Stop the Bleed: Packing Wounds When a Tourniquet Cannot Be Applied

Stop the Bleed: Packing Wounds When a Tourniquet Cannot Be Applied

When a life-threatening bleed occurs, seconds matter. A properly applied tourniquet can stop severe extremity bleeding, but not all wounds are suitable for tourniquet use. Understanding which areas of the body can be effectively packed is a vital part of hemorrhage control and can save a life when immediate medical help is still minutes away. This principle is central to Stop the Bleed training—empowering everyday people to take lifesaving action in emergencies.

Why Some Areas Cannot Be Tourniqueted

Tourniquets work by compressing arteries in the arms and legs to stop distal blood flow. However, not all major bleeding occurs in the limbs. Wounds in the neck, shoulder, groin, and certain parts of the torso are known as junctional areas—regions where the limbs connect to the body and where tourniquets cannot be effectively applied due to anatomy or risk of crushing vital structures.

In these cases, the proper approach is to apply direct pressure and, when appropriate, pack the wound with gauze or a hemostatic dressing. The goal is to fill the wound cavity and apply enough consistent pressure to help blood clot and stop the hemorrhage until professional medical help arrives.

Key Areas That Can and Should Be Packed

1. Groin (Inguinal) Area

The groin region is a common site for catastrophic bleeding in both trauma and combat injuries. Major arteries like the femoral artery pass through here, and a penetrating injury can cause massive hemorrhage within seconds. A tourniquet cannot be applied effectively because the artery lies deep within the junction of the thigh and pelvis. Instead, pack the wound tightly with gauze or hemostatic material while applying firm, continuous pressure until bleeding stops or emergency responders arrive.

2. Axilla (Underarm)

The axillary region, located beneath the armpit, contains several large blood vessels, including the axillary artery and vein. Bleeding here can be severe and life-threatening. Since this is a junctional area between the torso and the arm, a tourniquet cannot fully compress the vessels. The correct intervention is to pack the wound cavity firmly and apply direct pressure for at least three minutes. Maintain pressure even after bleeding appears to stop, as re-bleeding can occur if pressure is released too early.

3. Neck and Jawline

Bleeding in the neck or jawline area requires extreme caution. The carotid and jugular vessels are critical to brain perfusion, and incorrect compression can cause airway obstruction or stroke. Wound packing is appropriate for open wounds that do not directly involve the airway. Insert gauze into the wound cavity carefully, packing layer by layer, while maintaining pressure. Never wrap a circumferential bandage around the neck. Once bleeding is controlled, maintain manual pressure and monitor for airway compromise.

4. Buttocks and Gluteal Region

Injuries to the gluteal muscles may involve branches of the internal iliac artery. These wounds are deep, and blood can pool rapidly within the soft tissue. Tourniquets are ineffective here, but wound packing is extremely useful. Fill the wound cavity completely with gauze or hemostatic material and apply constant downward pressure. This is particularly relevant for gunshot or stab wounds in the lower back or hip area.

5. Shoulder and Clavicle Junction

The region around the collarbone and upper chest is another transition zone where tourniquets cannot be used. Major vessels such as the subclavian artery pass through this area. For bleeding at the shoulder or base of the neck, pack the wound with hemostatic gauze if possible and apply downward and inward pressure. Position the casualty on their back to maintain control and prevent pooling of blood beneath the shoulder.

Areas That Should Not Be Packed

Not all wounds are suitable for packing. Attempting to pack wounds in the chest, abdomen, or head can cause harm if not properly indicated. These regions contain organs and cavities that require surgical control rather than compression.

• Chest (Thorax): Wounds to the chest may cause lung collapse or tension pneumothorax. Apply an occlusive dressing (such as a chest seal), not packing.
• Abdomen: Abdominal bleeding requires rapid transport to a trauma center. Direct pressure is appropriate, but do not pack deep abdominal wounds.
• Skull or Face: Avoid packing inside the mouth, nose, or skull fractures. Control bleeding with external pressure and ensure the airway remains clear.

Hemostatic Agents and Gauze Selection

Modern hemostatic dressings—such as QuikClot, Celox, or ChitoGauze—are designed to enhance the body’s clotting ability. They contain agents like kaolin or chitosan, which activate platelets and help form stable clots more quickly. If these are unavailable, plain sterile gauze or even clean fabric can still be effective when packed tightly and held under pressure.

When packing a wound, always use a continuous, methodical motion. Push gauze deep into the wound cavity while maintaining pressure with each layer. Once the wound is full and bleeding slows or stops, continue holding firm pressure for at least three minutes. Secure the dressing with additional gauze or a bandage to maintain compression during transport.

Transitioning to Professional Medical Care

Even when bleeding is controlled, all patients with junctional or deep wounds require rapid evacuation to advanced care. Continue to monitor for re-bleeding, changes in consciousness, or breathing difficulties. If possible, mark the time of the intervention and inform emergency responders that wound packing and pressure have been applied. These details can help hospital staff assess the severity and manage further treatment efficiently.

Why Stop the Bleed Training Matters

Every second counts during a hemorrhage emergency. The Stop the Bleed program, adapted from Tactical Emergency Casualty Care (TECC) and Tactical Combat Casualty Care (TCCC) principles, teaches civilians the same lifesaving techniques used by first responders and military medics. Participants learn how to identify life-threatening bleeding, apply tourniquets, pack wounds effectively, and maintain pressure until help arrives.

Our Stop the Bleed training includes hands-on simulations where participants practice packing realistic wound models and using both standard and hemostatic gauze. This builds confidence and muscle memory—critical under stress when real-life bleeding emergencies occur.

Private Group Training Available

We proudly offer private Stop the Bleed classes for organizations, companies, and community groups throughout Orange County, Los Angeles, the Inland Empire, and San Diego. Our instructors bring all the necessary equipment and create immersive, hands-on scenarios designed to empower participants to act decisively and effectively during an emergency.

Whether you represent a corporate team, school staff, event security, or church safety group, we can tailor the training to your environment and schedule. On-site sessions can accommodate groups of various sizes and include all materials for practical skill development.

To book a private group session or learn more, visit our website at StopTheBleedTrainingCalifornia.com or call us directly to schedule your class. Together, we can make Southern California safer, one trained responder at a time.