I'm an EMT-B with my local fire dept. Unfortunately in my area we are not permitted to use homeostatic agents. However I do carry some in my personal FAK. I have been doing a bunch of research of these two brands specifically and here is the comparison I've come up with. (For the record, I am referring to the NEW generation quikclot. The old gen was only offered in granule form and got negative response due to a burning effect it caused. The new Gen is heat free)

Quikclot:
offered in
"Sport sponge" (picture a 5" tea bag full of the granules) ($16)
Infused gauze  ($25-30)
To my understanding, the gauze is currently in use by the US military


Celox:
offered in
Granule form ($22-26)
Infused gauze ($30-50)
(multiple variations)


Active ingredient of the Celox is a natural ingredient called chitosan, extracted from shellfish. (One point to emphasize, the company claims they tested the product on people with fish allergies, and had no reaction.)
One Major bonus to me is that the ingredients of Celox are made to be broken down into sugars and absorbed by the body naturally. This means, that if medical attention is not available, then it will heal, and the Celox will not cause any problems. As opposed to the quikclot which I understand (after emailing the company) must be removed before the wound seals. A lot of people choose the gauze format over the granules because they fear that in high wind, helicopter rotors, etc could displace the powder and potentially get into the rescuers eyes (for the record Celox does not indicate any potent effect on eyes, just flush for 5 min).

I had purchased the Quikclot sponge before hand and kept it in my bag. However after further research I think I'm going to replace it with Celox. Although all in all, I think they are both great products. Do any of you have any experience with either of them? if so, What do you prefer or think about them. Any additional info on the subject would be appreciated.

Links to some of the products

Quikclot sponge
http://www.amazon.com/Quikclot-Advanced-Clotting-Bleeding-Package/dp/B001BCNTHC/ref=sr_1_1?ie=UTF8&qid=1427313991&sr=8-1&keywords=quikclot
Quikclot gauze
http://www.amazon.com/QuickClot-Combat-Gauze-Z-Fold/dp/B001E1CLTC/ref=sr_1_5?ie=UTF8&qid=1427314034&sr=8-5&keywords=quikclot
Celox granule
http://www.amazon.com/Celox-V12090-35-Blood-Clotting-Solution/dp/B004NG8V1M/ref=sr_1_2?ie=UTF8&qid=1427313957&sr=8-2&keywords=celox
Celox gauze
http://www.amazon.com/First-Voice-TS-ZR-035-Celox-Package/dp/B00LPICQTE/ref=pd_sim_indust_4?ie=UTF8&refRID=0P827R0DEVCMKZV847SC

They both work (the gauze that is) and they both work well. Use whatever you can get your hands on. I doubt outside of a clinical/experimental setting you would really see much of a difference in real world application.

The worry about the granules blowing into the rescuers eyes was with the old QC granules that would cause an exothermic reaction in the presence of moisture. Hard to stop someones arterial bleed when your own eyeballs are on fire.

that was QC granules, not celox.

Thanks, good catch. I fixed the mistype. Serves me right for not proofreading.

TCCC recommends Combat Gauze, Celox Gauze or Chito Gauze in their guidelines, I would stick with one of these three.

The QuickClot ACS, Sport, First Response (the "sponge") is worthless for the most part. Get rid of it. Here is the USAISR study as to why to get rid of it - USAISR Hemostatic Agent Study Celox Granules did ok in this study, if you want granular agent this is what you should use.

+1 this
TCCC guidelines suggest the impregnated gauze.  Most arterial bleeding will require packing the wound to control it.  Granules can be hard to pack.  One of the pluses of the gauze is that if the wound continues to bleed you can pull it out and reapply as it probably wasn't packed deep enough.

Pick one you like. We have a medical variance to use it on our volunteer ambulance but we have never come across a situation where direct pressure or a TQ has not stopped the bleeding. One of the only situations I can see using it is severe arterial bleeding on the torso or a lib with an injury high enough up there is no room to properly use a TQ.

