Controlling Bleeding from the Neck, Groin & Armpit

The groin, axilla, and neck are the most lethal sites of penetrating trauma injury. A complete transaction of the femoral artery in the groin can cause death from haemorrhagic shock within 3–5 minutes. These areas are also the most anatomically challenging to manage because a tourniquet — the most effective limb haemorrhage tool — physically cannot be applied there. They require a different set of skills: direct anatomical pressure, wound packing, and improvised compression.

Understanding these techniques is increasingly relevant beyond military and tactical settings. Penetrating injuries from knife attacks, industrial accidents, and motor vehicle trauma frequently involve junctional anatomical zones, and bystander action in the first few minutes is often the only factor that determines survival.

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Why Junctional Wounds Are the Most Dangerous

Wound Location	Major Vessel at Risk	Estimated Time to Fatal Haemorrhage
Groin (femoral triangle)	Femoral artery	3–5 minutes
Axilla / armpit	Axillary / brachial artery	5–8 minutes
Neck	Carotid / jugular	2–4 minutes
Chest wall	Intercostal / subclavian	Variable (also internal haemorrhage)
Abdomen	Aorta / iliac vessels	2–10 minutes (often internal)

A limb tourniquet requires 5–7.5 cm of limb above the wound to be effective. At the groin and armpit, the major vessels are at the very root of the limb — there is no space above the injury to place a tourniquet. At the neck, the anatomy obviously prevents any circumferential compression.

⚠️ If you cannot place a tourniquet above the wound, do not waste time trying. Immediately begin wound packing and direct pressure.

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Neck Wound Management

Penetrating neck trauma is a surgical emergency. The carotid artery carries approximately 80% of cerebral blood flow; interruption for more than 4–6 minutes causes irreversible brain injury. The jugular vein is also a major vessel — and an additional danger in the neck is air embolism (air being sucked into the venous circulation through an open neck vein).

What to Do

1. Apply direct pressure immediately — use the flat of your hand or several fingers pressed firmly over the bleeding wound
2. Do not compress both carotid arteries simultaneously — compressing both sides of the neck simultaneously obstructs cerebral blood flow; treat only the bleeding side
3. Seal open wounds — an open neck vein can draw in air; seal with a gloved hand, clean cloth, or if available a non-porous dressing
4. Do not probe the wound — do not insert fingers into a penetrating neck wound to locate the vessel
5. Do not remove impaled objects — if an object is lodged in the neck, stabilise it in place; removal can cause sudden massive haemorrhage
6. Maintain airway — penetrating neck trauma can cause oedema and haematoma that compress the airway; watch for stridor, hoarse voice, and increasing respiratory distress — these are signs of impending airway compromise
7. Call emergency services — all penetrating neck injuries require immediate surgical evaluation regardless of apparent stability

Gauze packing for the neck: small wounds to the side of the neck (not central/anterior) can be packed with haemostatic gauze and firm direct pressure. Central anterior neck wounds are higher risk — pressure must avoid compressing the trachea.

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Groin (Femoral Triangle) Wound Management

The femoral triangle is bordered by the inguinal ligament above, the sartorius muscle laterally, and the adductor longus medially. The femoral artery, vein, and nerve all run through this space. A stab or gunshot wound to this area is immediately life-threatening.

Anatomy to Know

The femoral artery exits the abdomen at the midpoint of the inguinal ligament — approximately midway between the bony prominence of the hip (anterior superior iliac spine) and the pubic symphysis. This is where pressure must be applied.

What to Do

1. Apply immediate wound packing — push haemostatic gauze (QuikClot, Celox) into the wound cavity from the deepest point outward
2. Apply direct digital pressure — use your fingers or fist pressed hard into the wound over the packed gauze
3. The required force is significant — effectively compressing the femoral artery requires substantial downward force; your body weight over the heel of your hand is the appropriate approach
4. Hold for minimum 5 minutes — do not lift to check; set a mental timer
5. After packing, bandage — wrap a pressure bandage (Ace bandage, improvised with clothing) firmly over the wound and your hand as you withdraw
6. Junctional tourniquet devices — if available, the SAM Junctional Tourniquet (SAM-JT) and JETT device are purpose-designed tools that apply compression to the inguinal crease. These require specific training.

