From what I've gathered in reading other discussions the use of them should be limited. A good compression bandage may be in order first.


I'm not a doctor and I don't play one on  TV

You asked for it - you got it.


Quick Clot ACS+ or QC First Responder (same product diffrent packaging) - no sig heat production (this was the old orginal products). Made from a synthetic version of an vacanic clay material. Comes in sponge packet in 25, 50 and 100g size. You stuff down in a wound but the wound must be big enough to get it down into or it does no good, it would just sit on the skin being ineffective. Inexpensive

Quick Clot Combat Gauze - use like any other roll gauze. It's a gauze material impregnated with a Kaolin based product. you stuff in down into a wounds. Best thing is you can stuff it down into smaller holes than you can the ACS product. There is no additional training needed if you are trained on how to pack wounds with standard complressed roll or z fold gauze. Inexpensive

Celox - made from Chitosan based product which is derived form a protien found in shellfish (no danger with use if allergic to shellfish). This is a loose granular product available in a couple of diffrent sizes and is also available in a applicator device that looks like of like a large plastic syringe and also as a gauze product. Unlike the QC combat gauze I believe they said this gauze product was actually made of the Celox and not impreganted, but I may not be recalling correctly. I have not actually used the Celox Gauze. Chitosan becomes very sticky once it comes into contact with liquids, like well blood. People seem to either love or hate Celox. These products like many things tend to have loyal followings and it depends a lot upon ones training and what oyu build up confidence in. The down side to the granular product is you need to get this stuff down into a wound and into contact with the damaged vessels. Large wounds you can stuff anything down into them or pour items like celox into the wound but small wounds tend to be the challenge. This is an inexpensive product too.

HemCon- Also made from Chitosan. Comes as a 4x4 pad and a 2x2 pad (most commonly). For blow out type kits the 4x4 pad is the most common. It is a one sided pad so you must get the correct side applied to the wound. It's also somewhat stiff compared to a piece of "regular" gauze sponge or roll gauze product. Application is a little challenging and must be trained on to expect good results. If you continue to handle this product after it gets wet it will stick like no ones business to everything, esp. your hands and gloves. There is also a roll version of HeCon called Chitoflex. Unlike the "regular" HemCon it's two sided and intended to be used as a packing material. It's just as stiff as the pad and difficult to work with and to a degree even more so because as you are trying to stuff a wound with it your covered in blood and now the product is sticking to your gloves. To be honest for all the challenges of this product I like it. This crap once you learn how to use it works great. Also if you are a medical provider in a civilian enviroment this product is FDA approved for bleeding control. None of the other products are so you can't use them in a hospital. This is a plus for the HemCon. Down side is not only application but the cost. HemCon 4x4 costs about $140.00 and a Chitoclex costs about $175.00. So you need training to use it and each one you use to train with costs aobout $140 - see the problem with this one. If you find cheaper HemCon on places like Ebay they are usually some expired product or very short dated product that someone has gotten hold of and is selling for cheap.


Application is similar in principal regarless of what product you use. You must get the product into the wound and against the surface of the bleeder. So when you apply these products you sweep all the blood you can out of the wound and get the hemostatic agent in fast so it gets down to the wound and not sitting on a bunch of blood and loose clots on top of the bleeder. They must get against the end of the vessel or artery that is bleeding. LOTS of pressure must then be applied directly to the would, my saying is "if it ain't hurtin you ain't doing it right". This pressure must be maintained for no less than 5 minutes, but 10 is better. Remembering all this is intended to be done when not under fire, when you have time to do it right. A pressure dressing properly applied can supply all the pressure you want, for as long as it needed. The trick comes when you have wounds to the groin and axilla these are a bigger challenge to put a pressure dressing on, it can be done but it's not as easy as an arm or a leg and takes longer to apply. Hemostatic products that sit on top of a wound do NOTHING AT ALL. They are a waste of time, effort and a patients blood, get them down to the bleeder.  

All these products work on basically the same principal. They help accelerate the bodys own clotting process. The Gauze products also provide a packing material to put direct pressure on the wounds so with these you get a duel purpose. An exception is the HemCon, it will stick so firmly it can actually physically cover the end of a vessel and "plug it", if you can get it into place. This is not easy to do because of the challenges if getting it into a wound and on the ned of a vessel you can not see, but it can be done and I have done it. However this it's still just there until you body can start doing some bleeding control of it's own by forming clots.

