1. Are you a current member with account or password issues?

    Please visit following page for more information

    Dismiss Notice

2018/19: Given The Advancements In Hemostatic Gauze? Is It Even Worth Carring A Trauma Bandage?

Discussion in 'First Aid Station' started by bmstrong, Oct 8, 2018.

  1. bmstrong

    bmstrong Loaded Pockets

    Joined:
    Apr 20, 2006
    Messages:
    396
    Likes Received:
    64
    Given the rise of chitosan-based gauze and the efficacy of the QuikClot family of gauze products, the gain in space savings from these types of gauze(s) over the traditional counterparts like the Israeli or Oales has me thinking about what/why I would still carry something old-school. Why would one still carry an old school gauze bandage or kerlix over the modern hemostatic? Is cost the only factor? How much bleeding does the average hemostatic gauze package stop before being overwhelmed? Is there any field studies or side by side comparisons on something like a GSW and the efficacy of a Israeli vs a packet of Quikclot Combat Gauze LE?



    This is the video that has kind of started my thinking on this.
     
    Last edited by bmstrong, Oct 8, 2018
    #1 bmstrong, Oct 8, 2018
    Last edited: Oct 8, 2018
  2. ArkansasFan30

    ArkansasFan30 Loaded Pockets

    Joined:
    Dec 7, 2012
    Messages:
    1,546
    Likes Received:
    1,318
    Admittedly, trauma medicine isn't my field so I can't attest to the evidence base on gauze vs medicated gauze although I'd like to see some abstracts. I have each type in my kits - Quikclot in two, unmedicated gauze in all four.

    However, there a variety of wounds one may encounter, abrasions and burns come to mind, for which a hemostatic gauze wouldn't be beneficial, but a preferably nonadherent dressing would be. Additionally, the majority of lacerations and punctures people fall victim to don't require wound packing.

    I've become a fan of H&H compressed gauze and mini compression bandage due to their small size. I'm sure NAR and others have similar products.
     
  3. Kevin Walker

    Kevin Walker Empty Pockets

    Joined:
    Dec 19, 2016
    Messages:
    12
    Likes Received:
    23
    I keep pressure dressings because they're useful in situations where wound packing wouldn't be necessary. Also, they can keep pressure on packed wounds after you're done packing.

    Sent from my Moto G (4) using Tapatalk
     
    tdb, DSRacing, TJones and 3 others like this.
  4. Angry Medic

    Angry Medic Empty Pockets

    Joined:
    Sep 23, 2018
    Messages:
    2
    Likes Received:
    3
    Can’t use Chitosan on penetrating chest injuries.
     
    tdb, TJones and PragmaticMurphyist like this.
  5. SOS24
    • +2 Supporter

    SOS24 Loaded Pockets

    Joined:
    Feb 12, 2016
    Messages:
    1,158
    Likes Received:
    2,337
    I can see a few reason for a compression bandage over or in addition to hemostatic gauze.

    - From what I understand, to be effective hemostatic gauze must touch the source of the bleeding which means you must actually be able to see where it is coming from and push the gauze into that spot to make it effective. The pressure from a compression bandage can help stop or at least slow bleeding even if the internal source is not touched.
    - A compression bandage covers the wound which will help to keep it clean.
    - Compression bandage can be used for wounds other than traumatic bleeds even as an ACE/elastic bandage.

    I could see potentially carrying both but would not eliminate a compression bandage in favor of only a hemostatic dressing.
     
  6. Joe S

    Joe S Loaded Pockets

    Joined:
    Jul 3, 2008
    Messages:
    18
    Likes Received:
    11
    The bandage keeps pressure on the packed wound once you're done. It works on all the types of wounds that don't require packing. It's cheap in comparison to hemostatics.
     
    TJones, Jedi5150, SOS24 and 1 other person like this.
  7. maillet282

    maillet282 Loaded Pockets

    Joined:
    Apr 11, 2016
    Messages:
    209
    Likes Received:
    280
    this is true. when using the quick clot combat gause, or similar packing materials ( even the plain old H&H gause) your still required to hold pressure for 5 to 10 minutes to ensure that the hemostatic agent or the clotting can start to take effect. once this is done, a trauma dressing will assist to keep the packing material in place as well as providing proper wound coverage.
     
    SOS24 and PragmaticMurphyist like this.
  8. thegrouch314

    thegrouch314 Loaded Pockets

    Joined:
    Dec 10, 2015
    Messages:
    355
    Likes Received:
    258
    As others have said, both work well in conjunction with each other.

