29 September 2008

The Legend of Combat's Cotton Dutchboy - Debunk'd

...or Pulling the Plug on Tampons in Trauma.

There is a frequently cited story of a package being accidentally sent to some Marines in Iraq back in 2004. This care package was intended for a female service member, but somewhere along the pony express, the shipment was rerouted to a Marine line unit. Contained in this package were some feminine products. Not mud masks and loofahs, but hygiene products, like sanitary napkins and tampons. Lo and behold, while out on a convoy, the Marines were ambushed, and took some casualties. Supposedly, some "quick thinking" Marine used his issued ration of critical thinking and crammed a tampon in the wound, thereby staunching the bleeding, and saving the casualties life.

*ahem* Where to begin?

First, a bit of History. In 1914 Kimberly-Clark developed an absorbent wadding product they called "Cellucotton". Made from processed wood, Cellucotton was five times as absorbent as cotton, and cost half as much to produce. This product was used to bandage wounds during World War 1. In 1919, after the War, Kimberly-Clark had the notion of marketing Cellucotton as disposable sanitary napkins. Their marketing agency suggested changing the name to Kotex®, short for cotton textile. Prior to this, women used washable rags to absorb their menses. This disposable alternative took a while to catch on...but catch on it did. Tampax hit the scene in 1936.

You see, lesson one is that first aid dressings evolved into disposable sanitary napkins, not vice versa.

Next, the prospective use of a tampon as a field-expedient dressing has been around for quite some time. So this talk of using them in 2004 during OIF II isn't the first mention. Veterans of Viet Nam, Panama, Grenada, and the Gulf War mention hearing of it. Back when I was PVT ParaCynic, a veritable sponge for the knowledge imparted by the fine non-Commissioned officers of the United States Army, the life-saving trauma tampon was brought up rather frequently by instructors. "Carry tampons, they're great for plugging bullet holes."


Herein lies one minor dilemma. The "slick-sleeved" instructors that attempted to pass this information off as reputable had never seen Combat. They lived in a post-Cold War theoretical sand table. They had never seen an actual gunshot wound, let alone effectively treated one. Perhaps that's why they felt a birth canal and a bullet hole were interchangeable.

Does anyone reading this blog need me to draw a picture as to the difference between a high-velocity rifle entry wound and a vagina?

The two most commonplace sizes for high-velocity rifles rounds are 7.62mm and 5.56mm. Now, even when you factor in the tendency of the slug to yaw in flight, the hole created by a 5.56mm round is equivalent to the hole created when you push a Bic ink pen through a piece of paper. Although a 7.62mm is 27% larger than a 5.56mm, it's still not a very big entry hole.

Hardly large enough to push a finger into, without eliciting a painful response, and the associated cursing and threats upon your well-being. *pause*

When the Hell did we start encouraging people to [shove, cram, pack] fingers and foreign objects into open wounds? To all the folks that might say "well, it's ditch medicine", or "it's ghetto medicine": Those are two scenarios where we should discourage such practice even more fervently.

Now, the supposed practice is not to pack the wound with sterile gauze, or iodoform, or some other medically acceptable medium. Even if it were, I would still be opposed and out-spoken. No, they are talking about cramming a wadded piece of "cellucotton" into a hole that is 1/4 it's size, or smaller.

Next, what's the point? What are you trying to accomplish? Whether the entry wound is in an extremity, the chest, the abdomen, or head, it makes no difference. This is a terrible idea. You're not stopping the bleeding. The tampon will not "expand and exert pressure on the source of any bleeding". You are not "sealing the wound". You have now introduced a fibrous foreign body, into an otherwise "clean" wound tract.

Now, as a component of a dressing, I suppose it's not too terrible of an idea. They're absorbent, and might make a good addition to a pressure dressing, outside of the wound.

Mainstream media isn't helping matters. There was recently a video game trailer released, Army of Two, in which "buddy aid" consists of using a tampon to revive your teammate. ugh.

Satan's Little Cotton Fingers have no business in the management, [field, ditch, ghetto] medicine, or otherwise, of penetrating trauma secondary to high velocity lead poisoning. Much to my chagrin, however, this is another one that is not going to go away any time soon.


Medicmarch. said...

dude. Best post ever. Informative and snarky.

Welcome to the blogroll.


ice_gnome said...

Love it. Never heard of that use of them though.

However, I have been told that the really skinny ones are great for nose bleeds....never tried it though.

Anonymous said...

followed the link to landoverbaptist...
check it out.

Walt Trachim said...

Great post.

The last time I checked, unless there is an exit wound, isn't it appropriate to treat for air in the pleural space? Usually by way of a three-sided occlusive dressing over the hole. Personally I like Tegaderm for this because it sticks well and you still can open it up on the fourth side. I used this for a stab wound and it worked as advertised. Poor bastard still needed a chest tube in the ED, though.....

Rogue Medic said...

I had never heard of this use of tampons.

It is similar to the practice of applying direct pressure to a penetrating injury to the chest - as if that is going to have any effect on the significant and much deeper sites of bleeding.

I suspect that any such saves were patients with self-limiting bleeding to begin with. They would have survived if the medic had stuck feces in the wound, not that I would recommend that. :-)