Hands On

Re­view of the Wound Cube

RECOIL OFFGRID - - Contents - By An­drew Schrader

Wound pack­ing, be­sides ap­ply­ing a tourni­quet, is one of the most ba­sic tech­niques of bleed­ing con­trol in a pre-hos­pi­tal en­vi­ron­ment. In the­ory, the con­cept is rel­a­tively sim­ple: hold pres­sure on a wound, and af­ter sev­eral min­utes, the ap­plied pres­sure will help to en­cour­age the body’s nat­u­ral clot­ting fac­tors. This can vary from just three min­utes of pres­sure if us­ing spe­cially man­u­fac­tured gauze (i.e. Com­bat Gauze) im­preg­nated with hemo­static agents, to 10 min­utes if us­ing stan­dard gauze or other fab­rics.

The trick to this tech­nique, how­ever, is that the cor­rect pres­sure ap­pli­ca­tion point may be sev­eral inches down in­side the mus­cle. Pres­sure is much more ef­fec­tively gen­er­ated once you reach a hard sur­face, such as a bone, to push against. Oth­er­wise, try­ing to com­press rel­a­tively squishy fat and mus­cle starts to feel like push­ing rope.

The Wound Cube from Phokus Re­search Group is a new train­ing tool to help teach this vi­tal tech­nique. We’re fea­tur­ing it be­cause it’s dif­fi­cult to make a sim­i­lar tool on your own, and even harder to make it for less money than its cur­rent re­tail price.

Mis­lead­ing In­stincts

A layper­son’s in­stinc­tual re­ac­tion when pre­sented with a heav­ily bleed­ing wound is of­ten to ap­ply pres­sure di­rectly on top of the skin, pos­si­bly with their hands. Even if they have gauze, their first re­ac­tion is of­ten to try and mash a ball of it into the wound from the top. A more ap­pro­pri­ate tech­nique, how­ever, is to feed gauze or other wound-pack­ing ma­te­rial start­ing down at the bot­tom of the wound, slowly pack­ing from the bot­tom un­til the wound is filled. At that point di­rect pres­sure will be ap­plied from the out­side sur­face (skin) and this pres­sure be­comes di­rectly trans­mit­ted to the base of the wound — ex­actly where we want it.

Take a stan­dard gun­shot wound as a clas­sic ex­am­ple. Those fa­mil­iar with bal­lis­tic im­pact re­sponse may al­ready know that a wound into flesh can create a nar­row chan­nel at the start, grad­u­ally ex­pand­ing into a larger wound cav­ity as the bul­let ex­pands or mush­rooms. It would be im­pos­si­ble to ap­ply ad­e­quate pres­sure on the in­side of the ex­panded cham­ber by push­ing from the out­side.

But by feed­ing gauze in with your fin­gers, ½ inch by ½ inch, the wound cav­ity can be filled cor­rectly. This isn’t easy. Be­cause gauze is flex­i­ble and non-rigid, it can be tough to feed it down a nar­row tube where you can’t see what you’re do­ing or where it’s go­ing. It’s an ac­quired tech­nique and, like many sur­vival skills, re­quires pe­ri­odic re­fresher train­ing.

Feels Like Warm Ap­ple Pie

En­ter the Wound Cube. The cube, de­signed to ac­cu­rately de­pict the tex­ture and feel of a trau­matic in­jury in flesh, fea­tures sev­eral types of cor­rectly mod­eled and sized wounds. These in­clude lac­er­a­tions as well as dif­fer­ent types of gun­shot wounds. The bal­lis­tic pat­terns are au­then­tic, recre­at­ing the nar­row en­trance channels and larger in­te­rior cav­i­ties cre­ated by a gun­shot wound. Its durable sil­i­cone also fea­tures re­al­is­tic tis­sue den­sity and is tex­tured to feel sim­i­lar to hu­man skin, es­pe­cially when a few drops of sim­u­lated-blood lu­bri­cant is added.

For those of you who may be fa­mil­iar, yes, the Wound Cube is based on the same ma­te­ri­als tech­nol­ogy as the Flesh­light. The ver­sa­til­ity of science can en­rich many facets of our lives.

How It’s Used

The me­chan­ics of us­ing the cube are sim­ple. Ba­si­cally, it’s an in­ert block of sil­i­cone with holes that you stick your fin­gers (and only your fin­gers) into. Con­tin­u­ally train­ing on the act of feed­ing gauze into the tiny holes with your fin­gers will make it that much eas­ier if you ever have to aid a vic­tim who’s been shot or stabbed — at least if that in­jury is to the arms, shoul­ders, or legs. Wounds in places like the chest, ab­domen, neck, and head of­ten re­quire ad­vanced care tech­niques, and it’s usu­ally bet­ter to fo­cus on rapid evac­u­a­tion, as cov­ered in Is­sue 5 of our sis­ter pub­li­ca­tion CON­CEAL­MENT.

