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We applaud the authors for their effort to educate the bystander and even medical professionals with a means to provide care for the injured in terrorist attacks. While the majority of the information provided is based in historical evidence, in today’s era of superior wound packing materials the use of tampons for gunshot wounds (GSWs) is an inferior and dangerous suggestion.
Tampons have been around for many thousands of years for vaginal bleeding, but nothing has been documented for their use in GSWs. Stories of tampon use have been around since the Vietnam era. There have even been anecdotes posted on Snopes.com from the war in Iraq. The story is full of unsubstantiated information, yet it is a common reference for many.
One can find in the fringe of the Internet, other claims of tampon effectiveness. Bioprepper claims tampons are “designed to be ultra-absorbent” and “can be used to plug a bullet hole until…accounts of this use date back to World War I.” They go on to say, “Many items in modern society were first developed as a facet of military research – tampons being a prime example.” This is absolutely false. Not only that the article itself never demonstrates a tampon being used to stop life threatening hemorrhage – rather it illustrates a plethora of Boy Scout novelties of the tampon.
Elsewhere, there are anecdotes of tampons being used during World War I and II, but nothing specifically written from the era. Still, there is no def...
Elsewhere, there are anecdotes of tampons being used during World War I and II, but nothing specifically written from the era. Still, there is no definitive information that they were used as treatments for life-threatening wounds. In fact the majority of wounds for which tampons were used likely were NOT life threatening considering the person survived utilizing a device not intended to produce the necessary occluding effect of arterial bleeding. Kimberly-Clark, which produces Kotex® did make and provide Cellucotton, an absorbent wadding made of wood pulp as bandages. These are bandages, not tampons. It was after the war, when they began making sanitary napkins from this material. It was not till later, that tampons were made by Kimberly-Clark. Another tampon story says nurses made their own tampons during World War I. However, World War II, “production of cotton bandages and surgical dressings for the U.S. military now took place alongside the tampon assembly lines.” Where the idea developed that these two devices that were made on the same assembly line meant they were interchangeable – we have no idea.
Massive bleeding from an artery in an extremity is a life-threating wound and also a preventable death.[6-9] This is a significant issue, not only for the US military, but also the citizens of our nation. Of the 147,000 trauma deaths in 2014, 20% or 30,000 were potentially survivable. Many of these were due to bleeding from an extremity.
A tampon cannot provide the surface area or the pressure required to control massive bleeding. Tampons absorb blood, they do not provide any hemostatic assistance. The average tampon can absorb 9 mL of blood, or about two teaspoons. Life-threatening bleeding occurs when there is greater than 1500 mL creating a state of profound shock and impending multisystem organ failure. It would be not only irresponsible, but down right ludicrous to think a tampon designed for 10 mLs of blood or even 10 times that at 100 mLs of blood would suffice to stop an arterial bleed capable of pumping out 1000 mLs in just over 3 minutes. A tourniquet or hemostatic dressing is preferred to control massive bleeding, regular gauze may be used, but it needs to be in sufficient amount. Based on square inches, a tampon can be as small as 4 square inches.
The American College of Surgeons and Stop the Bleed program recommends, when you do not have a hemostatic dressing, sterile dressings, or a tourniquet, use clothing to pack wound. This can be a shirt, pants, etc. even if your clothing is covered in body sweat, it’s more likely to provide more hemorrhage control than a tampon.
A search of peer-reviewed medical literature will fail to provide you with any data whatsoever on tampon use. This is likely, because no physician or researcher would recommend such a dangerous practice or suggest something so inferior to products that are battle tested with thousands of hours of research and hundreds of lives saved.
The authors have been tampoozled. It is clear, that the tampon argument is based off passed down and unverified anecdotes. It is dangerous and needs to be dismissed as a potential use for gunshot wounds. We need to stop having this conversation and stop spreading this old wives tale before someone dies as the result non-evidenced based medicine.
1. Control, I.o.M.D.o.H.S.P.I.o.M.D.o.H.P.D.P.I.o.M.C.o.T.S.S.C.f.D., Toxic Shock Syndrome: Assessment of Current Information and Future Research Needs : Report of a Study. 1982: National Academy Press.
2. Mikkelson, B. Tampon Wound Dressing: Tampon used to stanch deadly wound saves Marine's life? 2007 August 30, 2018]; Available from: https://www.snopes.com/fact-check/tampons-to-the-rescue/.
3. Creek. The Swiss Army Survival Tampon: 7 Survival Uses. 2014 August 30, 2018]; Available from: http://www.bioprepper.com/2014/01/19/the-swiss-army-survival-tampon-7-su....
4. History of Tampons and Tampax. 2018 August 30, 2018]; Available from: https://tampax.com/en-us/offers/tampax-history.
5. War Souvenirs. 2015 August 30, 2018]; Available from: http://www.period.media/factsfigures/war-souvenirs-2/.
6. National Academies of Sciences, E. and Medicine, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, ed. D. Berwick, A. Downey, and E. Cornett. 2016, Washington, DC: The National Academies Press. 530.
7. Tien, H.C., et al., Preventable deaths from hemorrhage at a level I Canadian trauma center. J Trauma, 2007. 62(1): p. 142-6.
8. Teixeira, P.G., et al., Preventable or potentially preventable mortality at a mature trauma center. J Trauma, 2007. 63(6): p. 1338-46; discussion 1346-7.
9. Eastridge, B.J., et al., Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J Trauma, 2012. 73(6, Supplement 5): p. S431-S437.
10. Rossaint, R., et al., The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care, 2016. 20: p. 100.