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Axilla / Armpit Wound Management

The axilla contains the axillary artery and vein, the brachial plexus (major nerve bundle), and the beginning of the brachial artery. Wounds here are high-risk and difficult to compress due to the geometry of the armpit.

What to Do

1. Wound packing is the primary intervention — push haemostatic gauze deeply into the wound cavity
2. Apply pressure — with the patient's arm adducted (pressed against their side), apply direct downward pressure over the packed wound
3. Improvised compression — padding packed into the armpit and a bandage wrapped around the chest and upper arm can maintain pressure without continuous manual effort
4. Do not raise the arm above the head — this stretches the vessels and may worsen bleeding
5. Positioning — have the patient sit up or slightly lean to the affected side if conscious; this helps apply gravity-assisted pressure

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Open Chest and Abdominal Wounds

Penetrating Chest Wounds (Open Pneumothorax)

An open chest wound (sucking chest wound) that allows air to enter the pleural space can cause a tension pneumothorax — a life-threatening collapse of the lung with displacement of the heart. These require specific management.

1. Seal the wound — use a purpose-made chest seal (Hyfin Vent, Russell Chest Seal) if available; these allow air out but not in
2. Improvised seal — a plastic wrapper, bag, or non-porous material taped on three sides (not all four) creates a flutter valve effect; the fourth side is left unsealed to allow air egress
3. Do not use a fully occlusive seal — if air cannot escape, you may convert a simple pneumothorax to a tension pneumothorax
4. Monitor breathing — watch for deteriorating respiratory distress; if it worsens after sealing, briefly lift one corner of the seal to allow air out

Penetrating Abdominal Wounds

1. Do not remove impaled objects — stabilise in place with padding on either side; removing an impaled object removes the tamponade effect and can cause sudden haemorrhage
2. Cover eviscerated bowel — if abdominal contents are protruding, cover with a clean damp cloth or sterile dressing; do not push them back in
3. No food or water — abdominal injuries often require surgery; an empty stomach reduces anaesthetic risk
4. Lay flat — the anatomical position reduces abdominal tension

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Wound Sealing Devices

Several purpose-made devices exist for junctional and chest wound management:

Device	Purpose	Availability
SAM Junctional Tourniquet (SAM-JT)	Inguinal and junctional compression	Military / specialised first-aid kits
JETT (Junctional Emergency Treatment Tool)	Inguinal compression	Military / specialised
Hyfin Vent Chest Seal	Open pneumothorax	Tactical and advanced first-aid kits
Celox Rapid Haemostatic Gauze	Junctional wound packing	Widely available, civilian kits
Combat Ready Clamp (CRoC)	Inguinal bleeding	Military — specialist use

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Quick Reference

Wound Site	Primary Intervention	Key Caution
Groin / femoral	Wound pack + sustained hard pressure on inguinal crease	Force required is substantial — lean body weight
Axilla	Wound pack + arm-to-chest pressure bandage	Do not raise arm above head
Neck (lateral)	Direct pressure on wound, single side only	Never compress both carotids simultaneously
Neck (anterior)	Seal open wounds, minimal probing	Watch for airway compromise — stridor = emergency
Open chest	Three-sided or vented chest seal	Full seal risks tension pneumothorax
Impaled object	Stabilise in place, do not remove	Removal may cause immediate fatal haemorrhage
Eviscerated bowel	Cover with damp clean cloth	Do not push back inside

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Training and Preparation

Junctional wound management is more complex than limb haemorrhage control and benefits significantly from hands-on training. Stop the Bleed Advanced courses and Tactical Combat Casualty Care (TCCC) courses cover these techniques in detail. Workplaces in high-risk environments — construction, manufacturing, security, outdoor events — should ensure at least some staff are trained to this level.

The principle throughout every junctional injury is the same: get something into the wound and apply sustained pressure. Improvised, imperfect wound packing with direct pressure will always be more effective than standing back and waiting.