None of these items are magic bullets. They are all just tools and are not replacements to tourniquets and pressure dressings, the same things our gransfathers were using in WWII. Ours are just a hell of a lot better. What do I carry. I carry QC Combat Gauze x 2 and a 4x4 HemCon (I also have the Chitoflex close too).
What would I carry if I had to buy these items myself. Likely QC Combat Gauze and probably the 25g QC Sponge. But like I said it ends up being what you are comfortable with and have confidence in.

I only covered these products as they are the most common and either approved or accepted in mainstream TCCC. The actual TCCC guidlines state Combat Gauze only but HemCon is still in the supply pipeline and individual units I have seen get hold of Celox. I got a Ranger Medic buddy who thinks Celox is the bees knees and gets this for all his troops going into harms way as a secondary product to the Combat Gauze. In the civilian Law Enforcement fworld it's most commonly of the above products and of course for the civilian EMS ambulance enviroment or Hospital  Use HemCon is the only FDA approved item.

none of this matters until you get proper training on how to use them

Local Corpsmen said QC Combat Gauze takes 3 Minutes of Direct Pressure on the wound to take full effect.


Anybody know any different?




CXS

 

The companies all say 3 minutes but reality is 5 min. minimum. This applies to QC Gauze or what ever your agent de jour is.

Clotting starts immediatly upon injury to a vessel. Initially a weak clot forms, this is a primary hemostatis (basically platlets start sticking together). Simultaneously a secondary hemostasis is occuring where fibrin strands start strengthening this initial clot. This process normally takes about 15 minutes to start making a good strong clot (assuming your bodies clotting mechanism's read the text book). This is obviously a cliff note version as clotting/coagulation is a whole text book unto itself.
So you are using something to accelearate this, to me in training I'm going to train people to give a min. of 5 minutes and at best I would hope to get 3 minutes out of themwhen the bullets are flying, that's just reality.

Hemostatics are best used in very large wounds that do not allow TQ application and are hard to bandage or bleeding can not be controlled with a pressure dressing and you are most commonly just trying to buy some time for the clotting process to start prior to performing secondary methods to control bleeding such as further wound packing, pelvic wrapping to get some continual pressure in the groin area, ect.

I've seen Combat Gauze work in three minutes on a VERY de-coagulated patient (bled a lot).  But the trick to getting all of these to work is to get them where they need to be, put lots of pressure on it and leave it there for as long as possible.  The urge to look and see if it's working is both retarded and nearly irresistable.  

As for when to use them, as was mentioned they are specifically for the armpit and groin where you can't use a tourniquet.  It can also be used on the face and head, since you can't (or shouldn't) use a tourniquet there either.  The decision process should go like this- if there's heavy, spurting bleeding something needs to be done with either a tourniquet, or if it's up too high in the armpit or groin or on the face or head, then THAT's when you should be reaching for a hemostatic.  

The following is how I learned that plain gauze should be used ("Kerlix is King!"), and of course will work even better if it's hemostatic gauze.
If possible, feel around until you find the source of the bleed and stick a finger or thumb on it.  
Clear out as much of the standing blood as possible with the other hand (often the wound forms a bowl that collects blood that will dilute the agent down below workable levels).  
Wad up about 6 inches of the gauze into what I once heard an 18D refer to as a "powerball"- as dense and tight a ball as you can get with one hand- and jam that ball right on the source of the bleed.  
Then without letting up continue to pack the rest of the gauze on and around the original ball.  
Kneel on top of it and stay there for at least five minutes.  

I'd be interested to see how the Celox gauze works.  The original Celox worked better than both the ACS+ and HemCon, at least according to both Army's Institute of Surgical Research and the Naval Medical Research Center, who both did independent live tissue testing and came up with nearly identical conclusions.  I was at the TCCC Committee meeting when they presented their findings and the decision was made to go with Combat Gauze.  Celox saved 6/10 animals, Combat Gauze saved 9/10, and ACS+ and HemCon were both at 4/10 or something really awful like that.  We had boxes of ACS+ that I personally cut up and threw away, because those findings match my experience using it.  I have zero faith in ACS+ or HemCon for anything other than superficial bleeding.

True but he's an Air Force firefighter and may need too.

I know it's the air force but they should be training him on how to use these before he's authorized to even have them in his possession while on duty. I'm not trying to be an ass it's just that there's alot that can go wrong with traumatic wounds and inexperienced people trying to make up for lack of training with high speed medical gear.

I see.  They do train us.  However, it's only been with Quick Clot.  Not the other agents.  I spkoe to soon and I think he's asking for his IFAK kit or something.

Thanks for the great summary!  My HemCon is about to outdate in the zombie STOMP aid bag, and I need to look into a replacement.  FWIW, I haven't actually even kept any clot promoters in the smaller trauma bags - just the big hernia-maker bag.