One of the most important hemorrhage control interventions taught on the CTOMS POD Survival Course, or any proper tactical medicine course, is wound packing. In order to do this in training, a improvised wound simulator is used.
Penetrating trauma especially GSWs rip and tear tissue all along the wound channel. Vasculature damaged in that wound channel is the root cause of the life threatening hemorrhage. Unless the wounded area is amenable to a tourniquet, direct pressure must be placed against the sides of the wound channel to stop the hemorrhage. This is accomplished through wound packing the ENTIRE wound channel combined with significant directed pressure on to the superficial anatomy above the wound. In some cases, hemostatic dressings and indirect pressure may be required adjuncts.
Wound Packing is a skill that needs to be practiced perfectly many times to develop an acceptable level of skill that will not be affected by physiological response to stress. The techniques are relatively simple but can be hard to duplicate in action without practice.
I made these improvised wound packing simulators from Yoga Block. Using a drill and a Red Sharpie Paint Marker, I hollowed out different wound channels and then coloured them with paint marker. Most of the channels have smaller entrances and widen out within the block. I may add a blood bag with tubing in the future. But I will need to decide if the time lost in cleaning up is worth the lost repetitions. There is only so much time available during a course and additional clean up will eat up that time.
These DIY simulators offer significant advantage from a training point of view:
- the rectangular shape allows the simulator to lay flat without shift to allow the student to concentrate on the skill development;
- the foam can easily be adapted to different wound modalities;
- the foam is robust and will allow for hundreds of repetitions;
- they are inexpensive; and
- they are highly mobile and easy to transport from location to location
I recently used them on a POD Survival Practical course. They were a hit with students who had the opportunity to practice different wound shapes and sizes during the wound packing and hemostatic phase of instruction. Additionally, I used them during the scenario phase to allow the students to pack a wound in real time during scenarios. Their small size and easy mobility allowed me to place them near the simulated wounded area without disturbing the students patient assessment and then remove them again once the intervention was successfully done.
