One item I come across from time to time on social media is the persistent notion that tampons, the feminine sanitary product, are an excellent addition to your medical kit. I’ve read accounts by many, usually second- or third-hand, that these items saved the life of a soldier because a savvy medic made sure to carry what some call a “tactical tampon” in his pack.
I’m too polite to call these stories a lot of hogwash, so let’s just say they’re…amazing! Now, Why would I, a Fellow of the American College of Surgeons and OB/GYN, a guy who has dealt with his share of significant bleeding, have doubts about the benefits of sticking tampons into bullet holes?
Let’s talk about what happens in a case of ballistic trauma, something I’ve written and spoken about a number of times over the years. When soft tissue is struck by a projectile at high speed, it causes a cavity, a channel if you will, through which the projectile traverses. As a matter of fact, it causes two channels: A permanent one caused by the actual path (not to mention any fragments) and a larger temporary one caused by the kinetic energy being released into the body. Vessels and organs affected by this secondary shock wave might not be in the direct line of the permanent cavity, but can be damaged and easily bleed.
All this with an entry wound that might not even perfectly fit a tampon. As the examples above show, bullets traveling at high speeds go deep into the body; a lot deeper than a tampon will cover. Plugging a hole, even one that looks like it could fit a tampon, doesn’t stop the bleeding inside. It just pools internally or maybe finds an exit wound, but the tampon is just concealing the bleeding, not stopping it. Just because you can’t see it doesn’t mean it isn’t happening.
Tampons are meant to deal with menstrual bleeding, a type of bleeding that isn’t under much pressure, unlike the blood that’s coming out of a ruptured artery. Compare our tampon with an unwrapped compressed gauze dressing (image above).
How much blood are you absorbing with the tampon? Light tampons, about 6 grams, super duper absorbency, about 15 or so. That’s not so much, especially if there’s arterial bleeding. The rest has to go somewhere.
You should also know that tampons are clean items, but not sterile. Standard dressings used for wound care of traumatic injuries are sterile by and large, and having seen wound infections, should be.
Some believe that tampons are a formidable pressure
dressing. To me, not so much. The ability to absorb a small amount of bleeding
and a serious wound packing are two different things. A tampon is good at the
first but not the second. A tampon works for what the Good Lord and Proctor and
Gamble intended it for; any other possible purpose? It perhaps might make some
difference in a nosebleed along with pressure on the right-sized nostril, if
you could get it up far enough to where the bleeding is. I could imagine it
working on a very shallow stab wound with little bleeding, but in both cases I
think prolonged direct pressure would be a better strategy.
Honestly, you’d be better served with some decent rolls of
gauze or pressure dressings like the Israeli Battle Dressing than a box of
tampons. You’d be even better served with some of the fine hemostatic bandages
that are on the market, like Celox, QuikClot, and ChitoSAM. They’re expensive,
but you’re talking about saving a life here.
Don’t get me wrong, I’m all for improvisation and write about it often. Many of our kits carry a number of tongue depressors, for example. One is good for looking at your throat, but could also serve as a splint for a fractured finger. A few together might make a reasonable tourniquet windlass.
So, if you’re a combat medic who used a tampon on a bleeding casualty and the surgical team didn’t find a lot of blood internally somewhere, well, good job. I’ll bet, however, the actual verifications are few and far-between.