I take control of traumatic bleeding and clotting seriously, as I’m often working by myself at The Place with tools meant to do lots of cutting. I think you should take it seriously, too.
Everything from auto and home accidents to Apocalypse Now situations involves some risk of bleeding that can become life-threatening in (approximately) no time flat.
This is part one of a two-part series (part two is here CLICKY), with this piece being about products that include chemical agents to promote clotting, and a later piece about compression bandaging.
What clotting aids are available to control bleeding? (much of this is from source (1))
There have been a variety of products in use over the years, as the military has quite reasonably promoted their research and served as a big potential market. I’m mostly ignoring the old-style ones that people don’t really use anymore (super expensive and inferior to modern offerings), and one that looked great but turned out to have some nasty side effects.
If you see something called WoundStat for sale anywhere, you might keep in mind that the U.S. Military reversed their position and quit using it after only a couple of years of use. Clots forming later on in people’s blood vessels was not what they wanted.
Chitosan is a complex carbohydrate found in the shells of invertebrates. It can reduce bleeding, partly by just gumming up the blood as it tries to flow out and probably also activating the blood’s own clotting mechanisms such as by activating platelets. HemCon and Chitoflex are a couple of the commercial varieties.
Most of the bandages seem to be packed individually in sterile packages.
Zeolite products such as pre-2012 QuikClot are, at their hearts, powdered mineral products. They were pretty effective but had the nasty side effect that the chemical reactions they provoked produced a lot of heat. The patient would quit bleeding, but would get burn injury in many cases. They’ve mostly been replaced, so if you’re looking at QuikClot you might want to check out its production date.
Kaolin is a kind of powdered clay. Besides gumming up the bleeding, it activates one of the clotting factors to turn on your own clotting reactions. While similar to zeolite, it is more effective and doesn’t have those nasty side effects (not as much heat). QuikClot shifted to using kaolin in 2012. TraumaStat is also a kaolin product.
Fibrin sealant dressing (FSD) is the most effective option I found, halving bleeding time compared to plain gauze (2) and dramatically improving the survival of intentionally injured swine (they were anesthetized, by the way). (3) It’s a mixture of human blood clotting proteins (fibrin, thrombin, and Factor XII) and calcium ions, usually delivered impregnated into biodegradable vinyl or as a spray. As far as I could find though, it’s not an option for preppers without access to medical stores (as I said, not a master shopper). It’s often used in surgeries. It’s also reported to be much harder to use and much easier to use badly and cause additional problems than the other options on the list.
The kaolin, chitosan, and zeolite products also have some antibacterial properties. Nobody seems sure how helpful that is, but given the types of germs they suppress (such as MRSA), I can’t see how it would be a bad thing.
What bleeding control format is best?
The American College of Surgeons Trauma Committee suggests getting the gauze-impregnated products. (4) They’re easy to use; in fact a group of anesthetized pigs had a 96% survival rate from wounds that would have been fatal with normal gauze alone when treated with the modern impregnated gauzes Chitosan, HemCon, or QuikClot by Navy corpsmen who’d had only a fifteen minute introduction to the products and no practice. (5) Considering the stress of any situation where you’ll be needing such a bandage, I like the sound of that!
These gauzes are also good for packing and for use with compression, which is always recommended. It sounds a lot like they’d team up well with the compression bandaging techniques I plan to look at in Part 2 of this series.
The 4×4 gauze is a favored format, since it can be incorporated into compression bandaging.
You can also buy these as powders, or at least used to be able to. They work, but are harder to apply and more likely to be washed out by the flow of blood. They can also be difficult to removed, leading to more damage later (but after the risk of bleeding to death has stopped). The versions where the powders were contained in little biodegradeable envelopes were better spoken of than the ‘sprinkle in’ varieties, but still not greatly appreciated by my sources. Their only potential benefit seemed to be being cheaper.
When do you use it?
