Written by Keith Rodriguez, EMT, NREMT
**DISCLAIMER** This article is not a “how to” article, but an article arguing against the use of the tampon as a fix all to GSW’s. Please seek out proper training in order to effectively treat said injuries and always follow your protocols and scope of practice.
Anyone who works in emergency services has heard at least one person say it. “I carry tampons in my aid bag to fix gunshot wounds.” Or, “Well, my buddy is a combat medic in *insert branch of service here* and s/he carries one for that reason!” If you’re a provider worth your salt, you’ve probably had the same reaction that I had when I first heard it. A mixture of shock and awe that someone who has had all this training actually believes that insertion of a tampon into a GSW is good for their potential patient and will seemingly have a good outcome once this application has been completed. In that moment we have one of two choices to make. Do we just shake our heads and walk away? Or do we tell them why they are wrong and try and help them make better decisions in regards to patient care? In this article, I will hopefully be able to give you some ammo to help with the latter.
Firstly, lets talk about what a tampon is. A tampon is a feminine product that is inserted into the vagina and is used to absorb menstrual fluids during the course of ones menstrual period. These fluids are made up of approx. 50% blood, and some other biological materials such as shed uteral lining, vaginal secretions, unfertilized eggs, etc. The tampon is designed to be inserted and absorb a small amount of this fluid. This fluid, mind you, is also not pressurized in any way whatsoever and its presence is not required in order to sustain life. Typically tampons only hold approx. 5 milliliters of fluid when they are fully soaked to capacity. Others may hold about double that.
A tampon itself is usually made up of a small amount of absorbent cotton material attached to a string for easy removal, which is packaged in some sort of tube-like applicator (whether it is made of cardboard or plastic) which is usually housed in some sort of paper or plastic wrapper. These come in varying dimensions depending on the manufacturer. It should also be noted that these products are not sterilized as they leave the manufacturer as well, as there is no need for them to be. With all the different type of applicators out there, and different packaging, it can be very confusing for even the most experienced user to figure out how “This one works” in a stress free environment. Now imagine putting yourself in a stressful environment, where you potentially lose all fine motor skills, trying to open three layers of packaging and then trying to figure out how the applicator works on this particular product, just to try and plug a bullet hole. See where I am going with this?
Secondly, let’s discuss the morphology of a GSW. As we all know, the projectile from a firearm moves at a very fast rate of speed and enters its target causing extreme damages due to the force behind the projectile. Not only does its impact cause damage, but the kinetic energy of the projectile causes additional trauma to the area in question. As said projectile travels through the body, the kinetic energy is transferred and produces a shock wave that creates a cavity that is greater than the projectiles dimension. This cavity might be temporary and collapse or a permanent cavity wider than the projectile might persist. This is called the “Cavitary effect” and it is more prominent in injuries sustained from high velocity ammunitions. If the projectile severs an artery, the resulting cavity could easily fill with blood, which is an area of grave concern. Unless the bleeding is stopped appropriately, the bleeding could continue to fill the cavity and the patient will bleed out even though you have identified that wound as being “closed” due to the improper application of a dressing or using a “tool” such as a tampon.
If a tampon is applied to a wound, all it will really do is seal up the entrance wound. Without putting direct pressure on the artery itself, your patient will hemorrhage, become hypoxic and die. Proper wound packing, the use of pressure dressings, or the application of an approved tourniquet such as the CAT, or SOFTT-W are the only ways to effectively stop the bleed associated with a GSW.
Evidence based medicine has shown time and time again that these tried and true methods are effective, so why cheap out and improvise with a device that is not meant to treat the wound effectively? Spending money and time on proper training and proper supplies not only makes you a more competent provider, but also makes you a smart provider. After all, Proper preparation prevents piss poor performance.
About the Author
Keith has been a certified EMT in NJ since 2010, an NREMT, a Stop-The-Bleed Instructor, Incident Response to Terrorist Bombing Instructor and a US Army veteran.