QuickClot, Tourniquet, or Both?

[cclaxton]

Just finished my First Aid Class. The instructor told us they are not carrying QuickClot in their trauma kits, but he has heard it is effective in treating trauma in combat situations. He thinks that due to the side-effects they are not ready to put them into action yet. However, internet sources claim that they are effective when a tourniquet cannot be applied, such as the torso, neck, buttocks, and head (but not face due to scaring).

Another good application seems to be for wilderness trauma where getting the trauma victim help may take much more time, or difficult terrain, etc.

So, I am thinking it goes in the med-kit and would only be used when a tourniquet won't work and I can't stop the bleeding with a pressure dressing.

The QuickClot sponges and embedded gauze are considered the current state of the art, not the particles that you pour into the wound. Side effects are thermal heat and potential 2nd degree burns, patient discomfort, scarring, and the quickclot is more difficult to cut out of the wound and clean because it becomes a part of the blood clot in the wound.

Does anyone here have experience with QuickClot for trauma? Any recommendations?

CC

[Dropkick]

Quickclot Gauze is non-thermal, based on my research and recently attending a DARK Angel Class:
http://pistol-forum.com/showthread.php?10264-Dark-Angel-Medical-Tactical-Aid-Course-Nov-10-amp-11-2013

It was the old granular powder that caused burned tissue.
As for scarring... Um, any sort of wound that would need Quickclot is probably going to scar anyway.

Frankly, I don't think you can just pigeon hole medical treatment into "apply this or that." Assessment of the circumstances and patient is a critical part.

And I'm curious, what First Aid Class did you take?

[KevinB]

QuickClot and other hemostatic agents have come along way in the past 14 years. The thermal clotting methods have given way to non thermal clotting agents, so much less surrounding tissue is damaged, and the powders have been gone for some time, due to inhalation and eye exposure issues to both patient and first responder.

I carry both QC and TQ's - as sometimes you need to use both, or one is not practical.


I notice the OP mentions First Aid, as opposed to TEMS or TCCC. The majority of first aid courses, have zero relevance on a penetrating trauma wound that happens when a bullet enters the body -- I also carry chest seals and a needle kit, to deal with lung issues.

Don't expect a First Aid course will lend itself to dealing with combat trauma, as it won't. IF your looking for a TEMS/TCCC course take one from someone with significant experience in the field who stays current. Dark Angel or RedBackOne would be my recommendations for folks in the VA area.

[BillP]

Don't simply limit yourself to Quickclot either. Celox and Hemcon have excellent gauze based hemostatic products as well. Celox gauze had the best performance in the 2012 live tissue model testing at Lackland.

As to the other issues, good advice is posted above. Get training from someone who is current and most important someone who holds the appropriate certs to train you (reinforcing currency).

Sent from my SAMSUNG-SGH-I317 using Tapatalk

[cclaxton]

And I'm curious, what First Aid Class did you take?
Baltimore County Fire and Medical Training CPR+AED+FirstAid+Gun Shot Wound and trauma class. Taught by Baltimore County Fire Dept Instructor with 28 years of experience. Really great class including simulated blood squirting out of injuries, pressure dressings, tourniquet applications, occlusive dressings, shock treatment, bloodborne disease prevention, etc.

The same guy will be holding another one at Fairfax Rod and Gun in the Winter. Let me know if you are interested.
CC

[cclaxton]

I notice the OP mentions First Aid, as opposed to TEMS or TCCC. The majority of first aid courses, have zero relevance on a penetrating trauma wound that happens when a bullet enters the body -- I also carry chest seals and a needle kit, to deal with lung issues. Don't expect a First Aid course will lend itself to dealing with combat trauma, as it won't. IF your looking for a TEMS/TCCC course take one from someone with significant experience in the field who stays current. Dark Angel or RedBackOne would be my recommendations for folks in the VA area.

He taught us occlusive dressings application and serious trauma dressings. He also taught general first aid, such as poisoning, snake bite, burns, broken bones, etc. The teacher doesn't have combat experience, but plenty of experience in Baltimore with gunshot victims, druggies, diabetics, strokes, and car accidents. His experience with these various treatment options added great value. Not to say TEMS/TCCC wouldn't be better...just saying it was an excellent basic start. He also had a lot of good advice on how much we should do to the patient and when to stop and wait for the EMT/Paramedics. Unless the person has a prescribed Epi-pen, nothing gets inserted into the patient. With more training we could handle more invasive first aid, such as airway devices, etc.

He also helped us to recognize that not everyone is going to survive and some people will die...maybe right in front of us.
CC

[cclaxton]

Don't simply limit yourself to Quickclot either. Celox and Hemcon have excellent gauze based hemostatic products as well. Celox gauze had the best performance in the 2012 live tissue model testing at Lackland.

As to the other issues, good advice is posted above. Get training from someone who is current and most important someone who holds the appropriate certs to train you (reinforcing currency).

Sent from my SAMSUNG-SGH-I317 using Tapatalk
Thanks,
The trainer is a Baltimore County Firefighter/Paramedic and Baltimore County Fire and Medical is the company that trains all firefighters/EMT's and Paramedics for Baltimore County. Plus 28 years of experience as an EMT/Paramedic and more recently, teacher. Not sure how you get get more certified than that...unless you are talking combat certifications.

CC

[BillP]

TCCC and LE/FR TCC require specific instructor certs to deliver, from the certifying organization. Just as an example.

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[KevinB]

Thanks,
The trainer is a Baltimore County Firefighter/Paramedic and Baltimore County Fire and Medical is the company that trains all firefighters/EMT's and Paramedics for Baltimore County. Plus 28 years of experience as an EMT/Paramedic and more recently, teacher. Not sure how you get get more certified than that...unless you are talking combat certifications.

CC

All depends on your situations and requirements.

If your a LE Tac guy, certain methods of wounding are more prevalent and relevant. I'm not knocking on the guy, just Big City requirements due to transport time, are a lot different than rural areas where what you do in the golden hour are much more critical. I came into TCCC thru the military, and the department I am a reserve officer with is in the middle of nowheresville, so back to the self aid, buddy aid, medic aid Military methods.

