Regardless of how many times it is refuted, one of the many myths surrounding bleeding control that continues to linger, is using a tampon to treat a gun-shot wound.
The ‘tactical tampon’ is not a fancy, ‘high-speed’ product fresh from the minds of trauma device developers. We are talking about run-of-the-mill female sanitary products, that some believe are an essential part of every firearms owners emergency kit.
This pesky topic seems to rear its ugly head semi-routinely. Scarily, this is often shared as anecdotes by people who have never had to treat a gun-shot wound. There are plenty of internet experts and sadly, First Aid instructors in NZ who still tell people to carry a tampon in their pack in case of an accidental gun-shot wound. These people are often the same ones who say tourniquets are unsafe (read our article on TQ’s here!).
So, once and for all, let’s get this subject straightened out.
Injuries from gun shot wound’s are unique as opposed to many other mechanisms of injury associated with penetrating trauma. The location where the bullet goes in to the body will cause an entrance wound and depending on whether the bullet leaves the body, there may also be an exit wound. Bullets do funny things when they enter the body. They may continue on a straight path in and out. They may follow bone structure, or ricochet. In some instances, the bullet may not exit the body at all.
There are many factors which impacts the path of a bullet, and the amount of trauma from a GSW. These include:
Gun shot wound’s are unique because of the injury profile created in the wake of a bullets’ path, known commonly as cavitation.
When we talk about damage caused by a bullet, there are two main types – permanent and temporary cavitation.
The direct path of the bullet – where it cuts or shears its way through the body’s tissue – is called “Permanent cavitation”. It is the same diameter as the bullet or the bullet fragments and typically what you’ll see on the “in” or entrance wound.
This is as opposed to temporary cavitation, which is the damage to the body’s tissue caused by the energy dissipating from the projectile portion of the bullet. This transfer of energy essentially separates the layers of muscle tissue in particular and causes a hidden cavity behind the entrance wound of the permanent cavity.
Hornady explains it well: “In essence, a bullet going through soft tissue has the same effect as dropping a stone into a pail of water. If the stone (bullet) enters the water slowly, the water (tissue) displacement is so gradual that is has little effect on the surrounding molecules. If the stone (bullet) enters the water (tissue) with a lot of momentum, however, the surrounding molecules have to act a lot more quickly and violently, resulting in a splash (temporary cavity). Temporary cavitation is important because it can be a tremendous wounding mechanism.”
The entrance wound is typically where the fabled tampon is supposed to be inserted to assist with stopping bleeding. Remember, the entrance wound is determined by the size of the bullet, it is the wound you can physically see. The severity of the trauma caused internally, the cavitation, is often hidden, especially if there is no exit wound.
Depending on the calibre, the entrance hole might be small. In some cases, such as a .20 or .30, they’re smaller in diameter than a regular tampon. This means you would have to cause further damage just to shove it in the hole to plug it – it doesn’t make sense. But remember, just because the entrance hole is small, it does not mean the damage behind it is not significant.
This is the part that can trip people over. Due to the occult (hidden) nature of the trauma behind the skin layers, it won’t always present obviously or immediately.
Plugging the hole with a tampon might mean the blood is not visually coming out of the body. This does not mean it is in circulation. Blood will pool into the temporary cavitation. You’ll be thinking you’ve done your job, but wondering why your patient is still deteriorating and exhibiting signs of hypovolemic shock.
Let’s remember, the goal of controlling bleeding is not to absorb blood, but to keep it in circulation. Even if we wanted to absorb the blood, a regular tampon could absorb approx. 9g of blood (about two teaspoons). In no world would the 9g of absorption be beneficial to “stop an arterial bleed, capable of pumping out 1000 mLs in just over 3 minutes”.
You’ll hear us say it all the time – pressure wins the war against bleeding. This is the last (and possibly most pertinent point) as to why a tampon won’t work when treating a GSW – at best it will simply stretch the skin of the entrance wound and plug it creating a hidden cavity that will simply pool blood removing it from circulation.
Depending on the size, location and severity of the wound, your best best is direct pressure, tourniquets, chest seals or packing the wound with gauze if the injury is capable of being packed and in junctional area suitable for the delivery of wound packing. This is why include all of these in our Individual First aid System.
It is critical to remember that once you have managed the bleed, you still need to manage the casualty for hypovolemic shock.
Knowing what to use and when is crucial, this is why we have included Stop the Bleed® in all of our First Aid courses. We teach the science, the anatomy and the what, when and how to treat not only GSW, but bleeds from any mechanism of action.