A Manikin Model for Study of Wound Packing Interventions to Control Out-of-hospital Hemorrhage

With hemorrhage being the primary cause of mortality on the battlefield [1 3], wound packing practice by US military medics in the wars since September 11, 2001, has changed from a conservative to an assertive approach. The foremost emphasis changed from preventing contamination to controlling hemorrhage. As no specific hemostatic dressings were available at the start of the wars, after such dressings were fielded, medics changed their approach by packing wounds with more gauze earlier in casualty care and deeper into subfascial cavitary wounds as a way to control hemorrhage. Although experienced medics and trainers favor an assertive approach, there is limited empirical evidence of improvements. In addition, with the development of various dressings with hemostatic properties [4 6], no systematic approach to trial wound packing techniques easily has been developed. When a war ends and military medical care shifts toward peacetime duties and garrison work, skill sets in trauma care degrade as skill performance is less often. Furthermore, peacetime training reverts back toward everyday work such as sick call and away from future combat casualty care. The reversion tendency allows less training of new medics in combat casualty care than those who were trained during busy years of sustained combat; like nothing in peacetime, the present danger of combat during wartime focuses attention on hemorrhage control. A challenge for medics to be as well trained in peacetime in combat casualty care as during wartime is a recurring theme of military medicine. Of the medical advances in prehospital combat casualty care during the current wars, we feel that the most important are regular tourniquets, junctional tourniquets, and wound packing because of their potential capacity to save numerous casualties from the most common cause of death on the battlefield wound exsanguination. To not backslide on these 3 skills, we continue scholarly work to refine them. Published in the Correspondence section of the American Journal of Emergency Medicine, v32 p1125-1147, 2014. Prepared in collaboration with the USUHS, School of Medicine, Bethesda, MD, RevMedx, Inc., Wilsonville, OR, and the Emergency Medical Services Fellowship, San Antonio Military Medical Center, TX.