Also IF you can save a dude with an emergency tracheotomy, why wouldn't you (and I'm so pissed I never got to use my kit for that :D).
*no I don't carry that anymore, it's in my basement collecting dust -- but I often look at it with yearning...

But a simple needle decompression could save a dude that would otherwise not make it to the OR - and its not going to make it any worse...

[cclaxton]

All depends on your situations and requirements.

If your a LE Tac guy, certain methods of wounding are more prevalent and relevant. I'm not knocking on the guy, just Big City requirements due to transport time, are a lot different than rural areas where what you do in the golden hour are much more critical. I came into TCCC thru the military, and the department I am a reserve officer with is in the middle of nowheresville, so back to the self aid, buddy aid, medic aid Military methods.

Also IF you can save a dude with an emergency tracheotomy, why wouldn't you (and I'm so pissed I never got to use my kit for that :D).
*no I don't carry that anymore, it's in my basement collecting dust -- but I often look at it with yearning...

But a simple needle decompression could save a dude that would otherwise not make it to the OR - and its not going to make it any worse...

This has inspired me to consider getting an EMT Certification. It's not that bad: Biology lecture, and 8 credit hours including clinical portions. Could all me done in one term, or two terms comfortably.

CC

[ToddG]

Just finished my First Aid Class. The instructor told us they are not carrying QuickClot in their trauma kits, but he has heard it is effective in treating trauma in combat situations.

This is why I think it's important that we, as the shooting community, do a better job of defining what we want in a "gunshot wound care class." Such a class that doesn't cover hemostatic agents is failing from the outset. BTDT.

[DocGKR]

At a minimum, every person who CCW's and any LE or healthcare workers need to have a hemostatic dressing (ex. Quick Clot Z-Fold Combat Gauze) and a tourniquet (ex. SOFT-W) on them at ALL times. The life they save may be their own...

Key items for rural CONUS IFAK/BOK where transport times may be delayed include:
Pouch to hold everything (I use the small ATS: http://www.atstacticalgear.com/cgi/commerce.cgi?preadd=action&key=ST-13200)
Tourniquet (I use SOFT-T)
Hemostatic gauze (I like the Z-fold Combat Gauze)
Kerlix type gauze
Coban and/or Ace wrap
large safety pin
hemostat
shears/scissors
nitrile gloves

Nice but less important include:
Israeli bandage
nasopharyngeal airway (28 fr is a good size)
Lidocaine jelly
suture (I usually have some 3-0 Vicryl w/SH needle or 4-0 w/SH-1)
CPR barrier
band aids
epi pen
chest seal
14 ga cath (If you or your team members know how to use them)

[RoyGBiv]

Hemostatic gauze (I like the Z-fold Combat Gauze)
If I spend ~$45 (plus shipping) (http://www.chinookmed.com/cgi-bin/item/05168LE/s-hemostatics/-Combat-Gauze%2C-Z-Fold-%28Non-Military-Use-Only%29---) any idea what expiration date I'll get?

If I buy it from a surplus seller on fleabay, with a late 2014 or maybe 2015 expiration date for about $20 shipped, is this a good deal?

How far past the stated expiration date do these remain effective? (assuming reasonable care in storage)

[SGT_Calle]

I got a NPA once, as part of training... it was terribly uncomfortable.

[KevinB]

I got a NPA once, as part of training... it was terribly uncomfortable.

Like most things in training its hard to simulate a unconscious or non-responsive subject with an active alert person, people tend to fight airway insertion.


I was at Velocity Systems last week, they have a kick ass low pro med kit that can be deployed with either hand. I'm planning on getting three (green gear, black/blue gear, and EDC).



Roy, most Medical items have a real shelf life longer than their stated life --that said, I am not sure what the actual life span is.
Maybe Gary or Bill have a better idea?

I've used fluids past their due date - and in Iraq would only chuck them when the bags got floaties in them... CONUS I tend to be a lot more critical on dates (folks sue here and all).


I carry Crazy Glue instead of a suture kit - mainly as I can self glue and I suck at self sewing.

[ToddG]

I've used fluids past their due date

http://image15.spreadshirt.com/image-server/v1/compositions/104537300/views/1,width=178,height=178,appearanceId=258/Sterling-Archer---Phrasing.jpg

[TGS]

Just finished my First Aid Class. The instructor told us they are not carrying QuickClot in their trauma kits, but he has heard it is effective in treating trauma in combat situations. He thinks that due to the side-effects they are not ready to put them into action yet. However, internet sources claim that they are effective when a tourniquet cannot be applied, such as the torso, neck, buttocks, and head (but not face due to scaring).

Another good application seems to be for wilderness trauma where getting the trauma victim help may take much more time, or difficult terrain, etc.

So, I am thinking it goes in the med-kit and would only be used when a tourniquet won't work and I can't stop the bleeding with a pressure dressing.

The QuickClot sponges and embedded gauze are considered the current state of the art, not the particles that you pour into the wound. Side effects are thermal heat and potential 2nd degree burns, patient discomfort, scarring, and the quickclot is more difficult to cut out of the wound and clean because it becomes a part of the blood clot in the wound.

Does anyone here have experience with QuickClot for trauma? Any recommendations?

CC

Looks like you got some good answers so far.

Your title makes me want to address this, though I'm not sure if it's what you're meaning to convey: the choice between hemostatic agents and tourniquets is not an "either/or" situation. Someone who is carrying QuickClot without also having a tourniquet is missing the point, and doesn't understand the application of such.

Let's say you have an arterial bleed: first thing is tourniquet, immediately. The QuickClot would then be applied after first using the tourniquet; it will work much more effectively than just shoving the QC on a gusher by itself.


This has inspired me to consider getting an EMT Certification. It's not that bad: Biology lecture, and 8 credit hours including clinical portions. Could all me done in one term, or two terms comfortably.