For bleeding obviously, but there’s a bit more to it. This stuff is only for the most serious bleeding traumas. The medical opinion seems to be that if plain gauze and compression will stop the bleeding, go with those. There are places that compression is harder to achieve and less effective (very high on the limbs, on the neck, sometimes the torso), and these are the times you may really want the clotting aids.
Other considerations
How do you use these things? Just like other wound gauze, apparently. Pack it on the wound while it’s bleeding and apply compression overtop. It will need to be removed when it’s time to rebandage (the most common varieties aren’t biodegradeable). It sounds to me as if one of these under an Israeli or other compression bandage (to be covered in a future article) would be a good choice.
My personal choice (I’m not a doctor, so this isn’t a medical recommendation) will the newer QuikClot (post 2012, the kaolin stuff). I’ll get the gauze, and keep it with an Israeli bandage and plenty of plain gauze in the trauma pack I have on hand whenever working with cutting tools. I’ve read that it’s the Army’s current choice, for one thing, and I expect they know a lot about traumatic injury treatment in the field. Some of the chitosan bandages have a reputation for being too stiff to get good wound contact. That’s what gave rise to the ChitoFlex variant. I don’t like the heating effect of the zeolite, and the FSD is not feasible for me due to price and availability.
Just to be clear, there is some conflicting evidence on the effectiveness of these bandages. For example, my choice (QuikClot) didn’t save some pigs with arterial bleeds, while the FSDs did. (6) Some studies show the impregnated gauze doing significant good, some don’t. Overall, it looks to me like a big enough improvement over plain gauze that it might be the life-saving difference with a major trauma.
Do you want to stock any of these clotting aids? Your budget is an important consideration. The best readily available products are in the range of ‘expensive if I never need them, but cheap as dirt if I do”. I’m no master shopper, but a quick look at online prices had my favorite choice at about $45 per bandage. The FSD sellers, besides asking you to order through your medical unit’s purchasing office, wanted $600 a dose.
1) Gordy, Stephanie D, et al. “Military applications of novel hemostatic devices.” Expert Review of Medical Devices, vol. 8, no. 1, 2011, p. 41+. Academic OneFile, http://link.galegroup.com/apps/doc/A268360120/AONE?u=north1010&sid=AONE&xid=c86f92e9. Accessed 21 Feb. 2018.
2) Holcomb J1, MacPhee M, Hetz S, Harris R, Pusateri A, Hess J Efficacy of a dry fibrin sealant dressing for hemorrhage control after ballistic injury. Arch Surg. 1998 Jan;133(1):32-5.
3) Acheson EM1, Kheirabadi BS, Deguzman R, Dick EJ Jr, Holcomb JB.Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. J Trauma. 2005 Oct;59(4):865-74; discussion 874-5.
4) Sigal, A., Martin, A., & Ong, A. (2017). Availability and use of hemostatic agents in prehospital trauma patients in Pennsylvania translation from the military to the civilian setting. Open Access Emergency Medicine : OAEM, 9, 47–52. http://doi.org/10.2147/OAEM.S134657
5) Conley, S. P., Littlejohn, L. F., Henao, J., DeVito, S. S., & Zarow, G. J. (2015). Control of junctional hemorrhage in a consensus swine model with hemostatic gauze products following minimal training. Military Medicine, 180(11), 1189.
6) Acheson EM1, Kheirabadi BS, Deguzman R, Dick EJ Jr, Holcomb JB.Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. J Trauma. 2005 Oct;59(4):865-74; discussion 874-5.
What a great amount of information. Thank you. The only thing to add is that these clotting agents do not fix any damage, it just helps the red gooey stuff from leaking out until you get to proper medical professionals. A lot of people have been lead to believe from movies and books these are some magical items to ‘fix” gunshot wounds post-SHTF. A ER Doc I know has told me how much time is needed to wash out the material before fixing it, but still endorses its use for major wounds. He’s had people show up to the ER with basic cuts that don’t even require stitches with a quick clot pad over it because they saw blood. We stock some of the quick clot combat gauze, sponges and even have a couple of the CELOX-A Applicators in our medical bag.
Good point; I should have made that part more clear. Thanks!