The Myth of the ‘Tactical Tampon’ for Gun-Shot Wounds
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.
“A search of peer-reviewed medical literature will fail to provide you with any data whatsoever on tampon use. This is likely, because no physician or researcher would recommend such a dangerous practice or suggest something so inferior to products that are battle tested with thousands of hours of research and hundreds of lives saved.”
Myth #1: “… A tampon will plug a gun-shot wound…”
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:
- The weight of the projectile
- The type of projectile
- The velocity of the projectile
- The angle the bullet hits the body
- The distance of the body to the firearm.
Gun shot wound’s are unique because of the injury profile created in the wake of a bullets’ path, known commonly as cavitation.
What is 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.”
So why can’t the tampon plug the hole?
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.
Myth #2 “…But tampon’s are ultra-absorbent …”
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”.
So what does work for gun-shot wounds?
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.
Was in the army, was told by combat medics (who have said to have used them) that tampons can and do work at patching gunshot wounds. A “myth” it is not.
What might not fly as civilian medics is not the same with soldiers in a combat situation.
Hi Dexter, I too remember being told on my initial army basic training that tampons were appropriate for haemorrhage control. However, as my military medical career progressed and I gained more education and experience, this is one of several medical interventions that were either modified or removed. Tampons are not designed to stop bleeding but rather to absorb and catch menstrual blood stopping it from leaking out during a menstruating women’s daily activities. It is the pressure that stops bleedings, and there are additional mechanical and pharmaceutical tools that aid this. I understand your comment about medicine in the civilian vs combat environment, however, both environments have the same objective which is to keep people alive. Tampon use for traumatic haemorrhage control is dangerous and irresponsible when there are so many well research and proven options that are continually being assessed and improved. I would recommend this article that I have referenced below or alternatively the Committee on Tactical Combat Casualty Care (CoTCCC) guidelines which are reviewed annually and specialize in combat medical recommendations.
Shertz, M. (2019, July 18). Heavy flow is not massive hemorrhage: Tampons don’t belong in IFAKs. Crisis Medicine. https://www.crisis-medicine.com/heavy-flow-is-not-massive-hemorrhage-tampons-dont-belong-in-ifaks/
A pressure dressing and duct tape is better than a tampon. If it is arterial wound then you best get a TQ on or your buddy is going to die.
Dexter, so either:
1. You didnt even read the article about how plugging a tampon doesn’t even make sense nor helps to stop the bleeding from a gunshot.
2. You never served in the army and you’re just rambling.
3. Your combat medics were retarded or never dealt with a gunshot
So what’s it going to be? And please explain how a tampon DOES work?
Either they are lying or you are lying Dexter. Tampons DO NOT work to control bleeding from anywhere other than a uterus. Hearsay is not evidence.
It doesn’t ‘control ‘ bleeding from the uterus. It collects the bleeding . 🙂
You can thank Nose bleeds probably for helping create this line of thinking. Because that’s a different situation where tampons are useful for me .
What is the difference between “packing the wound with gauze” vs inserting a tampon?
I’ll describe one of the methods of packing that was taught to me, and I have seen used to good effect on live tissue.
There are other methods of packing a wound: all of them are similar in effect.
A pack always begins by immediately controlling the bleed manually with either direct digital pressure directly inside the wound and on top of the artery, or pressure on the skin(over the artery) above(proximal) to the wound. Press the artery to the bone to stop the bleed. This same pressure will now continually be maintained throughout the packing process, just by different mediums.
With bleeding now controlled, use a section of regular gauze to wipe away excess blood, blunt dissecting as necessary to locate and visualize the severed artery. Snip off the bloody excess and discard it, saving the rest of the unused regular gauze for further in the packing process.
With the wound now wiped out, prepare the hemostatic gauze for packing by opening one side of the package and putting the entire package into a pocket, or tucking it into a shirt so it can be pulled out easily section by section.
Ball up a large wad of gauze and place it directly on top of the end of the bleeder, replacing pressure with pressure, making sure to apply enough pressure to clamp the artery shut against the bone. Three balls in total will be packed in this manner.
After packing three balls, pack the remainder of the hemostatic gauze in an asterisk(*) pattern to create a tight dome over the bleeder.
After all the hemostatic gauze is packed, pack regular gauze on top, the asterisk pattern no longer necessary. Once 2-3 inches above the wound, fold over the remainder of the gauze and use it as a pressure pad to continue to apply firm pressure.
Pressure is now maintained for 3 minutes.
After 3 minutes, we will remove the regular gauze by reaching under to the hemostatic gauze and maintain pressure. Once reduced to the hemostatic gauze, you will press down harder on it, and peel back the wound around the edges of the pack, looking for blood welling up or pooling around the sides. Either of these signs, and you have messed up at some step(probably didn’t pack in the right place, or didn’t maintain continual hard pressure).
The whole thing comes out, and the process begun again.
If the packing is holding (no pooling or seeping), then replace the regular gauze and wrap it TIGHTLY with some variety of elastic bandage.
Packing a wound is a difficult, perishable, life-saving skill.
Popping a tampon in a hole just doesn’t cut it.