Combat Gauze / Quick Clot

[sargeek]

Can someone please point me in the direction of official protocols for using Quick Clot or Combat Gauze! I would also like to hear about personal experiences with these products.

What are the official indications to use it (beyond bleeding a lot)?

What are the contra-indications for the product?

Any problems with allergic reactions or side effects that a user needs to be aware of?

Any other things to be aware of?

I believe that in the Denver Metro Area, it has not been approved for use by line medics (fire and ambulance), so use would need to be in a “wilderness setting.” However, it seems widely accepted in the military community.

[weezerbot]

I am EMT-B certified and we were told, many many times in training about the dangers of using quick clot...it should only be used as a last resort when you cannot possibly stop the bleeding any other way. Most of the time once used, it has to be surgically removed from the patient and usually causes more harm than good.

I've removed it from all of my emergency kits, personally.

[1leglance]

I am very sure you will get more post on this so I will just start with my thoughts...
I used to think like Hiedi-weezer above and have no combat gauze or quick clot in my kits...
however after some recent threads here I have done more research and reading and I am starting to rethink my position.

First let me say NO POWDER, that is what was having the troubles in wind & wounds.
Second all the talk about surgical removal was second hand...when I started asking ER/Trauma and Military surgeons for first hand reports there was nothing negative I could find.

So my current position is that I still like direct pressure with lots of Kerlex (rolled gauze) but I am going to consider adding Combat gauze or Quickclot gauze to my kits after I take the Remote Medical Institutes recert for my W-EMT...I am a ICU RN as my paying job.

[dzzz]

Feeling uncertain I went with the Israeli pressure bandages. In another thread people were talking about pressure bandages treated with quick clot perhaps being a better solution.
My first aid training predates quick clot. I would really like to know how to use all the newer products.
Take a look at what SunTzuNephew has said about these products. He's an ER doc I think.

[baca327]

They way we are trained on Combat Gauze is to stuff the and apply directly to the ruptured artery. The Quick clot is used directly on the rupture to cauterize the wound. Any liquid will active weather it be blood on your hands, sweat, blown in to mouth, eyes, etc. could have bad results. It also must be surgically removed. So using in the wrong app may cause more damage than good. Here is a video of [ame="http://www.youtube.com/watch?v=DC1F08TtBG4"]Quick Clot[/ame] in use. Remember that is in a hospital setting no wind, no rain...

[sargeek]

Their seems to be a lot of urban legends regarding the stuff, that's why I would like to see some official protocals that has the indications and contra-indications for use.

The video was pretty darn impressive.

At this point, I would stock the items in my bag and use it in "wilderness setting" when all else fails.

Thanks for the help and lets see where this goes.

[sargeek]

OK found these links:

Affinity Medical Center
http://www.affinitymedicalcenter.com..._Protocols.pdf

I will ask on the NREMT LinkedIn Group and see what turns up.

[SunTzuNephew]

The quick clot powder (the one that had the rumors flying) isn't made any more. Other forms of quick clot products are gauze based, like impregnated sponges or roller bandages. The powder was improved with gauze carriers because in a windy environment it would blow around as you were trying to get it into a wound, and because pouring it relied on gravity you could only use it on patients in the right orientation - which made it hard to impossible to treat patients still entrapped.

I've used, and seen used, QC powder, in combat. I've talked to surgeons who treated wounded soldiers following use of QC, and I've read the professional medical literature on QC products, including the powder. My hospital now has the version for use on patients with bleeding disorders who bleed from angiocaths and the like - used like tegaderm over the caths, too.

AFAIK, there are no confirmed reports of any untoward results (burning, etc) from using the powder. The military did look for them, especially since the Army had a lot invested (pride, and lots of $$$$ for development) in the Hemcon bandages (which have since been pulled) and the other services decided on QC instead. Stories about surgeons having to remove it? So? Thats what they're doing in there - GSW or blast injuries have to be cleaned out (debrided) from all sorts of stuff. An ounce of a sterile powder isn't going to make much difference in the washout.

Because of the stories, the Uniformed Services University of Health Sciences did a controlled study of QC powder, to see if it 'burned' live tissue. The finding was no.

The way the QC material (zeolite, a mineral form of aluminosilicates) works is by adsorbing the water molecules in blood (from plasma), locally concentrating the clotting factors in blood - letting them work better. It doesn't 'cauterize' anything. The pores in the mineral are kind of like goretex: small enough to let water in, too small for any larger molecules. The adsorption reaction is slightly exothermic (heat generating) but not to any significant degree; and when the alternative is exsanguination would not be a major issue anyway.

The use of QC products is simple: For heavy, usually arterial bleeding (bright red, spurting, etc) where other forms of hemostasis (direct pressure, etc) are failing, or (say) a tourniquet is impractical (groin, abdomen, thorax, head/neck injuries) plug the hole with a QC product to get the stuff in there. Put a regular bandage (4x4, kerlix, whatever) over the QC product. Put a pressure dressing on top of all that, tight. Use an ACE or similar elastic bandage if possible to tighten it some more (not on neck, obviously). Call for transport to higher levels of care ASAP. www.zmedica.com has training available for their products, if anyone wants to avail themselves.

There is another, similar product in use in the military: Celox. They (celox) also make an impregnated gauze product, and a powder-like material with an applicator to get it into the wound. Use of the gauze products are similar to that of QC, the powder-like product is 'squirted' into the wounds. It works somewhat differently, it's based on chitosan, a polysachharide that is naturally metabolized by the body, and forms a gel that assists clotting. I've not used it but have talked to physicians in theater who have seen it work: It's about as effective in real life use as QC. I believe the current Army protocol is to use both.

Besides the hemcon bandages, there are a few other products that were approved for use and then removed when they were found to be dangerous. One product was found in several cases to transport itself through the bloodstream and cause thrombosis (clots) in vessels where you're rather not have them - the brain, lungs, heart.

FWIW, I carry QC products (which I buy). I think they're worthwhile for the types of injuries that they are intended for. They're not for every little boo-boo, of course. Fortunately, I haven't needed to use them outside of the military, and I have more leeway in using whatever I want than an EMT or first aider does. But, I think I'd use them if available, no matter what.