Treating Abdominal Eviscerations & Road Rash | Field Trauma Protocol

I still remember the first time I ran a trauma lane where the casualty didn't have a neat, single bullet hole. It was a simulation of an IED blast. The mannequin’s abdomen was wide open, and there was shrapnel tearing across the thigh. I looked at my standard IFAK, saw my trusty 6-inch pressure dressing, and realized with a sinking feeling that it was like trying to put a postage stamp on a pizza box. It wasn't going to cover anything.

That moment of hesitation is dangerous. In a clinical environment, you have endless supplies. Downrange or in the backcountry, you have what you carried in. If your kit is built solely around single-entry gunshot wounds, you are failing the protocol for massive tissue damage.

When we talk about the "M" in MARCH (Massive Hemorrhage), we usually think of tourniquets. But what happens when the injury isn't arterial spurting, but a large surface area evisceration or a massive road rash from a motorcycle wreck? That’s where standard kit fails and where bulk dressings become your lifeline.

The Limitation of Standard 4 and 6-Inch Dressings

Most tactical kits are optimized for penetration trauma. A standard 4-inch bandage provides great focused pressure over a specific point. But blast injuries, shotgun wounds at close range, and abdominal eviscerations present a geometry problem.

If you try to use a standard bandage on an evisceration (loops of bowel protruding through the abdominal wall), you'll likely push the organs back in (which is a major contraindication) or fail to cover the exposed tissue completely. Incomplete coverage leads to contamination and rapid hypothermia. You need surface area. This is why I stock the Elite First Aid Multi-Trauma Bandage 12″x 30″. It’s not flashy, but when you need to cover a third of a torso, nothing else works.

Protocol 1: Abdominal Evisceration Management

An open abdomen is terrifying to look at, but your job is to manage the environment of those organs. The bowel is incredibly vascular and delicate. If it dries out, the tissue dies (necrosis). If it gets cold, the patient goes into shock.

The Wet-to-Dry Fallacy: In the field, we do not use dry dressings on internal organs. Dry gauze sticks to the serous membrane of the intestine. When the surgeons at the Role 2 or 3 facility try to remove that dressing, they will tear the bowel, causing sepsis.

The Application Steps:

• Control Hemorrhage First: Ensure there isn't active bleeding elsewhere. Prioritize life over limb.
• Expose and Assess: Cut away clothing. Do not attempt to push the organs back into the abdominal cavity. You risk kinking the bowel or introducing bacteria.
• Prepare the Multi-Trauma Bandage: Open the 12x30 package. Before applying it to the patient, you need to moisten the sterile pad. Ideally, use warm, sterile saline. If you are in a purely austere environment, clean water is acceptable. The goal is to keep the tissue viable.
• Apply the Dressing: Gently drape the moistened bulk pad over the exposed organs. Do not apply pressure. You are creating a barrier, not stopping a bleed.
• Heat Retention: Once the moist dressing is on, cover it with an occlusive layer if available (like the wrapper of a chest seal or plastic wrap) to keep the moisture in, followed by a dry layer or blanket to retain heat.

Protocol 2: Large Circumferential Burns and Road Rash

Whether it's a fuel blast or a high-speed slide across asphalt, large abrasions and burns weep fluid rapidly. They are also prone to massive swelling (edema). This brings us to a critical limitation of standard elastic bandages: the Tourniquet Effect.

If you wrap a standard pressure dressing tightly around a limb that has been burned, you are creating a constriction band. As the tissue swells, that bandage won't expand. You will cut off distal circulation, turning a survivable injury into an amputation case due to compartment syndrome.

The Wrapping Technique:

Use the Elite Multi-Trauma Bandage for its coverage, not its compression.

• Cover the Area: Unfold the 12x30 pad to cover the entire burn or rash.
• Spiral Wrap (Zero Tension): Use the attached tails to hold the pad in place. Do not crank it down. Wrap it gently, just enough so it doesn't fall off.
• Check Pulses: Immediately check the radial or pedal pulse distal to the injury. If you can't find it, or if the patient complains of tingling/numbness, loosen the dressing immediately.
• Leave Room for Swelling: I always leave a finger's width of slack if I know I'm looking at a long transport time. The limb will get bigger.

Securing for Transport Over Rough Terrain

Once you've applied a dressing this large, your next enemy is gravity and movement. If you're moving a patient on a litter over rocks or debris, that dressing is going to shift. If the evisceration dressing slips, the bowel is exposed to dirt and cold air.

Don't rely solely on the attached strips of the bandage. Reinforce the edges with medical tape or Coban (self-adherent wrap). Tape the top and bottom edges of the dressing to the patient’s skin (if unburned) to act as an anchor. Re-assess your intervention every time you move the patient. A dressing that was secure five minutes ago might be loose now.

We train for the bullet holes because they are common. We need to carry for the blasts and crashes because they are catastrophic. Having a bandage that actually fits the injury isn't a luxury; it's a clinical necessity.

Disclaimer: The information provided in this blog is for general informational purposes only and does not constitute professional advice. Luminary Global makes no representations or warranties regarding the accuracy, completeness, or reliability of any information presented. We are not responsible for any actions taken based on the content of this blog or for the content of any third-party websites linked herein. Use of this blog and any linked resources is at your own risk.