The Wound Cube is made from clear sil­i­cone, mak­ing it semi-trans­par­ent and easy to con­firm that you’re ef­fec­tively get­ting the wound-pack­ing ma­te­rial to the base of the wound in­side the body. While you’re get­ting to third base with the cube, an in­struc­tor can shine a flash­light into one of the other open holes to il­lu­mi­nate the in­side of the channels and make easy vis­ual con­fir­ma­tion on how ef­fec­tively you’re pack­ing the wound.

Prac­ti­cal­ity and Ef­fec­tive­ness

Al­though the premise of the Wound Cube is very sim­ple, it’s also very ef­fec­tive and ro­bust. Wound pack­ing isn’t a del­i­cate act — fin­gers have to work fast, plung­ing re­peat­edly into the wound cav­ity in an ef­fort to tamp down as much gauze as will fit in­side, in a hurry. First timers or the un­trained may look like they’re del­i­cately try­ing to knead the world’s tini­est pizza dough, softly feed­ing one fin­ger in af­ter an­other and al­ter­nat­ing in­dex fin­gers. More ex­pe­ri­enced medics on the other hand, may use more arm mo­tion to ag­gres­sively pack in the gauze and make sure they’re hit­ting the bot­tom of the wound or a hard bone.

The point is that if these cubes are be­ing reg­u­larly trained on like they should, the rel­a­tively small wound channels will see a lot of ac­tion from big fin­gers, which raised a ques­tion in our minds about whether the holes would in­ad­ver­tently split or ex­pand. Phokus Re­search Group states that they’ll stand be­hind their prod­uct and of­fer a five-year guar­an­tee that the wound channels won’t “stretch out” or in­crease in size from reg­u­lar use.

Un­for­tu­nately, we didn’t have five years to test this thing, but we did have one night of in­tense train­ing in a bleed­ing con­trol class taught by our friend De­tec­tive Eric Soder­lund, who is fea­tured in RE­COIL OFFGRID Is­sue #25 teach­ing im­pro­vised evac­u­a­tion tech­niques. Along with law en­force­ment of­fi­cials from the Trea­sure Is­land, Florida Po­lice De­part­ment, we went fam­ily style on the Wound Cube and passed it around the class.

The dif­fer­ence was im­me­di­ately ob­vi­ous. Un­like the other home­made train­ing de­vices which Eric had painstak­ingly carved out of foam blocks, the cops us­ing the Wound

Cube had in­stant feed­back on not just the me­chan­ics of their wound pack­ing tech­niques, but vis­ual con­fir­ma­tion once the gauze had com­pletely filled the hole. This made it eas­ier for the stu­dents to ad­just their tech­niques since their per­for­mance was so easy to mea­sure.

The only com­po­nent that didn’t make sense to us was the sim­u­lated lac­er­a­tion wound. We thought the lac­er­a­tion was too shal­low and didn’t al­low a lot of gauze to be packed into the wound. We took an X-Acto knife and cut it a bit deeper, but that was only marginally suc­cess­ful.

Fi­nal Anal­y­sis

With a price point start­ing at $140 and first re­spon­der dis­counts avail­able, the Wound Cube is a rel­a­tively af­ford­able, durable train­ing tool that’s sig­nif­i­cantly less ex­pen­sive than sim­i­lar com­pet­ing prod­ucts. For a homegrown al­ter­na­tive, there’s no easy way to ac­cu­rately recre­ate the en­large­ment of the wound cav­i­ties as they vary in depth, and it be­comes even more dif­fi­cult if you’re try­ing to find a semi-trans­par­ent ma­te­rial so you can ac­tu­ally see what’s hap­pen­ing in­side.

Sim­i­lar to the idea that it’s bet­ter to have a small­ca­pac­ity, small-cal­iber hand­gun on your per­son than a larger “bet­ter” weapon in your truck, we feel it’s prefer­able to have a tool that aids in re­al­is­tic train­ing for bleed­ing con­trol, in­stead of think­ing you can im­pro­vise or fig­ure it out on the fly. It’s not per­fect, but it fills a very spe­cific niche that has never pre­vi­ously been ad­dressed at this price point and with such ease of use. Over­all, we like what we’ve seen and what we felt when we were in­side the Wound Cube, and we’d def­i­nitely take it home to meet our par­ents.

Us­ing a flash­light to il­lu­mi­nate the in­side of the Wound Cube al­lows for in­stant feed­back as to whether or not your wound pack­ing tech­nique is prop­erly fill­ing the wound cav­ity. Top, right: Once the wound is packed with gauze, pres­sure can be ap­plied from the top to stop the bleed­ing.Bot­tom, right: Us­ing fin­gers to pack gauze down into the small wound cav­ity is an ac­quired tech­nique — the Wound Cube will help buildthis skill.

A Trea­sure Is­land (FL) po­lice of­fi­cer hon­ing her wound pack­ing skills us­ing the Wound Cube sil­i­cone block.

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