze, their first reaction is often to try and mash a ball of it into the wound from the top.
A more appropriate technique, however, is to feed gauze or other wound-packing material starting down at the bottom of the wound, slowly packing from the bottom until the wound is filled. At that point direct pressure will be applied from the outside surface (skin) and this pressure becomes directly transmitted to the base of the wound — exactly where we want it.
Enter the Wound Cube. The cube, designed to accurately depict the texture and feel of a traumatic injury in flesh, features several types of correctly modeled and sized wounds. These include lacerations as well as different types of gunshot wounds.
The ballistic patterns are authentic, recreating the narrow entrance channels and larger interior cavities created by a gunshot wound. Its durable silicone also features realistic tissue density and is textured to feel similar to human skin, especially when a few drops of simulated-blood lubricant is added.
The Wound Cube is made from clear silicone, making it semi-transparent and easy to confirm that you’re effectively getting the wound-packing material to the base of the wound inside the body. While you’re getting to third base with the cube, an instructor can shine a flashlight into one of the other open holes to illuminate the inside of the channels and make easy visual confirmation on how effectively you’re packing the wound.
Although the premise of the Wound Cube is very simple, it’s also very effective and robust. Wound packing isn’t a delicate act — fingers have to work fast, plunging repeatedly into the wound cavity in an effort to tamp down as much gauze as will fit inside, in a hurry. First timers or the untrained may look like they’re delicately trying to knead the world’s tiniest pizza dough, softly feeding one finger in after another and alternating index fingers. More experienced medics on the other hand, may use more arm motion to aggressively pack in the gauze and make sure they’re hitting the bottom of the wound or a hard bone.
With a price point starting at $140 and first responder discounts available, the Wound Cube is a relatively affordable, durable training tool that’s significantly less expensive than similar competing products. For a homegrown alternative, there’s no easy way to accurately recreate the enlargement of the wound cavities as they vary in depth, and it becomes even more difficult if you’re trying to find a semi-transparent material so you can actually see what’s happening inside.
Andrew Schrader recently served as an advisor/reviewer for the San Bernardino (CA) City Fire Department’s After Action Report (AAR) of the Active Shooter Incident Response which took place in December 2015. His company, Recon Response Engineering LLC, educates firefighters and search-and-rescue teams on the subject of urban search-and-rescue and building collapse. Most recently, he was deployed in Florida to support rescue operations following Hurricane Irma. www.reconresponse.com / @reconresponse