    That said, if I had to choose one, I'd probably go with the trauma bandage because it is more versatile and because it's so much cheaper, you can carry more for the same price. In a full size trauma kit I run one haemostatic gauze and two or three pressure dressings.
     
    volvoboy and Jedi5150 like this.
  9. Jedi5150

    Jedi5150 Loaded Pockets

    Joined:
    Nov 28, 2018
    Messages:
    23
    Likes Received:
    58
    Good answers. To keep it simple, I'd just add that you need to keep in mind the difference between a dressing and a bandage. Israeli and OALES are combination dressings (applied to the wound), and bandages (hold dressings in place). Hemostatic gauze is not a bandage, and doesn't take the place of one.

    I'd also second what maillet282 said about time; An Israeli or OALES is much faster to put on and have it stay than a hemostatic gauze dressing, which you would then have to bandage (with an Ace wrap or similar). I had a situation recently where I needed to get my patient out of Dodge in a hurry, and a TQ and Israeli were very quick to put on. I simply didn't have the time to fart around with a hemostatic dressing.
     
    FiaOlleDog, volvoboy and JHGM like this.
  10. huntnow

    huntnow Loaded Pockets

    Joined:
    Jul 29, 2013
    Messages:
    316
    Likes Received:
    535
    I'm no expert, I have received only basic field trauma response training. In the training I attended though, I was instructed if quick clot or it's variants do not stop the bleeding for some reason, it is to be completely removed and a new one is to be packed into the wound. I was told this was not the case with traditional dressings and they could be packed in on top of one another. If that is correct, I wouldn't think the advantages were all that much greater. I carry it anyway, along with traditional dressing vs, and a tourniquet. One is none...
     
  11. chaosmagnet
    • GITD Manix 2XL Owner
    • Sponsor - Home Craftsman
    • In Omnia Paratus

    chaosmagnet Loaded Pockets

    Joined:
    Apr 13, 2008
    Messages:
    1,490
    Likes Received:
    842
    I was taught to never remove a bandage packed into a penetrating wound until the patient reaches definitive care -- but I'm no medical professional.
     
    FiaOlleDog, huntnow and Jedi5150 like this.
  12. Jedi5150

    Jedi5150 Loaded Pockets

    Joined:
    Nov 28, 2018
    Messages:
    23
    Likes Received:
    58
    That's what I've always been taught as well. But if hemostatic agents are an exception to the rule, I'd like to know about it. I'd be curious to hear the thought process behind it.
     
    huntnow and chaosmagnet like this.
  13. SOS24
    • +2 Supporter

    SOS24 Loaded Pockets

    Joined:
    Feb 12, 2016
    Messages:
    1,158
    Likes Received:
    2,337
    I recently attended a Stop the Bleed course and the guidance was if packing with gauze did not work then tourniquet if in area that could and direct pressure. Nothing was said about removing.

    The problem with removing is that even though it may not completely stopping the bleeding, it may be partially working and removing it could cause the bleeding that is stopped/slowed to start again full force, which is why I’ve always heard to never remove, just add to.

    But I am not a medical professional, so I would be interested in what their training is.
     
    FiaOlleDog, huntnow and chaosmagnet like this.
  14. maillet282

    maillet282 Loaded Pockets

    Joined:
    Apr 11, 2016
    Messages:
    209
    Likes Received:
    280
    When it comes to a hemistatic gauze. Once it’s been exposed to liquid( weather it’s blood or accideltuly dropping it in the mud while packing a wound) it will no longer be effective due to the agent being activated. Combat gauze will require the old packing to be removed and replaced with new stuff. And then a firm 5 minutes of pressure applied to ensure that it’s doing its job. If you have used the entire roll of combat gauze but there is still a larg space you can then substitute to a H&H kerlex style gauze to fill the rest of the hole. The Oales dressing comes with this extra packing material already available with in the bandage itself
     
    chaosmagnet likes this.
  15. Jedi5150

    Jedi5150 Loaded Pockets

    Joined:
    Nov 28, 2018
    Messages:
    23
    Likes Received:
    58
    I did some looking into it (Like anything on the internet, take my opinion for what you paid for it:D); Removing a Combat Gauze dressing that has not effectively stopped the bleeding is currently being taught to both military medics and civilian paramedics, in at least some courses/ schools. Like maillet282 said, if the substance (kaolin) has been exposed to liquid and is no longer working, removing it and replacing with a new one might help. That said, removing the old one is against the manufacturer's recommendation on their FAQ list:

    "More severe and traumatic wounds may require additional dressings. In such cases, multiple QuikClot® devices may be used. However, it is suggested that the first dressing used remains in place while a second is applied over the first. Do not disturb the clot that is forming under the first device. QuikClot® devices are single-use only."