CC

Getting an EMT certification will not get you anywhere near performing crics or needle thoracentesis. That's an ALS (Advanced Life Support) skill, meaning Paramedic certification.....which you will first need significant BLS (Basic Life Support: an EMT) experience before attending medic school (not all states are like this.....some do zero-to-hero, but it is the exception). On top of that, medic school will be a significant investment; up here, it's a few thousand hours, plus $10k or so. People who bang it out hard-and-fast usually take 1.5 years up here, and the failure rate is extremely high in accelerated classes (most have eliminated the accelerated option due to attrition rates). I have a few EMTs in medic school, and one is 1 of 2 people left in his class of an original 14. On top of that, there will be several certifications you'll be required to attain separate from the class.

This is in contrast to EMT, which on the NAEMT national curriculum is currently 250 hours (200 hours class, 40 hours self-study, 10 hours on truck). Paid jobs will usually entail 16-40 hours of follow-on certs, plus a varying amount of shifts on probation.

Don't let me talk you out of it, though: getting your EMT and working per-diem or as a volunteer can be a very rewarding experience. We have several people that drive $80k+ cars to work due to their income at their full-time job, and just work with us per-diem for drinking money and because it's fun.

[cclaxton]

This is why I think it's important that we, as the shooting community, do a better job of defining what we want in a "gunshot wound care class." Such a class that doesn't cover hemostatic agents is failing from the outset. BTDT.

I think the problem is that most EMT/Paramedics aren't authorized to use them, or they are so new that they are not trained to use them. Just this year the Commonwealth of Virginia began a training module for application of hemostatic agents.

Maybe we just need to do a better job of encouraging EMT's and Paramedics to take the trainings and use the agents.

CC

[JV_]

Maybe we just need to do a better job of encouraging EMT's and Paramedics to take the trainings and use the agents.I thought their lack of use was a management approval issue, rather than their lack of a will/want to use them.

[TGS]

I think the problem is that most EMT/Paramedics aren't authorized to use them, or they are so new that they are not trained to use them. Just this year the Commonwealth of Virginia began a training module for application of hemostatic agents.

Maybe we just need to do a better job of encouraging EMT's and Paramedics to take the trainings and use the agents.

CC

It's not as simple as that. Protocols are protocols. We can kick and scream all we want, take as many classes as we want, and it still won't make a difference.

The protocols are written/signed in by doctors. Most doctors are not pro-EMS, treat their title of "Medical Director" as an afterthought, and have zero EMS experience.

[cclaxton]

Let's say you have an arterial bleed: first thing is tourniquet, immediately. The QuickClot would then be applied after first using the tourniquet; it will work much more effectively than just shoving the QC on a gusher by itself.

Getting an EMT certification will not get you anywhere near performing crics or needle thoracentesis. This is in contrast to EMT, which on the NAEMT national curriculum is currently 250 hours (200 hours class, 40 hours self-study, 10 hours on truck). Paid jobs will usually entail 16-40 hours of follow-on certs, plus a varying amount of shifts on probation. Don't let me talk you out of it, though: getting your EMT and working per-diem or as a volunteer can be a very rewarding experience. We have several people that drive $80k+ cars to work due to their income at their full-time job, and just work with us per-diem for drinking money and because it's fun.

Thanks for the good application note on using the tourniquet first.

I just thought it was interesting and fun and wanted to learn more. I am definitely not wanting to go for Paramedic at this time. But it was interesting and fun, and EMT Certification had reasonable amount of time I would need to apply. Who knows, I may get to EMT-Basic and want to go for Intermediate, but lots more time involved and might interfere with shooting...and can't have that! Didn't really think about making money at it. Also, they probably won't let me carry on the ambulance....

CC

[TGS]

Glad you enjoyed your class and are interested in learning more. I'd say that's more valuable than having gone to the coolest milspec operator 5000 bearded tactical medicine extreme course and come out without any interest of going further.


Thanks for the good application note on using the tourniquet first.

I just thought it was interesting and fun and wanted to learn more. I am definitely not wanting to go for Paramedic at this time. But it was interesting and fun, and EMT Certification had reasonable amount of time I would need to apply. Who knows, I may get to EMT-Basic and want to go for Intermediate, but lots more time involved and might interfere with shooting...and can't have that! Didn't really think about making money at it. Also, they probably won't let me carry on the ambulance....

CC

Not sure about Virginia, but it's illegal here. Even the cops cannot ride the ambulance with a firearm if the patient is a criminal, danger to himself-others, ect.

[TGS]

Glad you enjoyed your class and are interested in learning more. I'd say that's more valuable than having gone to the coolest milspec operator 5000 bearded tactical medicine extreme course and come out without any interest of going further.



Not sure about Virginia, but it's illegal here. Even the cops cannot ride the ambulance with a firearm if the patient is a criminal, danger to himself-others, ect.

Correction: May not be illegal, that was a bad choice of word. However they don't carry in the back either way.....I'm not sure if it's a policy, Dep. of Health regulation, ect. The cops have to give up their guns to their partner, put it in a lock box in an outside compartment, or just ride behind us in their patrol car.

[DocGKR]

If a cop around here has prisoner in custody and is escorting said felon in the back of the bus, the officer had better be armed or will be facing significant disciplinary action...

[Joseph B.]

Combat gauze with a good wound packing class is a must IMHO. Not a fan of the grainuals/powder.

Tourniquets are a must as well.

[ToddG]

If a cop around here has prisoner in custody and is escorting said felon in the back of the bus, the officer had better be armed or will be facing significant disciplinary action...

In fairness, it's almost more noble that NJ is scared of people with guns whether they're cops or not, while California still believes that while the masses cannot be trusted with sharp sticks the guys with badges are all beyond reproach. Not that recent history indicates otherwise or anything.

Still, I have to admit to shaking my head when I read TGS's first comment about this policy. Because if you're locked inside a metal box with a violent criminal the last thing you'd want was, like, an armed policeman. Why, he might shoot the poor patient before the paramedic had a chance to verbally judo him and save the world from frowns and rainstorms.

[TGS]

In fairness, it's almost more noble that NJ is scared of people with guns whether they're cops or not, while California still believes that while the masses cannot be trusted with sharp sticks the guys with badges are all beyond reproach. Not that recent history indicates otherwise or anything.

