sanitary napkins

Sanitary Napkins, Tampons and Diapers Are They Good Blood Stoppers?

This post was sent to me by a friend.  For many years, I have been told that sanitary pads, diapers and tampons worked well as wound dressing.  This article disagrees and says that they should not be used on a heavily bleeding wound.  What he is saying sounds logical, but I would like some feedback from people that may have used them.

Howard

Every now and again, this bad recommendation surfaces.  I actually saw this printed in an emergency veterinary book recently which prompted me to finally write this article.  It’s time to bust this myth.

I think it was the 2008 SOMA conference and the medic’s were presenting their combat medical vignettes.  A medic was presenting his casualty vignette when it started going something like this:

“…so I stuck my finger in the wound, and it…it felt like a vagina.”

At which point, the entire audience of about 500 collectively looked at their neighbor and asked “did he actually just say that?”.  And then he continued:

“…so I put a tampon in it.”

I’m sure almost everyone that has ever received ‘tactical medical’ training, and many that haven’t, has probably heard this advice in some form.  Back in 2000 during my EMT ambulance practicum, noticing there were no big field dressings like the Army issued me, I asked my preceptor ‘if we get a really big bleeder, what do we have to use?’ to which he answered ‘probably the diapers’.

Enter critical thought.

To start with, let’s define exactly what the issue is I’m addressing in plain language.  Often, so called “subject matter experts” will give the advice, that to treat massive hemorrhage, tampons, sanitary pads and even diapers are acceptable and effective ‘bandages’.  The qualification they give is that they are designed to ‘soak up blood’.

I’ve said it before, and I’ll say it again; if you’re ‘soaking up blood’, you aren’t controlling hemorrhage.  You are only keeping the floor clean.  When someone asks the question ‘how much blood can this bandage soak up?’, they are completely missing the point, and don’t fully understand hemorrhage control.

Sanitary Pads and Diapers

Let me first address sanitary pads and diapers.  These are specifically engineered and manufactured to soak up blood and urine and hold it in ‘keeping you dry’.  They rapidly wick fluid away from the surface.

If you consider the way blood clots in a wound, this actually works against what you are trying to accomplish.  Effective hemorrhage control is to tightly pack gauze up against the damaged vessel, and inside the wound, and hold it under pressure.  Medical gauze is specifically designed for this purpose.  It puts a significant amount of ‘surface area’ in the form of the gauze fibers in the area where the blood is leaking out.  The (manual) high pressure is to minimize this leaking out by squeezing the damaged blood vessel(s) closed.  Blood flow is slowed, and with the clotting factors in the blood activated, it becomes sticky, and hopefully sticks to the gauze fibers and all their surface area.  With pressure maintained and minimal movement and disruption, hopefully, eventually a clot will form within the matrix of gauze fibers, over the hole in the damaged vessel(s) that will hold and prevent further hemorrhage.

Place a sanitary pad or diaper on a wound and it doesn’t put surface area in the form of gauze fibers in the wound.  Rather, it actually wicks the blood away, almost sucking it out of the wound, leaving no clotting or clotted blood present in the wound to seal it.  The blood is wicked into the core and clots inside the pad and away from the damaged vessel where it is actually needed to adhere to, to form the plug.  Not the best conditions to promote clotting.  So the next time someone tells you to use these devices, please educate them on the difference between their great theory of hemorrhage control, and the reality of physiology, physics and the design of these products.

Tampons

The other adjunct I’ll address is the tampon.  The theory is that tampons soak up blood so they should be good for hemorrhage control.  After all, that’s what they are designed for isn’t it?  They come on a stick that seems like it should fit into a bullet wound track, so why wouldn’t it be effective in a gun shot wound for hemorrhage control.

If you understand ballistics, you know that when tissue is struck with a high velocity projectile, the kinetic energy transfer causes both a permanent and temporary cavity.  Those cavities also disrupt tissue planes which creates access to potential spaces for blood to pool in internally, as well as following the permanent wound cavity out the entry and exit wound (if an artery is damaged).

Medical gauze sold for packing wounds is usually around 4 inches x 12 feet (144 inches).  And a typical gunshot wound will easily eat that entire roll and possibly then some.

Does anyone know how much gauze is in a tampon?  I didn’t, so I opened one up.  I needed to soak it in water as it was compressed extremely tight and trying to open it dry, just pulled off little pieces.  Little pieces that if they became loose and lost in a wound would be great infection beds.

A tampon is made of two 2 inch x 4 inch pieces of gauze-like material and a little string.  And that’s it other than the applicator.  Compare that to 12 feet of medical gauze.

Compare this to the volume that comes in one gauze package.

A tampon is not designed to stop bleeding.  It is not designed to clot blood from a wound.  And I absolutely refuse to entertain any jokes whatsoever regarding the natural physiology of the female body.  This is serious and respectful business.  The bleeding source is not the vagina, but rather from the uterus, and blood flows out through the cervix then the vagina.  The tampon is deigned to soak and hold a small amount of blood.  The required function is very different.  In the presence of a damaged artery, two 2″x4″ pieces of gauze is like throwing a rock at a tank.

