"PLUG THE HOLE" IN YOUR SYSTEM. What's missing in your trauma EDC, and what do you choose to fill it?

By Jonathan Willis

Bleeding is the number two cause of trauma related death in the United States. Thankfully, in the realm of trauma care, through many different outreach efforts, civilians are more equipped and capable than ever to effect a positive outcome on the bleeding emergency. Tourniquets for example are more plentiful, easy to use, and of a higher quality than ever before. Bleeding control kits are more visible in the day to day environment and  more people are choosing to carry them on their person daily. This is great progress. 

Although carrying a tourniquet is wonderful for preparing a person to stem life threatening extremity hemorrhage with a quickness, most people leave it at that. Effectively choosing to realistically affect the outcome of only one type of bleeding. In the absence of wound packing gauze, no matter the type, I ask, why bother? 

Now, many are gonna read that and recoil. "HOW DARE HE??" I've had many discussions with folks in which I strongly encourage them to carry gauze. If we've accepted that in our day to day lives we may need to use a firearm, or tourniquet an extremity bleed, then we must recognize that a junctional hemorrhage (bleed from the neck, armpit/axilla, groin) might present to us as well. If you've accepted that life threatening bleeding is indeed an emergency you are ready, willing, and able to thwart, why would you not carry gauze? After all, it is literally the lowest profile, least expensive piece of trauma medical kit a person can carry. 

In the general community of people who call themselves "prepared" we know the amount of folks who would suggest they daily carry a firearm is exponentially higher than those who actually do carry said firearm. The amount of folks who've had meaningful trauma training, or something as simple as Stop the Bleed training, who carry trauma equipment on their person is in actuality minuscule. If they do it's generally only a tourniquet. The amount of people who'll carry a tourniquet AND gauze, or anything beyond that, is smaller still. Why no gauze??

When I'm out in the world or discussing different trauma equipment choices with folks, I ask probing questions. One, because I'm genuinely curious as to the why's and how's people make their decisions, and two, as a matter of anecdotal data collection for my work as an instructor in this field. Every once in a while I run into someone who is actually carrying a tourniquet, and that is great. Almost without exception, that is all they are carrying. I'll never shame them, because something is indeed better than nothing, but I do ask them why they make the TQ the extent of their daily carry capability as it pertains to bleeding control. Many will say, almost as though they know why I'm asking, that their immediate action plans for junctional hemorrhage is improvised packing materials. "Materials of opportunity" is the phrase I like to use for this Basically encompassing their knife and clothing/materials in the environment. Sorry friends, and some of you aren't gonna like this, but that answer is bullshit. 

If improv is the totality of your immediate action plan, then why not ditch the tourniquet, and make that up as well? I have spent over 20 years of my life in environments where people bled and died a lot. I am more familiar than most, not as much as many, with the rapidity with which these events unfold, and where opportunities for improvisation exist and generally do not. Know this. Unless you are EXTREMELY familiar with trauma management and/or making meaningful decisions quickly in extremely dynamic environments, you should think long and hard before you leave ANY aspect of your bleeding management plan to "materials of opportunity." I suggest, get real gauze, and carry them. When bright red blood is rapidly exiting an insult to the neck, armpit, or groin, you are behind the curve. Especially if you are alone. I assure you that you want you stack the deck in your favor. 

The following points have been discussed at great length with multiple experienced trauma docs who work in real trauma centers, operationally experienced medics, and respected trauma trainers. What gauze are you carrying on person or putting in your kits? Would it surprise you to know that in my small, but very experienced, sampling of trusted providers with whom I've discussed this topic, not one person exclusively carries hemostatic impregnated gauze. This mix of professional's wound packing "plan of attack" was quite interesting. The answers varied between 1. Plain wound packing gauze. 2. Hemostatic AND non-hemostatic gauze. 3. Plain gauze augmented by "materials of opportunity."

This circle of trauma experienced providers spans the realms of domestic emergency services, metropolitan trauma centers, and GWOT medics, and all made the choices above. We are still seeing many well intended folks seeking civilian level trauma training, being told to go all in on Combat Gauze (or equivalent) because trainers are simply regurgitating what they have been told. These folks are not being told what research, or domestic trauma skills actually show us. What is concretely true is that wound packing skills, having gauze, and speed of action, is far superior to the presence or absence of hemostatic agents within the gauze carried. The reality is that there is no study that shows that use of hemostatic impregnated gauze in lieu of plain gauze actually improves patient survival. Don't take my word for it. Dig deep into the research yourself and you will see.

The information above is IN NO WAY to suggest that a person should not choose to carry hemostatic impregnated gauze if they wish. The hemostatic agent can do nothing but help the provider using proper technique. But, to not mention that there is no proven life saving superiority to a product that costs 10X what another does, in the hands of a person with identical skill levels would be irresponsible in my opinion. I'm sorry, but I would rather a person have a quality tourniquet, 2 packs of gauze, a pressure bandage, and a pair of shears, for the same money spent on one pack of hemostatic gauze. 

This small but highly effective implement is an afterthought to most. It weighs a couple of ounces, costs a couple of bucks, and might save the life of someone you care about. I carry this tool every day of my life without a shred of notice or inconvenience, and you can as well. I have responded to countless events in which, had a single person been so inclined or skilled, the result would have been a transport rather than "terminating resuscitative efforts." You carry a gun. You found a place for that TQ. Let's get serious about those gauze.