Still, I have to admit to shaking my head when I read TGS's first comment about this policy. Because if you're locked inside a metal box with a violent criminal the last thing you'd want was, like, an armed policeman. Why, he might shoot the poor patient before the paramedic had a chance to verbally judo him and save the world from frowns and rainstorms.

I'm not a cop, but I think it's more along the same lines as to why cops don't bring guns into prisons.

With that said, I don't get it. If a cop is in the back, then the dude is handcuffed to an aircraft-grade aluminum stretcher, and possibly tied down as well. In addition, I'm a firm believer that he who hath the biggest motherf'in gun makes the rules. So, if a cop gets in, I'm not telling him what to do with his gear. I can't actually ever remember anyone telling a cop to do such, but again, they usually don't ride in the ambulance. It's pretty rare.....I'm actually convinced that cops are straight up allergic to anything EMS.

Coolest thing that I have seen involving cops is an EMT asking a cop to remove a medic from his rig when the medic refused to transport and wanted to triage to BLS an obvious multi-system trauma alert. Dude threw the medic's $25k LifePak right out the side door.

[KevinB]

Prison/County Lock-Up is weapon protocol, you enter to a point - and then secure your firearms and other weapons, to hand the suspect over.

Either you lock your guns in your car/truck and drop off the 'passenger', or you put them in a lock box -- you are at that point inside a secure structure and the Holding folks are taking care and control.

Like the Doc said you don't unstrap in a bus, or at a hospital.

[TGS]

you don't unstrap.....at a hospital.

Have you seen such happen somewhere?

[Dropkick]

At a minimum, every person who CCW's and any LE or healthcare workers need to have a hemostatic dressing (ex. Quick Clot Z-Fold Combat Gauze) and a tourniquet (ex. SOFT-W) on them at ALL times. The life they save may be their own...

Key items for rural CONUS IFAK/BOK where transport times may be delayed include:
Tourniquet (I use SOFT-T)
Hemostatic gauze (I like the Z-fold Combat Gauze)
...

Nice but less important include:
...
chest seal

I'm curious why you wouldn't rank an occlusive dressing up there as a key item? It seems like there would be just as much chance (maybe more?) to get shot in the chest as a limb. Am I missing something?

[KevinB]

I'm curious why you wouldn't rank an occlusive dressing up there as a key item? It seems like there would be just as much chance (maybe more?) to get shot in the chest as a limb. Am I missing something?

Not Gary - but most of the dressings covers can be used as a makeshift one, if they are downright now designed that way to begin with.

[Joseph B.]

I'm curious why you wouldn't rank an occlusive dressing up there as a key item? It seems like there would be just as much chance (maybe more?) to get shot in the chest as a limb. Am I missing something?

I know quite a few guys who subscribe to the less is better when dealing with all type of kit. IFAK and performing self-aid. NPA, Chest seal and decompress needle, are not something you will be doing to yourself. When their is a medic on the team with an aid-bag, having all the extra IFAK stuff becomes redundant.

Personally I do not subscribe to that thinking, I've run into too much first hand stuff to not pack 2+ of each, blood, dirt, sewage water, and all kinds of "oh crap" tends to mess up the "I only brought one, wheres the aid-bag" theroy.

[SGT_Calle]

Not Gary - but most of the dressings covers can be used as a makeshift one, if they are downright now designed that way to begin with.

That's what I was thinking too. Tape down all but a corner for a flutter valve.
I am, in no way, an expert however... I've just been through the Army CLS class about a half dozen times, lol.


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[cclaxton]

My trainer from the class asked his medical director about QuickClot. Here is his answer:
"1) Expensive 2) Produces chemical burns
3) Military is getting away from it. We do have it but it is falling out of favor. Does do a cool job melting styrofoam "

I asked if the same is true of all hemostatic agents, and he said, "yes."
I can buy a ton of gauze and gauze rolls and large gauze pads for the cost of one QuickClot package...it is expensive.

CC

[KevinB]

My trainer from the class asked his medical director about QuickClot. Here is his answer:
"1) Expensive 2) Produces chemical burns
3) Military is getting away from it. We do have it but it is falling out of favor. Does do a cool job melting styrofoam "

I asked if the same is true of all hemostatic agents, and he said, "yes."
I can buy a ton of gauze and gauze rolls and large gauze pads for the cost of one QuickClot package...it is expensive.

CC

He's 100% wrong, with VERY dangerous ignorance.

[Joseph B.]

Hmmm. I've heard they were pulling the hemcon pad out of the IFAK (not sure if that is true) but I have never heard they were pulling the combat gauze from the aid-bags. That would be really stupid if they did, as there are bleeds that you could never pack enough gauze in to stop, hints the reason quick clot and other have hit the market, after being fully vetted by the US Mil in combat operations.

I'm not a fan of the hemcon pad or the quick clot grainuals/powder (the pad needs to be cut and placed direct and the powder tends to get airborne/ in your eyes and all over the place, especially when working a helo medevac) But the combat gauze is pretty awesome. I find the cost argument a bit silly, on a forum that proclaims maintenance cost of a firearm is irrelevant, but something that would be a "oh crap I can't stop this bleed I need something more than regular gauze or this person is going to bleed to death" situation. I guess that breaks down to priorities or something, not sure I can understand it, but don't recommend being skimpy on the medical kit, it costs, but you get what you pay for and normally the difference between having the kit/training to save a life vs "we tried".

My$.02

[cclaxton]

He's 100% wrong, with VERY dangerous ignorance.

I am just the messenger and this is just one Medical Director, although in a County that has a lot of trauma victims including gun shot victims.

Cost is always A factor, but not necessarily THE factor. If you have to outfit 1000 medical kits with a $20 item, but can get 3 months worth of other dressings for the same amount....that can be THE cost factor.

If you had no other means to control trauma, then cost would not be a factor, but tourniquet's, better bandaging, Tegaderm, and better training make cost an issue.

