On another forum, a company representative of QuikClot wrote up an excellent post concerning the modern use of QuikClot, in order to address some of the common misconceptions of QuikClot. A lot of the information found on the internet is from military personnel who admittedly received only basic instruction in QuikClot's use.
The two most common misconceptions, which I was also taught, include:
1) Surgery is needed after QuikClot is used.
2) QuikClot can only be used on arterial bleeding.
The first version of QuikClot was a granular product which was awkward to apply in
windy environments, could blow into your eyes during application, and could cause burns to the patient or the person applying it. The new version of QuikClot is infused into a gauze which is packed directly into the wound, and does not burn hot enough to cause injury.
This is an interesting and informative read; enough to convince me that QuikClot holds a viable place in my trauma kit.
I originally wrote in to offset any misconceptions about QuikClot, and this last post (while having a bunch of good info) shows that there are still plenty of misconceptions out there regarding the product.
The source of much of the misconceptions and rumors floating around about the QuikClot products come from individuals who were exposed to its use in the military.
When it first came out, the military did not do a good job on training
for it. They literally issued it out to soldiers with instructions to
"pour it into a bleeding wound". This is not the way it should be used
and caused some bad outcomes that could have been avoided. The
ORIGINAL QuikClot was in a granular form and did need to be washed out,
"lavaged" is the medical term, of the wound. However, every wound has
to be cleaned prior to closure anyway so saying that use of QC
"requires surgery" is incorrect and misleading. Furthermore, the
granular form of QC isn't the current standard. Combat Gauze is now
the military approved hemostatic agent. In this product, the hemostatic
agent (Kaolin) is impregnated into the gauze. Once the patient
arrives at the hospital, the Combat Gauze is simply removed from the
wound like standard gauze. In fact, it is likely that the surgeon/ER
doctor won't even know that it is a hemostatic agent unless you tell
him. So, again, saying that the "you need to make sure you local
Hospital knows how to deal with it" isn't entirely accurate. Wound
packing with gauze is common practice in EMS and the hospital already
knows how to remove the gauze and prepare the wound for closure. If
you are using the non-military forms of QuikClot (ACS+) the granules
are contained in a mesh baggie and, like the gauze, are removed from
the wound intact. Furthermore, while there was some confusion when the
product was new, QuikClot has now been on the market over 10 years in
one form or another and doctors in the U.S. are familiar with it.
XXXX is correct that a tourniquet is the preferred immediate treatment for life threatening bleeding from an extremity wound. QuikClot/Combat Gauze is the preferred immediate treatment for a wound not amenable to tourniquet placement (i.e. the
torso, groin, head, etc.). But, AND THIS IS IMPORTANT, the procedure
he describes for replacing the tourniquet is called "converting". This
is when you convert from tourniquet use to a pressure
dressing/hemostatic agent. THIS IS AN ADVANCED SKILL that should be
saved for a skilled provider under special circumstances. Numerous
studies have shown that a tourniquet can be left in place for HOURS
prior to any damage occurring to the limb. On the battlefield, it is
entirely possible that we might get into a situation where delayed
transport could occur and only then would I consider converting from the
tourniquet. In a domestic setting, it is rare if ever that we will be
hours away from the hospital (please, save the theoretical "what if"
responses here). If you are in an operational setting where you are
going to be that far away from definitive care then you should plan to
have some form of trained provider with you.
Blood does not "become toxic" from
tourniquet placement. That is just a misconception that has no basis
in truth. I don't know where that one comes from but I hear it all the
time when I teach. No offense to XXXX intended but I really want that
one to go away because it scares people off of tourniquet use when the
tourniquet could be saving lives. The final consideration on
converting from the tourniquet is this. If you put one on, the wound
was probably bleeding so heavily that it caused you to think a
tourniquet was needed. If so, the last thing you want to do is remove
that tourniquet and possibly cause the bleeding to resume. RAPID
TRANSPORT TO A HOSPITAL IS THE TREATMENT HERE. My mantra is "blood in
the body GOOD, blood out of the body BAD". Simple words to live by
(literally).
"QuikClot is a last resort." Again, not an accurate statement. Using the old product, that was partially true. But remember that the product is designed for LIFE-THREATENING
BLEEDING. At that point, I would stuff goat dung and gravel in the
wound if I thought it would keep my buddy alive. The new products sold
today have zero side effects and can be used on any wound. But, due
to expense, I would advise saving it for when it is needed.
"Celox is better than QuikClot."
Based on what? I am not going to engage in a debate about competitors
products in this forum but I would suggest that you read the medical
studies and decide based on science. You can start by looking at the
U.S. Military Tactical Combat Casualty Care guidelines (TCCC). They
recommend Combat Gauze.
Lastly, XXXX is 100% correct that trauma medicine always advances through armed conflict. Vietnam was what created domestic EMS and QuikClot was developed and used in the first Gulf War. My company specializes in developing cutting-edge
military medical technology and I can tell you that we have numerous
products in development that are a direct result of the current
conflict.
I am just happy to see that domestic law enforcement is starting to embrace the need for basic trauma training and equipment.
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