Photo courtesy Celox
FEATURED IN TRAINING
As history demonstrates, conflict often breeds remarkable innovation. The development of hemostatic clotting agents is among these breakthrough technologies. Pick up any police or military-supply catalog lying around your agency and turn to the first-aid products. Chances are you ll find one or more hemostatic agents listed, such as QuickClot, HemCon and Celox.
Designed for treating battlefield injuries where 90 percent of deaths occur due to blood loss, hemostatic agents help provide temporary control of life-threatening external bleeding by enhancing or accelerating the natural clotting process through various physical reactions between the agent and blood. Hemostatic agents prove particularly useful when extraction to a field hospital is delayed or when the injury occurs to areas where tourniquets are not effective or possible, such as the shoulders, torso and pelvis.
In the United States, traumatic deaths usually result from car accidents and falls, where bleeding is often internal and doesn t benefit from field hemostatic-agent use. Although deaths from external bleeding are not as common in the civilian world as in combat, they do occur, especially with law officers. In 2007, the National Law Enforcement Officers Memorial Fund reported an increase in officer deaths, many from gunshot wounds. At press time, 186 officer deaths occurred in 2007 (a 28-percent increase from 2006), with at least 69 from gunshot wounds (a 33-percent increase from 2006).
Researching hemostatic agents can lead to a confusing quagmire of conflicting information and opinions about which products to use, when to use them and their effectiveness.
Individual military personnel and entire units returning from overseas have provided conflicting views of the same hemostatic agents. Uninformed distributors, sales staff and catalogs can lead officers to believe hemostatic agents are the magic bullet of bleeding control and that training is not required for effective use. In fact, some law enforcement instructors have encouraged the use of these products by street officers without first understanding proper training or procedures for hemostatic-agent use or emphasizing the importance of basic first-aid skills.
On the flip side, others have claimed the perceived risk of additional harm to the patient is too great to make use of hemostatic agents. One presenter at a major national conference erroneously told attendees these agents would likely cause a patient to suffer a stroke when applied to a simple scalp laceration.
Understand the facts, pros and cons of each of these products before making your own decision about which one best fits your needs. Below, I provide overviews of three of the most popular hemostatic agents marketed to first responders.
What s Available?
Probably the most well known of the hemostatic agents currently on the market, QuikClot, from Z-Medica Corporation, is made of a zeolite material that promotes rapid clotting by absorbing water molecules from blood, leaving larger platelet and clotting-factor molecules behind in a heavily concentrated form.
The first version of the product, introduced in 2002, was a granular form that users poured into a wound. Some controversy surrounded the original formulation as claims surfaced that its use could cause burns to the patient on application. Some of these incidents were attributed to improper usage, though increased temperature still caused some concern.
Since its original formulation, QuikClot has evolved into improved variations, including QuikClot ACS+ and QuikClot 1st Response for first responders, and two consumer versions, QuikClot Sport and QuikClot Sport Silver with anti-microbial properties. The composition now includes non-allergenic, X-ray detectable, granular beads of clotting agent contained in a porous mesh netting resembling a sponge. Users can apply and remove these newest formulations much more easily than the original version, and they generate little heat, preventing the burns reported in the past. These QuikClot products cost $20 $30 per unit.
QuikClot has been approved by the FDA, tested and recommended by the U.S. Navy, adopted by the U.S. Marine Corps for general issue, adopted by the U.S. Army for issue to field medics and adopted by the U.S. Air Force for inclusion in all first-aid kits. According to Z-Medica, QuikClot has saved more than 150 lives in Iraq and Afghanistan.
Law enforcement has successfully used QuikClot in a number of publicized incidents nationwide. A San Jose, Calif., police officer applied QuikClot and a pressure dressing to a civilian who suffered severe bleeding after putting his arm through a large window. Officers in Maricopa County, Ariz., used it to save the life of a range master who was hit by a .50-caliber ricochet in the abdomen and femoral artery. The Hillsborough County (Fla.) Sheriff s Office estimates its deputies have used QuikClot nearly 100 times, including an incident in which the product was credited with saving the life of an undercover deputy who sustained a gunshot wound to the abdomen.
Manufactured by HemCon Medical Technologies, the HemCon Bandage incorporates a hemostatic agent into a flexible bandage. The bandage becomes sticky when it comes in contact with blood or other moisture, and adheres to the wound site, sealing it. HemCon works through ionic interaction by drawing red blood cells and platelets to the bandage, forming a clot and creating an anti-bacterial barrier that protects the wound from infection. Though it s made of a shrimp-shell based component called chitosan, repeated testing has shown it has no known side effects or allergy-causing properties.