CC

[cclaxton]

Found this excellent Medical Review. In summary, they said that laypersons should not use hemostatic agents, such as QuickClot. And, they said it could be used by EMS/Medicalprofessionals to control bleeding when direct pressure or tourniquet could not stop bleeding. And, they said it was effective but more research and studies are needed to confirm which specific types of injuries should get a hemostatic treatment. So, in summary: Only use when nothing else stops the bleeding, and more research needed.

http://www.instructorscorner.org/media/resources/SAC/Reviews/Topical%20Hemostatic%20Agents.pdf

CC

[ST911]

The hemostatic agents give the rescuer options and can make good interventions better.

[KevinB]

Found this excellent Medical Review. In summary, they said that laypersons should not use hemostatic agents, such as QuickClot. And, they said it could be used by EMS/Medicalprofessionals to control bleeding when direct pressure or tourniquet could not stop bleeding. And, they said it was effective but more research and studies are needed to confirm which specific types of injuries should get a hemostatic treatment. So, in summary: Only use when nothing else stops the bleeding, and more research needed.

http://www.instructorscorner.org/media/resources/SAC/Reviews/Topical%20Hemostatic%20Agents.pdf

CC

So the widespread use since 9/11 with US and Allied Military needs more reviews :rolleyes:


Also
http://www.naemt.org/education/TCCC/guidelines_curriculum.aspx

Combat Gauze is mentioned -- check the video.

I'm not suggesting Hecon dressing be used all the time, but there is a role for them CONUS, and failure to understand that will result in lost lives.

[Joseph B.]

1) Nobody has claimed that hemostatic agents is the first method in treatment of bleeds that have not been packed/dressed with pressure. It is a fail-safe when proper emergency treatment has not been effective at stopping the bleed

2) Everything used in emergency trauma management is constantly studied and reviewed. US Army TCCC (the group charged with study/recommendation of combat casualty care, recommends quick clot "combat gauze" for uncontrollable bleeding) as in packing/pressure dressing has failed to stop the bleed.

3) The argument of cost is pretty irrelevant to the end result of having a fail-safe in the aid-bag. The cost of having to fill aid-bags of a local EMS provider is moot as the cost is passed onto the patient, besides I am pretty sure the military has a few more aid-bags to fill than the local EMS provider. As for an individual not wanting to invest, I guess that's up to them, but again pretty stupid that $40-50 is too expensive to save a life.

Personally I think people are fooling themselves if they think something like hemostatic agents that has been used to save countless lives over the past decade by the US Mil, is a bad thing/product/investment.

To each their own.

[Joseph B.]

http://www.narescue.com/portal.aspx?CN=2D7701A3A9DA

Not trying to beat this to death, but NAR has Celox hemostatic gauze onsale right now for less than $30, pretty much a box defensive rounds.

[cclaxton]

Just to be clear: I do have QuickClot gauze in my first aid kit and will use it if required after first trying pressure dressings and tourniquet.

I have already made the investments.

Medical protocols CAN change, and DO change. Doctors are in the business of saving lives, too. Military doctors may find that hemostatic agents were not as valuable as advertised...that determination should be based on factual data.

My own read on the situation is that Doctors think that EMS personnel can achieve the same results with traditional pressure bandages and tourniquet's and if the use of hemostatic gauze is useful, they will support it. But the costs and side effects are still an issue for them.

CC

[KevinB]

My own read on the situation is that Doctors think that EMS personnel can achieve the same results with traditional pressure bandages and tourniquet's and if the use of hemostatic gauze is useful, they will support it. But the costs and side effects are still an issue for them.

CC


I don't think it has anything to do about costs.

I see it as mainly 1 and 2 below - but some of 3 rears its ugly head.
1) Lack of Knowledge
2) Belief that the time from treatment to surgery is not significant
3) Generally MD belief that they are the sacred holders of life (somewhat cynical but based on experience).

The unfortunate aspect of Doctor's and Surgeons in specific, is that they are the end stop, and not first responders, and don't often understand what a first responder faces, this is upped to the 9's when it is a care under fire aspect.

[SamuelBLong]

Unfortunately cost is always a factor in deploying hemostatic agents across a service. That's the only reason they don't have them on the bus in Albuquerque.

That being said, I think they're an essential tool, but must be judiciously used... Just like anything else. Personally I always carried a full IFAK like Doc was talking about earlier in my EDC bag when I'd go off to work.

It seems I've missed a lot of great discussion. I guess that's what I get for concentrating on getting LEO status this year. Thank goodness that's finally going through after the 1st of the year.

Back to the depths... License renewals and Studying. Studying. studying... As always.

[DocGKR]

"My trainer from the class asked his medical director about QuickClot."

The guy is an ignorant moron espousing inaccurate drivel.

Last month I was asked to present a 90 min lecture on the pathophysiology of penetrating trauma at the Stanford University Medical Center Emergency Department Grand Rounds (professors, attending physicians, fellows, residents, interns, med students, PA's, NP's, RN's, and other support staff, etc...). I discussed the use of hemostatic gauze--one of the doctors tried to make the same inaccurate arguments as noted above; he was soundly put down by the Head of the Department (who happens to be a sworn Deputy running the tacmed program for the SO here) as well as another professor who has written a text book on austere and wilderness medicine.

[cclaxton]

The guy is an ignorant moron espousing inaccurate drivel.

With all due respect: Don't you think that comment was uncalled for?

The trainer is a 28 year Fire Dept Paramedic and the primary trainer for their training company. The trainer I know is certainly not a moron, nor ignorant, and knew about their use and knew it was not supported in their EMS operation. And, I am sure the Medical Director for Baltimore county is neither ignorant nor a moron. The trainer took time to research the question about hemostatic agents and got an answer of how things stand today....in their operation.

You think they have inaccurate information and you may be correct...I don't know. The appropriate response is to explain why they are incorrect and put forward facts and supporting documentation or studies or point to Military protocols that support the use of hemostatic agents.

It is common for Doctors, Lawyers, Engineers, and other professionals to have opposing views on many subjects, and especially emerging technologies or procedures. I see that as a healthy debate. But I don't see how you win that debate by calling someone a ignorant moron. That doesn't provide much support for your position.