Let me leave you with this advice on managing massive traumatic hemorrhage; soaking blood does not equate to stopping bleeding.  Once you get past that, you’re on your way to really understanding how clotting, and hemorrhage control works.  You need to provide surface area (gauze fibers), including pro-coagulants and or muco-adhesives if available, in and against the actual wound, specifically the damaged vessel that is the source of the bleeding, under pressure, for an adequate duration, so that the minimal amount of blood that does leak out forms a stable clot.

If you need to improvise, a cotton T-shirt can’t be beaten, except by a bamboo T-shirt.  Leave the diapers, sanitary pads and tampons alone or else you could be ‘doing more harm’.

 

14 thoughts on “Sanitary Napkins, Tampons and Diapers Are They Good Blood Stoppers?”

  1. I was not under the opinion that tampons in an emergency were for soaking up blood. They were first suggested as something to push into the wound to cut off the source of the blood. Same with the other two, just something to press into would to stop blood by pressure, not soaking it up.

  2. The use of tampons in wounds is outdated information. In the 1970s tampax tampons were cotton and densely packed paper sewn together with a covering, not unlike some of the dressings we already used. There were some wounds which could benefit from their use in a narrow band of circumstances, and this was actually taught in universities. However, now sanitary napkins, tampons, and diapers all use some degree of a water absorbing clear polymer, which although for most people is inert when held up to their skin, is not inert or harmless inside the body. (Soak one, let it swell and then take it apart over the trash and see all the swollen polymer beads.) Tampons are even implicated in toxic shock syndrome when used in vaginas ! These new products should not be used directly in wounds. Thank you for your post.

  3. It is my understanding that tampons were invented by a French doctor, sometime before WW1, to plug bullet holes. The modern use came later.

    1. The original “kotex” fibers were found when attempting to creat wound dressings- as stated above the modern versions are not the same.

  4. NGO_Disaster_IAO

    To All,

    The article(s) written on this subject have lots of debate….

    Starting in my old EMT Days in the early 80’s it was in basic training that the sanitary napkin was part of the trauma items – primary use for feminine emergencies and as a adjunct when you run out of your primary dressings.

    Lets remember that all the information on service, absorption, clotting etc is well noted. Having been in countries during/post civil unrest, humanitarian disasters, war – when you can buy the optimal dressings, stock pile, and or wait for refills/resupply…the sanitary napkin works along with the tampon(break it open fluff it) can be used as primary and or secondary along with all the other IAO(improvise, adapt, overcome) techniques… perhaps the article you referenced catches your attention and draws debate and discussion which is good.

    And I go back to when general first aid and treatment items are scarce so are the feminine / infant care items… however they are available and should be considered as options…from experience in taking the cloth dressings off the dead boiling in hot water, air dry and use again to attempt to save a lives…the sanitary pad and tampon does work (they also work great in the surgical processes)…not the best options…but in a IAO it has a purpose with trained personnel.

    Great Discussion Point!

  5. Makes sense! I guess the best alternate use for them would be for wiping up the lost blood for easier disposal.

  6. I wonder if you could also soak the wound with eyedrops – a vasoconstrictor. They are designed to constrict blood vessels. The same chemicals are often used in nasal sprays and anyone who has used a vasoconstrictor in their nose knows (har har) that they work very well, in just a minute or two.

    I asked my doctor and he didn’t reject the idea as an emergency tool.

  7. I find it constantly frustrating, I’m not a emergency medical practitioner but I’m surrounded by them in my family. Modern day young smart people working in that industry still think that diapers and feminine products are great for bandages. Not only do I read a lot off the Internet, I’m before the age of the Internet and I read actual books. They probably think about the fact that they don’t have to clean up so much blood after the event. My only hope is that if some terrible event happens to me I don’t Exsanguinate into a feminine napkin due to ineptitude.

  8. I was a Navy Corpsman back in the 80’s and spent some time with a Marine Corps infantry Unit. Even today I keep tampons and sanitary pads in my first aid kit and here is way. Lets say we are hiking one of us slips and opens a large wound on an extremity. Our combined first aid kits will only have so much gauze. That will be used to line the wound and do what gauze does best as explained above. The pads will be used to fill the remaining space and combined with the Israeli bandage or similar tool a great amount of pressure will be put on the wound.

    Unless there was no other choice I would not use pads directly on the wound. Nor would I use this as a definitive treatment it is emergency aid only. Pads are not sterile and the first layer of a bandage should be.

    I only use tampons for hard to control nose bleeds lasting more that 20 minutes using conventional treatment. This is meant to wick the blood forward preventing it from running into the throat. If the beading has lasted more than 20 minuets it is likely coming from further back then pressure can be applied so the tampon is not really performing that function. However it should be left in until definitive treatment can be obtained in case it does come into contact with the beading area and a clot does form. Removing the tampon will also remove the clot and the whole thing will start again. If the nose bleed lasts more than 20 minutes definitive care should be sought anyway.

    That is just my opinion and how I treat my family.

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