Our medical director recommends Celox as it will work with patients who are taking anti-coagulants or anti-platelet drugs

I wouldn't be removing any gauze if your packing a wound just continue packing. By removing the gauze from a wound you are pulling out the clot thats developing on the gauze and by removing said gauze you are now starting over from scratch. The granules actually work great in principle and are supposed to be packed into the wound with a dressing behind them.

Funny I actually did a research paper on hemostatic agents in Medic school and the "Burning" reaction from Quickclot isn't actually a chemical reaction but a physical reaction of the powder sucking up the water. If you have time look up the femoral artery/ venous injury otherwise known as the black hawk down injury on youtube they take pigs cut down to the vessels then purposely jagged cut them to recreate it. Quickclot had the highest survivability.

Another interesting tidbit they found studying it use in the field was the lack proper training caused a high failure rate, IE it blowing it around when poured into a wound. So they changed to the impregnated gauze and Pads with it inside. They also changed the "Burning" sensation by impregnated the actual material with water from the factory.

I have no experience with either agent in the field as I have always been able to control wounds with pressure etc. but it's always better to have options then none at all. I personally would use the TCCC guidelines as my guide and become familiar with whatever option you decide.

You would not be following the most current practice then.  The most common error when applying combat gauze is that it not placed deep enough into the wound channel.  For optimal effectiveness the gauze should be packed against the bleeding vessel.  If this doesn't happen, a void can be created allowing the blood to pool and not clot effectively.  If bleeding is not controlled then the combat gauze should be removed and reapplied ensuring that it is placed deeper in the wound channel.
I know this must sound counter intuitive as we have always been taught to not remove dressing after application as this will disturb formed clots.  However, a pool of blood will take much longer to coagulate then a vessel with QC combat gauze applied directly to it.

Awwwh yes I should have read into your comment more and was unaware of new teaching surrounding the quick clot gauze. Thanks for the info it's been a while since I have read any new info pertaining to hemostatic agents as it's not something we carry.

Glad to share the info with you.  When I first heard it at the instructor update, I had the same initial response. What's that saying about old dogs and new tricks? This is a particular tough one as not taking off a dressing after its been applied has been one of those "cardinal rules".

i run and my friend runs, from his recommendation, the Celox Rapid gauze. hes an 18D former FMF HM2 corpsman with 10 years MIL experience and probably 20 overall doing anti piracy and all the lovely shitholes around the world. considers it his top choice for kits, its expensive but the rapid works in roughly 33 seconds

I have heard good things about CR but have yet to use it in the field myself.  I would like to see some real side by side comparisons done.  I know of at least 2 videos that time the packing and extol how CR is better then CG.  In my opinion, the CG wound packers are not working at the same speed as the CR packer.  The other thing to keep in mind is that Celox R is 5ft long where combat gauze is 12ft in length.  

This raises the question, is 12ft needed? Are CR results equal to or greater than CG using the same length of gauze.

I have also seen a study that suggests Celox R causes a faster clotting cascade than CG but I would like to see some more studies done.

Celox Rapid is showing impressive results in some studies. I would expect it to become an accepted gauze as soon as some third party testing is done (USAISR OR NAMRU).  The main benefit (and it is a significant one) is the decreased time pressure must held on the wound ((5 minutes in the case of Combat Gauze).

As far as amount or length, there was a study done a few years ago (I think by NAMRU) with Combat Gauze being the baseline to determine if there was anything better than Combat Gauze. This is the study that got Celox Gauze and Chito Gauze added to TCCC guidelines. The other interesting result was the more gauze or agent you have the better it works. I would have to go back and re read the study to remember exactly why, but it was an interesting result.

5ft vs 12ft is why the third party testing should be done to compare to other products. It is almost apples to oranges with CG vs. CR.

Basically this. There are VERY few applications outside of combat where either will be appropriate treatment unless tq/pressure aren't available.  The above situations being one possible scenario that they would be appropriate, and the other would be if you may be first on scene, with multiple sever bleeding traumas that you are unable to address properly, when backup isn't as close as you would like.