CC

[DocGKR]

My comment was VERY called for and is aimed solely at the medical director who is utterly inaccurate and factually erroneous in his comments (ie. 1) Expensive 2) Produces chemical burns 3) Military is getting away from it. We do have it but it is falling out of favor. Does do a cool job melting styrofoam). His job is to know this material and not regurgitate out of date misinformation from a decade ago. Again, I just gave a lecture on this topic at a major level I trauma center and similar balderdash was spewed forth by an equally ignorant practitioner and then shot down...

[Joseph B.]

Cclaxton, I think the main problem is you are quoting a person, who is supposedly quoting some other person, who are not here to clarify the context or products being discussed. The other problem is the content you presented as the quote from 28 year whoever, from director whatever, is factually incorrect on several levels that have already been pointed out.

I think you would be better off seeking clarification on the actual context and products being quoted and than adjusting your opinion/statements as necessary.

What level of trauma training do you possess? Was this your first first-aid/trauma/GSW training course? Are you an EMT, nurse, etc? What is your medical training or background?

[ToddG]

With all due respect: Don't you think that comment was uncalled for?

If the doc you quoted expressed, with such authority, information which is so obviously flawed can you explain it any other way than someone who simply feels he's above researching the topic before offering an opinion?

DocGKR's story from his presentation is a good example. Some doc -- certainly respected and good enough at his job to get on at Stanford University -- was quick to offer those same criticisms of the hemostatic gauze. Three people (including DocGKR) pointed out that no matter how smart the guy thought he was, he was just parroting pabulum without actually knowing what he was talking about.

One of the most important things I see separating docs I trust and those I'm wary of: the docs I trust say "I don't know" once in a while.

Same is true of firearms instructors, fwiw. :cool:

[BillP]

I will go ahead and add that the guy from Baltimore is wrong. It is not expensive (+/- cost of a tourniquet). It is not thermogenic. That stuff went out of circulation a decade ago. It is not falling out of favor with the military. It continues to be the intervention of choice for controlling compressible hemmorage in military circles.
Wrong. Dead wrong. As in his ignorance and prohibition of its use may well leave someone dead, because he was wrong.

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[cclaxton]

Cclaxton, I think the main problem is you are quoting a person, who is supposedly quoting some other person, who are not here to clarify the context or products being discussed. The other problem is the content you presented as the quote from 28 year whoever, from director whatever, is factually incorrect on several levels that have already been pointed out.

I think you would be better off seeking clarification on the actual context and products being quoted and than adjusting your opinion/statements as necessary.

What level of trauma training do you possess? Was this your first first-aid/trauma/GSW training course? Are you an EMT, nurse, etc? What is your medical training or background?

I think it is clear that the reason for this posting was to get this question in front of people here who have some experience with this. I can't speak with authority on this subject, but I can simply forward on my own research and answers I received from my trainer when I took my recent CPR/AED/FirstAid/Gun-Shot-Wound course. He asked HIS Medical Director, and I copied his direct reply without his contact information.

My issue here has to do with 1) The manner in which someone was labelled an "ignorant moron," as a basis to prove him wrong, and 2) The idea that just because someone here says the Medical Director is wrong doesn't make it wrong. In my mind that means he has a difference of opinion. And, for me to resolve a difference of opinion, I want to hear the facts and research papers, official statements of other Medical Directors, and other substantiation.

Otherwise I am being asked to believe people here, just because they say so. In any professional career, professionals will have differences of opinion, and that is a good thing. But facts and good clinical reports help me to decide for myself.

My opinion right now is that I would use Quickclot after trying to use a pressure dressing or tourniquet (based on the situation), and if that failed to stop serious bleeding, I would use Quickclot. I think most people here agree with that protocol. So, why is there an argument?

CC

[ToddG]

My issue here has to do with 1) The manner in which someone was labelled an "ignorant moron," as a basis to prove him wrong,

DocGKR doesn't need me to defend his comments, but he didn't say the MedDIR was wrong because he's an ignorant moron. I believe DocGKR was saying he was an ignorant moron because he was wrong.


and 2) The idea that just because someone here says the Medical Director is wrong doesn't make it wrong.

How the heck is "hemostatics are thermogenic" a matter of opinion?

CC, I'm not sure why you feel the need to defend this guy when so many people with proven expertise in the subject matter have explained how wrong he is. Nor do I think you can find a comfortable diplomatic negotiating point in the middle of the two camps. The MedDIR's information directly contradicts the first hand experience and professional first-hand training of many people on this forum. I'd be willing to bet you $20 that the MedDIR hasn't seen someone treated with a hemostatic in the past five years. Who are you going to believe?

[Joseph B.]

I think it is clear that the reason for this posting was to get this question in front of people here who have some experience with this. I can't speak with authority on this subject, but I can simply forward on my own research and answers I received from my trainer when I took my recent CPR/AED/FirstAid/Gun-Shot-Wound course. He asked HIS Medical Director, and I copied his direct reply without his contact information.

My issue here has to do with 1) The manner in which someone was labelled an "ignorant moron," as a basis to prove him wrong, and 2) The idea that just because someone here says the Medical Director is wrong doesn't make it wrong. In my mind that means he has a difference of opinion. And, for me to resolve a difference of opinion, I want to hear the facts and research papers, official statements of other Medical Directors, and other substantiation.

Otherwise I am being asked to believe people here, just because they say so. In any professional career, professionals will have differences of opinion, and that is a good thing. But facts and good clinical reports help me to decide for myself.

My opinion right now is that I would use Quickclot after trying to use a pressure dressing or tourniquet (based on the situation), and if that failed to stop serious bleeding, I would use Quickclot. I think most people here agree with that protocol. So, why is there an argument?

CC

The argument is that you posted inaccurate information, using a proxy of a class instructor and his medical director, and attempted to defend their statements, when you are not even qualified to form an opinion on the subject in the first place.

My posting was not to attack you or the class/trainer, etc. It was to offer enlightenment from a person has been trained for years on this exact subject, in one of the best programs in the world, and I have actually used it on the ground in Iraq. I am not an expert by any means, but I would not put myself in the "ignorant" group of this subject.

