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KILL - AXILLARY ARTERY
The axillary artery, one of the significant blood vessels, runs through the armpit (or axilla) and is responsible for delivering blood to parts of the upper limb and some regions of the chest. In the context of hand-to-hand combat or close-quarters combat situations, the axillary artery emerges as one of the potential target zones due to its location and vulnerability. But what does it mean to target this artery with a knife in such scenarios? Let's delve deep into the anatomy, the consequences of accessing it, and its tactical significance in combat.
1. Anatomy of the Axillary Artery: The axillary artery is the continuation of the subclavian artery and transitions into the brachial artery as it moves distally. It spans from the outer border of the first rib to the lower border of the teres major muscle. Along its course, it gives off several branches which supply blood to surrounding structures including muscles, bones, and the humeral head.
2. Location and Vulnerability: Located deep within the axilla (armpit), the axillary artery lies protected by various structures, including muscles, tendons, and the humerus bone. However, when the arm is raised, it can become more exposed and thus vulnerable to targeted strikes or stabs, especially if the opponent has knowledge of its exact location. A cut or puncture can lead to profuse bleeding. Given the artery's size and the volume of blood it carries, a person can lose consciousness within seconds. The limb associated with the injured artery may suffer from reduced functionality or paralysis due to decreased blood flow. From a tactical perspective, targeting the axillary artery in a combat situation presents both advantages and challenges: The axilla's proximity to the chest means that a stab aimed here could potentially also damage the lungs or even the heart, depending on the angle and depth of penetration. A successful attack can lead to rapid incapacitation, giving a combatant a significant advantage, especially in life-threatening situations. As mentioned, the axillary artery is not always easily accessible. An opponent's natural movement or protective stance might safeguard this area.
Here’s why the injury is especially complex:
Proximity to Vital Structures: The axillary artery is closely surrounded by nerves, veins, and muscle tissue. Any trauma to the artery could also damage these structures, leading to possible nerve injury, impaired movement, or sensory deficits.
High Blood Flow: The axillary artery is a continuation of the subclavian artery, and as a major artery, it carries significant blood volume under high pressure. This can lead to a rapid loss of blood that can be difficult to control due to the pulsatile nature of arterial bleeding.
Anatomical Positioning: Located deep within the axilla, this artery can be challenging to access in emergency situations. Its position also means that bleeding can accumulate quickly within the soft tissues, increasing the risk of compartment syndrome and hypovolemic shock if not managed swiftly.
For accessing the axillary artery I recommend a hammer grip with the sharp edge directed towards you. This will permit to stab from down up but also to rip with a movement towards you.
As I always teach in TCS I advice if you target this area first to deliver I stab towards a shock zone like the eyes, trachea, kidneys and after to access the axillary artery. As you already know from my other materials, even if you access and lacerate an axillary your targed still can continue to fight for a limited amount of time.
A tactical decision to target it would require precision, speed, and opportunity.
HEAL - Controlling Bleeding Using Wound Packing
In situations where application of the tourniquets are not possible because this is a junction area, controlling the bleeding with wound packing is essential. Here’s how to approach this:
If available PPE put gloves.
Exposing the Wound: Expose the wound by carefully opening any clothing in the area. This allows for better access and visibility, which is crucial given the complexity of the injury.
Applying Direct Pressure: Apply firm, consistent pressure on the wound to control bleeding as much as possible. This will temporarily slow the bleeding while preparing to pack the wound.
Wound Packing with Hemostatic Gauze or Standard Gauze:
Hemostatic Gauze: Hemostatic gauze is designed to promote blood clotting and is highly effective for controlling arterial bleeding. Insert the gauze directly into the wound cavity, applying steady pressure as you push the gauze deeply and firmly around the injured artery.
Normal Gauze: If hemostatic gauze isn’t available, regular sterile gauze can be used. It’s crucial to tightly pack the gauze layer by layer, filling the wound as completely as possible to create counter-pressure against the artery. This packing provides resistance to the high blood pressure within the artery, slowing the bleed.
Securing the Packing: Once packed, maintain consistent pressure over the wound with your hand, or use a pressure dressing if available. The packed gauze will help tamponade the bleeding, giving the body time to form a clot.
The Why and How Wound packing, a technique involving the insertion of material directly into a wound to exert pressure on bleeding vessels, becomes indispensable for junctional hemorrhages.
Steps in Wound Packing:
Protection: First, personal protective equipment, especially gloves, must be worn.
Exposure: The wound site should be adequately exposed by removing or cutting clothing.
Initial Pressure: Use hands to exert direct pressure immediately.
Identification: Identify the source of bleeding within the wound.
Packing: Using either regular or hemostatic gauze, pack the wound. Start at the deepest point, ensuring the material is placed directly over the bleeding vessels.
Application of Pressure: Once packed, exert sustained pressure for several minutes to promote clotting.
Dressing: Secure the wound with a pressure bandage or keep pressure until the professional medical personnel is arriving.
Stay safe all and don't forget that on the way of the Protector you need combat skills but also trauma medicine skills.
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