How to Pack a Wound Like a Professional
Deep wounds need to be packed immediately to stop the bleeding, promote healing, and prevent infection. Knowing how to pack a wound correctly helps to prevent further damage and stabilize a trauma patient before medical professionals arrive.
Wound packing involves placing packing material inside the laceration with bandages to apply pressure to broken blood vessels. This internal pressure helps to control bleeding at the wound site. Knowing how to pack a wound and having bleeding control supplies on hand could save your or somebody else’s life.
How to Pack a Wound
Important: Call the emergency medical services or send someone else to make the call if you are helping someone with serious, life-threatening bleeding. Then, follow these steps for packing a wound:
1. Determine that the Wound Requires Packing
Deep bleeding wounds from a traumatic injury (such as from a gunshot or blast injury, or accidental deep laceration) need to be packed. Serious bleeding on an extremity should be treated first with direct pressure and then with a tourniquet if the bleeding doesn’t stop after a minute or so.
Wound packing isn’t usually recommended for wounds to the chest, abdomen, or pelvis because the bleeding is typically coming from a source that is too deep to reach from the outside and the bleeding can only be stopped with surgical intervention. In these cases, apply direct pressure, call 9-1-1, and follow the operator’s instructions.
2. Apply Direct Pressure While You Gather Supplies
Apply direct pressure to the bleeding blood vessel with material, your hand, your elbow, or your knee while you (or a bystander) gathers the following supplies:
- Sterile gloves, if available
- Hemostatic gauze, if available
- Sterile gauze or other wound packing material such as strips of cloth
- Bandages
- Scissors
The following supplies are helpful for repacking a wound that has already stopped bleeding. DO NOT waste time looking for them in an emergency situation:
- Saline solution or other product to clean the wound
- Antiseptic wipes and a clean cloth
- Soap and water
- A clean bowl
- Cotton swabs
- A large bag
The best way to ensure you have appropriate wound packing materials ready in an emergency is to purchase a bleeding control kit before an accident or mass casualty incident (MCI) occurs. You can carry the kit in an emergency pack in a car, purse, backpack, or keep it in a highly visible location in your home or business.
3. Prepare and Clean the Wound Space (for non-life-threatening bleeding or repacking a wound)
Important: This step should only be used for non-life-threatening bleeding or when changing wound packing after the bleeding has stopped. For heavy bleeding, skip straight to Step 4.
Put on a pair of sterile gloves, if available. Clean the wound space using a saline solution or soap and water and pat it dry with a clean cloth or towel. Gently remove any debris or dead skin. Take a moment to look over the wound to determine its depth and shape. Look for tunneled areas that may need to be filled with packing material.
4. Prepare the Packing Material
Use hemostatic gauze, if available, as the first packing layer for bleeding wounds in any bodily area except the brain and eye. Hemostatic gauze accelerates the clotting process thanks to the use of hemostatic agents like kaolin (which is used in QuikClot Combat Gauze) or hemostatic clotting fibers (used in the NuStat Hemostatic Dressing).
If no hemostatics are available, use prepackaged compressed gauze or wound-packing gauze. Gauze labeled as “wound packing” typically means that it contains an x-ray strip through the length of the gauze so that it can be seen by surgeons in the trauma center, making it the better option. This also allows it to be labeled for wound packing with appropriate instructions. In contrast, compressed gauze must be labeled “just for external use” since it doesn't contain the x-ray strip, even though it can also be used for packing wounds if wound packing gauze is unavailable.
5. Pack the Wound Tightly
Take the packing material and pack the wound as tightly as you can. Your aim is to press the material tightly against the blood vessel to compress it. Use your fingers to guide the dressing material snuggly into all areas of the cavity while simultaneously continuing to hold direct pressure as well as possible. When you have packed the wound space completely and no more gauze will fit, continue to apply direct pressure for three minutes.
6. Secure with Outer Dressing Material
Cover the wound with a pressure dressing or wrap a bandage tightly around the wound and packing material. This dressing should cover the packing and wound site completely and extend past the edges of the wound.
Use another bandage or medical tape to secure the outer dressing in place. Continue to apply direct pressure until medical professionals arrive or until the patient can be transported to the emergency room.
Pro tips:
- Immobilize the area during transport to prevent the packing material from becoming dislodged as this could cause the bleeding to restart.
- If a hemostatic agent was used, tuck the hemostatic gauze outer packaging into the outer bandage, so as to alert the trauma center to its use upon the patient’s arrival at the hospital.
7. Monitor the Wound for Signs of Infection
Once the patient has been treated by medical professionals and is stable, check daily for signs of infection at the wound site. Some of the signs to look for include:
- Wound redness
- Pus
- Increased pain
- An odor
- Red streaks leading to the heart
- Wound fever
If any of these signs appear, seek immediate medical attention.
8. Change the Dressing
A healthcare provider will tell you how often to change the dressing. If no instructions have been given, change the dressing daily, or when the old bandage has been steeped in drainage (blood or pus).
After you wash your hands with soap and water and put on gloves, carefully peel the old tape or other outer dressing from the wound starting from the top. Next, rinse the wound clean with a recommended wetting solution. Pat the area dry with a clean towel. Look for signs of infection including red streaks, increased pain, or any of the other above-mentioned signs. Finally, apply and fasten a new inner and outer dressing to the wound.
When to Contact a Healthcare Provider
Call the emergency medical services immediately if you or someone else is experiencing traumatic bleeding. You should also seek prompt medical attention in the following situations:
- A large or complicated deep wound
- A foreign object lodged in a wound
- Underlying health conditions
- Improper packing
- Severe pain
- Excessive bleeding
- Delayed healing
- Allergic reactions
Care for wounds vigilantly after hospital discharge and schedule follow-up appointments with a medical professional to monitor wound healing and check that you’re caring for the wound correctly.
Wound Packing Can Save a Life
Packing a wound like a professional may not be something people need to learn for their 9 to 5, but it will empower you to lend a helping hand at a moment’s notice. You know a wound needs to be packed when a broken blood vessel is more than skin-deep.
Wound packing helps to stem bleeding by applying pressure to the broken blood vessel. This is critical after a traumatic injury. Having a bleeding control kit on hand (and the skills to use it) is the best way to ensure you’re always ready to respond.