    So apparently, we have to pick whether to follow current trends in medical training, or the manufacturer's suggestions, which don't match up.

    To further muddy the waters, the quote I posted above from their FAQ page now reads:

    "What if the wound bleeds through the QuikClot® device?
    More severe and traumatic wounds may require additional dressings. In such cases, multiple QuikClot® devices may be used per the Instructions for Use."

    ...which is ambiguous. It makes me wonder if they changed the wording to be in line with current trends...
     
    Last edited by Jedi5150, Dec 8, 2018
    #15 Jedi5150, Dec 8, 2018
    Last edited: Dec 8, 2018
    SOS24 and chaosmagnet like this.
  16. chaosmagnet
    • GITD Manix 2XL Owner
    • Sponsor - Home Craftsman
    • In Omnia Paratus

    chaosmagnet Loaded Pockets

    Joined:
    Apr 13, 2008
    Messages:
    1,490
    Likes Received:
    842
    I don't carry anything other than Combat Gauze. Based on what I know right now, I'd be more inclined to use multiple hemostatic dressings rather than remove one and try another, if it wasn't working with direct pressure and I could not apply a tourniquet.
     
    Jedi5150 likes this.
  17. maillet282

    maillet282 Loaded Pockets

    Joined:
    Apr 11, 2016
    Messages:
    209
    Likes Received:
    280

    this is where I learned and I have used combat gauze. and I still carry combat gauze in my IFAK, Front line, and med bag just in case one of my casualties needs it. although I am a Medical Technician and am trained on using it
     
  18. Joe S

    Joe S Loaded Pockets

    Joined:
    Jul 3, 2008
    Messages:
    18
    Likes Received:
    11
    I could not find it just now, but there was a study that found that while there was a difference between hemostatics versus standard gauze, it was not as big as many presume. That tells me that most of the work is done by the pressure of packing. That tells me that if even if the magic powder isn't working, the cloth still is. If it's working partially, I want to pack in more gauze, and apply more pressure. I wouldn't pull out the gauze, potentially removing any clotting, as well as essentially removing ALL pressure on the site, after having potentially caused slightly more trauma from the packing, unless I was in an OR, with extra blood available, and an ER doc looked at me and said, "OK, unpack it".

    My qualifications in the medical field: none. But I read the papers, and talk to medics and Corpsmen who have done the dirty work in awful conditions. I think a lot of people miss what these discussions are about. If you're packing a wound, it's because you have a horrible, potentially lethal penetrating wound. You use your fingers to jam fabric down into the fresh hole just torn into someone's flesh. It's not gentle, it's not pretty and it's painful. It's just better than them dying. Then, you probably have to move the patient under far from ideal conditions in a chaotic environment. Because your getting them to a trauma surgeon, who they really need to see. Your job is just to attempt to keep them alive until then. That's hard enough .
     
    FiaOlleDog and chaosmagnet like this.
  19. maillet282

    maillet282 Loaded Pockets

    Joined:
    Apr 11, 2016
    Messages:
    209
    Likes Received:
    280
    going to break down your post for my next comment.

    the idea behind removing the old packing material is for 2 reasons. 1 the Kaolin in the combat gauze has already been activated and will no longer be effective with the new bleed. 2 if initially properly packed and the wound has begun to bleed again due to the clot being dislodged from moving the casualty your going to want to regain control of the artery ( or bleeder) with direct pressure then repack while applying direct pressure with the packing material.

    reading and discussing with medics and corpsmen about how this stuff is used can be a bit of an issue. similar to posts and threads like this where people will read and take it as the exact how to complete a task. ( potentially a delegated medical act where ever your located). if people are really interested on how to properly pack and what's the best way to do it is that "you" ( Generalising not specifically referencing Joe S) should take an approved and accredited Stop the Bleed course that is COTCCC compliant.

    as for myself, this is what I have been taught on what to do regarding massive Haemorrhages that can not be stopped by a TQ also what I have been teaching . I have been using and packing CAT TQ's, SOF-TW, and Combat Gauze in my Med bag as a medic for close to 10 years ( since I've deployed to Afghanistan). again my best advice is for people to take the training if you want to carry and use these specific medical devices.
     
    FiaOlleDog, Jedi5150 and chaosmagnet like this.
  20. Joe S

    Joe S Loaded Pockets

    Joined:
    Jul 3, 2008
    Messages:
    18
    Likes Received:
    11
    All good points. Thanks for the good conversation and info from your experience.
     
    chaosmagnet likes this.