I would like to provide the most current information regarding hemorrhage control. This information is based on the evidence coming out of Iraq and Afghanistan in treating our soldiers.
The Committee on Tactical Combat Causality Care has revised their recommendations for the 2008 Guidelines. See the info below.
2008 TCCC Updates
The 2008 TCCC Update has a Chart on page 21 showing the major Hemostatic Agents
Here are the important notes for the changes in Hemostatic Agents in TCCC. This is from a memo from Capt. Frank Butler the Chairman of CoTCCC.
2. A number of new hemostatic agents have recently become available. These new agents have undergone testing both at the U.S. Army Institute for Surgical Research (USAISR) and the Naval Medical Research Center (NMRC). The findings from these studies were presented to the Committee on TCCC (CoTCCC) on 1 April 2008. Three different swine bleeding models were used: a 6mm femoral artery punch model at USAISR and both a 4mm femoral artery punch model and a femoral artery/vein transaction model at NMRC. Both the NMRC and the USAISR studies found Combat Gauze and Woundstat to be consistently more effective than the hemostatic agents HemCon and QuikClot previously recommended in the 2006 TCCC guidelines. No significant exothermic reaction was noted with either agent. Celox was also found to outperform the current agents, although it performed less well than WoundStat in the more severe USAISR model, where 10 of 10 Woundstat animal survived, 8 of 10 Combat Gauze animals survived, and 6 of 10 Celox animals survived. The reports detailing this research will be available shortly from USAISR and NMRC.
3. In light of these findings, the CoTCCC voted to recommend Combat Gauze as the first line treatment for life-threatening hemorrhage that is not amenable to tourniquet placement. Woundstat is recommended as the backup agent in the event that Combat Gauze does not effectively control the hemorrhage. The primary reason for this order of priority is that combat medical personnel on the committee expressed a strong preference for a gauze-type hemostatic agent rather than a powder or granule. This preference is based on field experience that powder or granular agents do not work well in wounds where the bleeding vessel is at the bottom of a narrow wound tract. A gauze-type hemostatic agent is more effective in this setting. Combat Gauze was also noted to be more easily removable from the wound site at the time of surgical repair. Woundstat might, however, be very useful in circumstances where the first-line agent has been ineffective or where the characteristics of the wound make a granular agent preferable.
You can get Combat Gauze and WoundStat from
North American Rescue Products or
Chinook Medical
The disadvantage to Combat Gauze and WoundStat is cost. Both are between $30 and $40 per package.
If you want Celox I would go
Calvery Arms
I would stay away from QuickClot as the new versions just do not work as well as Combat Gauze, WoundStat, or Celox. In fact in the USAIR and NMRC study referenced in the above memo, 0 out of 10 animals survived with QuickClot.
But if you want it, try
L.A. Police Gear
Before you set out to buy Hemostatic Agents be sure you understand the proper wound management and packing. Direct pressure is the first line treatment. The American College of Surgeons and the Pre-Hospital Trauma Life Support Guidelines no longer recommend elevation and pressure points for severe bleeding. There is no evidence that these techniques work and you may be wasting precious time. It is possible to bleed out from a femoral artery injury in as fast as 3 minutes. If direct pressure does not work, for extremity trauma go directly to a tourniquet.
No they will not lose the limb. See the links below for the studies. For bleeding that is not amenable by a tourniquet such as a high femoral artery injury go to your hemostatic agents. Apply the agent and pack the wound with gauze and apply constant pressure for 2-3 minutes. Wrap with compression bandage to keep pressure on the wound.
The most important step is to pack the wound and fill the void. Go HERE scroll down and click on Videos to view proper wound packing.
Like many traditional beliefs, the tradition is strong, but the evidence is weak. Here is the evidence supporting tourniquet use
February 2008 Journal Of Trauma - Tourniquet Use
This is an overview of the article. I have the PDF of this that I can email if you would like
Here is an article from JEMS
Tourniquet First
Another JEMS Article
Return of the Tourniquet
If you are looking for the best Tourniquet available look for the
C-A-T or
SOF Tourniquet both are approved by the CoTCCC for use by the military and both provide complete blood flow stoppage in the femoral artery. Both can be placed one handed and just plain work. The C-A-T is the current issue to US Special Operations Soldiers.
The nuts of it is Tourniquets are very effective lifesaving tools that have very few side effects, even when placed incorrectly and left in place for several (greater than 2) hours. Tourniquets are used in surgery everyday with no complications. We must retrain ourselves and remember that Tourniquets work and are safe, just ask the many soldiers who are alive today because of one.
Take Care
