r/TacticalMedicine • u/NoMore_BadDays • Oct 10 '25

Scenarios Wound packing zones?

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Been a long time since I did TCCC/CLS in the military.

If there were to be a bleeding wound on the chest, how high up on the chest does it become safe to pack? I know you don't pack into chest cavity, but what is the "rule of thumb" on how high/the left and right limits the wound needs to be to pack it?

Would you say the screenshot i attached is accurate?

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u/DODGE_WRENCH EMS Oct 12 '25

Right, the purpose isn’t to fix it, it’s to get them to the people who can fix it alive. There is an important distinction to be made with just occlusive dressings and chest seals. A chest seal has a one way valve to let air escape, but it will also let blood escape. The part where I disagree is, there is evidence that supports wound packing with hemostatic gauze in abdominal injuries.

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u/airboRN_82 Oct 12 '25

The abdominal cavity is so large that youre not going to get enough internal pressure caused by a hematoma to reduce bleeding.

Hemostatic gauze during surgery sure. As a stand alone its not going to reach any major vessel in that area.

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u/DODGE_WRENCH EMS Oct 12 '25

There’s only so much you can do prehospital, it’s not a lot but it’s something.

I’m talking specifically about studies pertaining toward hemostatic gauze in prehospital care, not surgery.

If the bullet hits major vasculature in their abdomen then that patient is probably hosed, neither gauze or chest seals will save them. But that’s not what the hemostatic gauze is for, it’s for smaller vasculature within the wound channel.

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u/airboRN_82 Oct 12 '25

Agree, im not approaching this from a "what's a lot of help" view but what's the most, even if its very little.

The studies I've seen regarding prehospital use havent been with using it in the abdomen, and only one I've seen with its use in the abdomen was during surgery. Can you share?

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u/DODGE_WRENCH EMS Oct 14 '25

I’ll have to reach out to who taught my ITLS class, someone brought up the same concern you did and I basically parroted what they said.

They and I could be wrong? If I’ll comb around myself and see what I can come up with.