Your point of view is that you are not going to listen to anyone on here, who are trying to help you, is perfectly clear. I will not offer any more opinions or advice to you....good luck!

[Dropkick]

My opinion right now is that I would use Quickclot after trying to use a pressure dressing or tourniquet (based on the situation), and if that failed to stop serious bleeding, I would use Quickclot. I think most people here agree with that protocol. So, why is there an argument?

Could you please explain how you would do this? Rip the saturated standard gauze out of the wound, and then pack it with QC? Or pack the QC on top of the saturated standard gauze?

Or... How much blood do you think the patient should lose to find out that the standard gauze isn't working?

Oh and here's a study:
Prehospital topical hemostatic agents – A review of the current literature
Lance E. Stuke, M.D. MPH; August 2011
http://www.naemt.org/Libraries/Trauma%20Resources/Prehospital%20Tobpical%20Hemostatic%20Agents.sflb

Combat GauzeTM is a 3”x4 yard long roll of nonwoven gauze impregnated with kaolin. Combat Gauze has all the advantages of normal gauze (easy application, flexible, large coverage area, and easily removable) with the additional advantage of hemostatic function from the kaolin. It is designed for packing into deep wounds which are actively bleeding (i.e. arterial injury in the groin). Prehospital personnel can also use combat gauze as they would any standard Kerlix gauze. Combat Gauze was recently compared to several newer generation products, including the HemCon RTS, and found to be superior and had no apparent side effects.11 A study from the Israel Defense Force reviewed fourteen uses of Combat Gauze and noted a 79% success rate.12 The authors noted that in the three instances where Combat Gauze was unsuccessful, the soldiers had such severe injuries that only surgical control was successful. One of the three soldiers died from the severity of his wounds. Currently, Combat Gauze is the only product endorsed by the Tactical Combat Casualty Care Committee and they recommend it as first line treatment for life-threatening hemorrhage on external wounds not amendable to direct pressure and tourniquet placement.

[Adam]

Great thread.

I took a civilian/CCW focused version of TCCC from a national TCCC instructor. Use of TQs, hemostatic agents, NPAs, chest seals, etc. One of the best training experiences I’ve ever had. Since then, I carry a trauma kit in each car with all the current common trauma kit contents. I also carry a pocket kit every day in my back pocket which contains a pair of gloves in a freezer bag (to protect the gloves and serve as an improvised chest seal if required) a TK-4 tourniquet and 2 feet of duct tape wrapped around a section of Bic pen stick. I hear a lot of chatter about improvising TQs in the field. It is possible, but a TK-4 is very carry friendly. Not a SOFT-T but, I have it on me any time I’m wearing pants. I’d rather improvise a trauma dressing with an undershirt (and maybe the TQ for pressure) then hunt for something to make a TQ out of.

As far as hemostatic agents, I have them in car kits, but don’t carry it on me. Serious arterial bleeding is getting a TQ as soon as I deem it a TQ kind of day. Combat gauze is made for wound packing. We shoved gauze in to a pork roast in class and it was an odd feeling.

In summary (and again this is just my current opinion):

Assessment
Direct pressure
TQ if necessary
Wound packing and other measures

[peterb]

I work under uniform statewide EMS protocols that are formally reviewed and updated every two years. Hemostatics were first mentioned in the prior revision. In the current edition routine patient care for bleeding is:

"Control active bleeding using direct pressure, pressure bandages, tourniquets, or hemostatic bandages"
"Hemostatic bandages must be of a non-exothermic type that can be washed off with 0.9% NaCl (normal saline)"

Basically, use whatever works, and don't make it harder for the next person who sees your patient.

[KevinB]

Basically, use whatever works, and don't make it harder for the next person who sees your patient.

The one edit I would add is, "and try not to make it harder for the next person who sees your patient, unless it ensures the next person who see the patient isn't at the morgue."

[Cookie Monster]

Thats for the study, it is a awesome piece to read.

I could care less about making it harder for the trauma doc at the hospital (within reasonable limits of course), I want to make sure they have enough blood left to make it there.

Thanks for everyone's time and expertise. I've sat in many EMT classes, thinking the person is just wrong when talking about TQ's and QuikClot.

Cookie Monster

[WobblyPossum]

When I was in Afghanistan last year, everyone was issued a combat gauze packet to keep in their IFAK. I can tell you for a fact that the military is NOT going away from these kinds of hemostatics. I can also tell you that QuickClot Combat Gauze is not thermogenic, unless every medic who ever taught CLS re-certification courses I have sat through is a liar or an idiot.

The information given to you by this Baltimore doctor is counter to these verifiable facts. That means he is wrong. If he is wrong because he hasn't bothered to get updated training and is still making decisions based on information that was outdated years ago, then I agree with DocGKR. This guy sounds like an ignorant moron. He should update his program of instruction because it just might save someone's life.

[SGT_Calle]

When I was in Afghanistan last year, everyone was issued a combat gauze packet to keep in their IFAK. I can tell you for a fact that the military is NOT going away from these kinds of hemostatics. I can also tell you that QuickClot Combat Gauze is not thermogenic, unless every medic who ever taught CLS re-certification courses I have sat through is a liar or an idiot.

The information given to you by this Baltimore doctor is counter to these verifiable facts. That means he is wrong. If he is wrong because he hasn't bothered to get updated training and is still making decisions based on information that was outdated years ago, then I agree with DocGKR. This guy sounds like an ignorant moron. He should update his program of instruction because it just might save someone's life.

I remember in '06 getting our IFAKs supplemented with that patch thing that you were supposed to cut into smaller pieces. Also, not for use on Soldiers allergic to shellfish, lol.

[Joseph B.]

I remember in '06 getting our IFAKs supplemented with that patch thing that you were supposed to cut into smaller pieces. Also, not for use on Soldiers allergic to shellfish, lol.


Hemcon bandage, looked like a small 3x4" pad covered with foil wrapper. I am pretty sure I still have 3 or 4 sitting in my black box. Those things sucked, the QC combat gauze is way better.

[DocGKR]

"the QC combat gauze is way better"

Yup.

