Wound Packing

Part of First Aid

Deep wounds — stab injuries, gunshots, large lacerations — bleed from within. Surface pressure alone cannot reach the damaged vessel. Wound packing fills the cavity with material that applies pressure directly to the source of bleeding.

When to Pack a Wound

Wound packing is appropriate for:

• Deep wounds where the bottom of the wound is not visible
• Puncture or stab wounds to the trunk, limbs, or junctional areas (groin, armpit, neck)
• Wounds where direct surface pressure is not stopping the bleeding
• Gunshot wounds (pack the entry wound; do not probe for the bullet)
• Large, gaping lacerations with visible muscle or tissue layers

Do NOT pack:

• Chest wounds with sucking sounds (these need an occlusive seal, not packing)
• Abdominal wounds with exposed organs (cover with moist dressing, do not push organs back in)
• Shallow surface wounds that respond to direct pressure
• Skull fractures or wounds exposing brain tissue

Warning

Wound packing is painful. The patient will resist. This is expected. Inadequate packing because the patient flinched will result in continued bleeding and potentially death. Be firm, be fast, explain what you are doing, but do not stop.

Packing Materials

In a post-collapse scenario, you use what you have. Prioritize by cleanliness and absorbency.

Material	Absorbency	Availability	Preparation
Boiled cotton cloth strips	High	Common	Tear into strips 3-5 cm wide, boil for 10 minutes, air dry
Clean gauze (scavenged)	Very high	Rare	Use as-is; the gold standard if found
Sphagnum moss	Excellent (20x weight)	Forest environments	Gather from clean areas, shake out insects, use fresh or dried
Sanitary pads / tampons	Very high	Scavengeable	Individually wrapped = still sterile; unwrap and use
Clean cotton t-shirt strips	Moderate	Common	Boil if possible; tear into strips, do not cut (torn edges are more absorbent)
Dried clean grass	Low	Abundant	Inferior option; use only when nothing else is available

Avoid: Dirty rags, paper towels (disintegrate inside the wound), synthetic materials that do not absorb fluid, anything with visible contamination.

Step-by-Step Packing Technique

Preparation

1. Wash your hands with clean water or alcohol if available. This step is non-negotiable.
2. Prepare your packing material: strips of cloth 3-5 cm wide and 30-60 cm long. Multiple strips may be needed for a deep wound.
3. If possible, irrigate the wound with clean water to flush debris before packing.
4. Position yourself so you can see into the wound. Use available light. If it is dark, have someone hold a flame or flashlight.

The Packing Process

Step 1 — Identify the bleeding source. If blood is welling up from the deepest point of the wound, that is where your packing must reach.

Step 2 — Take the end of your packing strip and push it firmly into the deepest point of the wound using your finger. Your finger is the packing tool. Push the material all the way to the bottom.

Step 3 — Use a zigzag (serpentine) pattern. Do not just stuff material loosely into the cavity. Pack deliberately: push material to one side of the wound base, fold it back, push to the other side, fold again. Each layer should be pressed firmly against the one below it.

Step 4 — Continue packing layer by layer, working from the deepest point outward toward the surface. Each layer compresses the one beneath it, building pressure against the bleeding source.

Step 5 — Pack until the wound is completely filled and the material is level with or slightly above the skin surface. The wound should feel firm when you press on the outside of the packing.

Step 6 — Apply a pressure dressing over the packed wound. Place a folded cloth pad over the packing and wrap firmly with a bandage or cloth strips. The outer dressing maintains the internal pressure.

Step 7 — Maintain direct pressure with your hand over the dressing for 3-5 minutes after packing to allow initial clotting.

Packing Specific Wound Types

Deep Limb Wounds

These are the most straightforward to pack. The wound channel is usually accessible, and you can apply a tourniquet above the wound if packing alone fails. Pack aggressively, then bandage. If a tourniquet is already in place, pack the wound before considering loosening the tourniquet.

Junctional Wounds (Groin, Armpit, Neck Base)

These are the most dangerous because tourniquets cannot be applied to these areas.

• Groin: Pack the wound tightly, then use a rolled-up shirt or ball of cloth over the packing and hold it in place with a belt or strap wrapped around the waist and thigh in a figure-eight pattern.
• Armpit: Pack and hold a pressure ball in the armpit. Bind the arm tightly against the body to maintain pressure.
• Neck base: Pack the wound and apply manual pressure. Do NOT wrap circumferentially around the neck — you will cut off the airway and blood flow to the brain.

Warning

Neck wounds: Pack the wound and press firmly on one side only. Never encircle the neck with a bandage. If the trachea or airway is exposed, protect it but do not occlude it.

Stab / Puncture Wounds

Puncture wounds are deceptively dangerous because the small entry hides a deep wound channel.

1. Do not enlarge the wound to pack it unless bleeding is uncontrollable. The narrow channel itself provides some tamponade.
2. If you must pack, use narrow strips (2-3 cm) and feed them in carefully using a thin, blunt probe or the tip of your smallest finger.
3. If the weapon is still in place, do NOT remove it. Stabilize it and pack around it.

Hemostatic Improvisation

Commercial hemostatic agents (QuikClot, Celox) may be found in first aid kits. If unavailable, some natural materials promote clotting:

• Yarrow leaves (Achillea millefolium): Crush fresh leaves and pack into wounds. Known as “soldier’s woundwort” for millennia.
• Sphagnum moss: Naturally acidic, antimicrobial, and highly absorbent. Used in WWI as wound packing.
• Spider webs: Contain vitamin K and promote clotting. Gather into a ball and press into shallow wounds. Not effective for deep packing.
• Wood ash (clean): Mildly caustic, promotes clotting. Mix with a small amount of water to form a paste for surface wounds only.

These are supplements, not replacements for proper mechanical pressure through packing.

After Packing

1. Do not remove packing to check the wound for at least 24 hours unless signs of severe infection appear. Removing packing disrupts the clot.
2. Monitor for infection: Fever, increasing pain, redness spreading beyond the wound edges, foul smell, or pus draining around the packing.
3. When it is time to change packing: Soak the wound and old packing with warm clean water for 10-15 minutes before slowly removing it. This softens the dried blood bonding the packing to tissue and reduces the risk of re-opening the wound.
4. Re-pack with fresh, clean material if the wound is still open and bleeding. Most deep wounds will need multiple packing changes over days to weeks.
5. Consider wound closure once bleeding has been controlled for 24+ hours and there are no signs of infection. See Wound Closure.

Common Mistakes

Mistake	Consequence	Correction
Packing too loosely	Material does not apply pressure to bleeding source; bleeding continues	Pack firmly, compress each layer against the one below
Not reaching the deepest point	Surface packing misses the bleeding vessel	Use your finger to push material to the very bottom
Using dirty material	Introduces bacteria deep into tissue; severe infection	Boil cloth before use; prioritize the cleanest available material
Removing packing too early	Disrupts clot, re-starts bleeding	Leave undisturbed for minimum 24 hours
Packing a sucking chest wound	Prevents lung re-expansion; worsens pneumothorax	Seal chest wounds with an occlusive dressing (plastic, tape)

Key Takeaways

• Pack deep wounds from the bottom up in a zigzag pattern, pressing each layer firmly against the one below
• Use the widest, cleanest, most absorbent material available — boiled cloth strips or scavenged gauze
• Always apply a pressure dressing over the packing and hold direct pressure for 3-5 minutes
• Junctional wounds (groin, armpit, neck) require creative pressure solutions since tourniquets cannot be used there
• Do not remove packing for at least 24 hours; soak before removal to prevent re-bleeding