Just keep in mind that a homeostatic is a last resort, and is not a wonder pill to stop any and all moderate to severe bleeding.

I have a few of each around.

Only experience with it's use was with a buddy who had a moderate slice on a finger, who really wanted to try some QC granules.  He tried it, and damn near cried like a little girl from the pain.

Not to mention the permanent scaring and loss of nerve function in his finger now.


I keep both QC granules and celox sheets in my bag. Whatever a TQ doesn't work on, I will use it. Hopefully it'll expire before I have to use it.

As someone who has used tons of combat gauze / QC in real world combat zones I can tell you it doesn't work as well as most think
I would say venous bleeding it works Okay. But will not do much for arterial bleeds

My brother (a LEO) used the Celox Granules on a lady with a GSW to the head (her bf shot her then killed himself) and managed to save her life.  No clue on if she turned out to be a vegetable.  But it did it's job at that moment in time.

.02... My first hand experience with Granular type is that it worked as advertised. Pretty darn quick too.
I had a 5" knife wound at least 3/4" deep. No Doctor for a couple days. That was not good...but the bleeding was under control.
Cleaning that shit out of the wound 3 days later was painful. Third world country issue...The Doc looked at me ..

I'm sure.  But it's still better than dying.

Only if it was actually necessary. People without training AND the experience to put the training in context have a lot of difficulty grasping the real level of severity and appropriate treatment.

In 15 years of EMS the only time I could not stop the bleeding with direct pressure was a mid femur amputation. This usually meant that someone was dedicated to the task but you do what needs to be done and manpower was rarely an issue.

Celox has low risk for complications but QuickClot has the potential to cause damage to any tissue it contacts.

I'm just a Blood Banker who has worked Trauma for most of my career.

I would use a gauze type product for this type of stuff. I've seen a powder used once on a deep wound and it seemed to have made a mess of things. I would like to add that in the civilized world 99% of things can be controlled through pressure and packing.

I removed powders a few years ago from all my kits and utilize gauze products in them now. I think I have a mixture with no real preference.

Only if it was actually necessary. People without training AND the experience to put the training in context have a lot of difficulty grasping the real level of severity and appropriate treatment.

In 15 years of EMS the only time I could not stop the bleeding with direct pressure was a mid femur amputation. This usually meant that someone was dedicated to the task but you do what needs to be done and manpower was rarely an issue.

Celox has low risk for complications but QuickClot has the potential to cause damage to any tissue it contacts.

I have not heard this. Could you provide the source of this info?
Thanks.

OK, I was aware of the heat issue.  I thought you were referring to the newer quick clot.

Can't wait till Verti-gel is released.

It's right in the product info, mechanism of action and has been noted in several papers comparing the it with Celox and Hemcon . QuickClot works with osmotic pressure, pulling water from the surrounding cells in effect killing everything to comes in contact with. Not a big deal if the surrounding tissue is blood but anything like muscle, organs, nervous tissue ect. and it make the problems worse.

In the old days tissue that even looked damaged was excised by the surgeon to prevent the necrotic tissue from complicating recovery, so necrosis from the QuickClot was not a big deal. Over the last decade of trauma care a lot more tissue is left in place because it's been found to recover well and the less tissue removed the better the recovery, so now Quickclot is a problem.    

Does that include Combat Gauze, or just the older iteration?

This is what I was going to point out.
debridement is required with the granules however the impregnated gauze is not an issue.
my .02 cents

We had a big discussion about this in a class recently.

Our instructor, who seems pretty sharp, pushed us toward combat gauze.


Anything in powder form or granules is a no go, for reasons already covered in this thread.

 
I agree. A simple rolled gauze would probably work for packing 99% of wounds.


I would only really use a combat gauze in a BOK, because I might not have access to more gauze for packing.


What do you think?

 
Hell yes. I'll be there after work.


 

Since we are on the subject, I've been thinking about getting a slightly larger BOK, one that can treat both entry and exit. I know the pressure bandages can go around both sides, but I was considering having two wound packing rolls along with the OLAES (wrapper for seal if needed). That should be enough right?