[Dogtown]

Hemcon bandage, looked like a small 3x4" pad covered with foil wrapper. I am pretty sure I still have 3 or 4 sitting in my black box. Those things sucked, the QC combat gauze is way better.

I was issued Celox in 07 or 08 (along with Hemcom.) More recent training was with Combat Gauze, though.

Did Celox fall out of favor?

[Joseph B.]

Not that I am aware of, I know a couple of 18D's that prefer/recommend it over combat gauze. I know TCCC is recommending QC combat gauze, but I have not seen anything say Celox is not recommend, etc.

[cclaxton]

The argument is that you posted inaccurate information, using a proxy of a class instructor and his medical director, and attempted to defend their statements, when you are not even qualified to form an opinion on the subject in the first place.

My posting was not to attack you or the class/trainer, etc. It was to offer enlightenment from a person has been trained for years on this exact subject, in one of the best programs in the world, and I have actually used it on the ground in Iraq. I am not an expert by any means, but I would not put myself in the "ignorant" group of this subject.

Your point of view is that you are not going to listen to anyone on here, who are trying to help you, is perfectly clear. I will not offer any more opinions or advice to you....good luck!

I was the messenger. I am trying to decide for myself given all the facts and professional opinions. I didn't defend the Baltimore doctor's statements. I simply think calling anyone an ignorant moron is wrong. It doesn't help. Bad manners too. In fact it starts a fight and creates enemies. If you want to get someone to change their position then show them the facts. We live in civil society, not a barroom or WWF arena.
CC


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[Dropkick]

We live in civil society, not a barroom or WWF arena.

This -is- the internet, bro.

[ToddG]

I simply think calling anyone an ignorant moron is wrong.

I simply think being an ignorant moron is wrong. It's more wrong when he makes declarations from on high that will affect the treatment -- and therefore lives -- of countless trauma patients.

No one should ever feel like it's rude to question medical advice or the opinion of a single doctor. Especially when, as in this case, the doctor in question appears utterly and completely out of his lane.

[Josh Runkle]

#1: the doctor in question is said to be a medical director. While he may not have the latest facts, he's definitely not "out of his lane". It is LITERALLY his job to give his opinions on emergency procedures. Someone may be WAY more informed than him, yet it does not mean that he should shut up. It doesn't even mean he is misinformed, it means that he is under-informed. That's the whole point of peer-review. To put forth what you know so that others can review and help you change it.

#2: I think DOCGKR is right on this issue as far as the science goes. Time and time again, he only offers his opinion on things that he is superbly educated about.

#3: Ad Hominem, ie: personally attacking the doctor as a "moron" rather than simply addressing why he is wrong doesn't really add any value to conversation. While that may be a personal opinion about that doctor (I'm assuming he is personally known), it doesn't add value towards changing the minds of people on the forum to support a different position, which may be the better one, because they get offended over the personal attack.

[DocGKR]

Again, it is the JOB of the medical director to KNOW this material and NOT regurgitate out of date misinformation from a decade ago. If he does not know how to do his job, if he does not keep up to date on crucial life saving information, if his ignorant comments result in needless deaths, then how should this person be described? What if it was your child or loved one who died as a result of his patently false statements? I get a bit indignant when purported professionals do not adequately do their jobs and properly serve the public they are entrusted to protect...

[TCinVA]

Thats for the study, it is a awesome piece to read.

I could care less about making it harder for the trauma doc at the hospital (within reasonable limits of course), I want to make sure they have enough blood left to make it there.

Thanks for everyone's time and expertise. I've sat in many EMT classes, thinking the person is just wrong when talking about TQ's and QuikClot.

Cookie Monster

The folks working trauma in Iraq and Afghanistan are at the cutting edge and often have more practical experience than the medical establishment here. Old notions sometimes die hard, and the old canards about TQ use seem to be especially resilient even in the face of so much evidence.

Those perpetuating the outdated ideas in the face of such a mountain of evidence are actively doing harm to others. Tom Jones' wife is alive today because there was a TQ handy when she needed it. Had this retarded prejudice against a proven life-saving tool made her command structure waver on the decision for even a short while longer, she likely wouldn't be here.

That's why this form of ignorance needs to be mercilessly smashed...because people's lives are at stake.

[cutter]

Just like to remind everyone that the folks working trauma in Vietnam came up with MAST pants, which took us 20 years or so to figure out they didn't work.

[rudy99]

So I ended up with a quik clot trauma pad and an Olaes bandage in the kit I put together as my "hemostatic remedy", which might have other uses. Would Combat Gauze alone replace these two items considering it is treated with a clotting agent?

[Dropkick]

So I ended up with a quik clot trauma pad and an Olaes bandage in the kit I put together as my "hemostatic remedy", which might have other uses. Would Combat Gauze alone replace these two items considering it is treated with a clotting agent?

I view gauze and compression bandages as two different things. You can pack penetrating wounds with gauze.

[rudy99]

I view gauze and compression bandages as two different things. You can pack penetrating wounds with gauze.

You know what, you're right. Two separate things. Bad question.

[SGT_Calle]

Just like to remind everyone that the folks working trauma in Vietnam came up with MAST pants, which took us 20 years or so to figure out they didn't work.

I had never heard of MAST pants before this post, then I see this today:
http://soldiersystems.net/2013/12/16/soma-global-protection-medical-group/
The Mechanical Blood Volumizer.

[vaspence]

I view gauze and compression bandages as two different things. You can pack penetrating wounds with gauze.

The Oales has removeable gauze for packing in the bandage. .

[Dropkick]

The Oales has removeable gauze for packing in the bandage. .

This is true, but I was responding to Oales vs. QC Gauze.

[BillP]

Dogtown, The Committee on TCCC has held QC Combat Gauze as the standard since they yanked Wound Stat. That isn't to say it's the best. That says it is what the highly political committee working under the auspices of a very political organization have left as the status quo.
In DOD's 2012 study on newer hemostatics on the market vs. Combat Gauze, Celox gauze (as issued to Her Majesty's Forces) outperformed CG by a notable margin. It is a British made product, however. That could potentially cause issues for DoD procurement in broad strokes.

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