Medical Equipment Facts and Myths (hemostatics, tourniquets, etc.)

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TrailBossTrauma

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I was originally going to reply to a post but felt this was a good opportunity to start a thread to provide some solid info on medical equipment.

So if I may start on the hemostatic (blood clotter) discussion and hopefully provide some clarity. Hemostatic agents such as your quick clot, celox etc, all work by very different mechanisms. All of which are not created equal. The budget constraint thoughts are valid for something you may not use everyday however, please do your research before purchasing.

QuikClot is arguably the most prevalent hemostatic agent available, and with that comes some blind attraction to it. I’m 100% a proponent of it, and have used it many times. With that it has taken a long time to understand the differences in mechanical and chemical means of bleeding control. A wound that requires packing (typically a site that doesn’t work with a tourniquet, base of neck, groin or armpit) are the ones that are best treated by wound packing. The skill of packing far outweighs the piece of kit you carry. Any hemostatic no matter how Gucci will not overcome inadequate technique. Hemostatic agents provide a chemical adjunct to your mechanical “packing of the wound”’ultimately you are trying to pack the wound bowl tightly to compress the vessel that has been interrupted. The chemical piece simply helps to promote the clot once it comes into contact with the interrupted vessel or immediate area around it. QuikClot works by pulling plasma (fluid) into the gauze allowing for better concentration of blood cells and clotting components. It then activates factor 12 on the intrinsic side of the cascade (nerd stuff). Take away from it is it’s not perfect, and WILL NOT work on people that are on anticoagulants.

Celox and some of the other products are a mucoadhesive that work independent of the clotting cascade and will work better on patients that are anticoagulated.

Long and short of it is. If you commit to buying a piece of kit especially medical know how to use it!! Hemostatics are a great tool if you know how it works and how to wound pack.

I guess I’m using this to open a discussion on medical kit and training, and happy to answer any other questions around that topic. My background is in military/austere medicine as well as flight and enroute Care. Hopefully I can help guide some people!
 

MunsterGeo Overland

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Training is everything. If you have it, know how to use it. It's too easy to carry something on the basis that someone else may be able to use it. There may not be someone able to use an item in question and time is wasted...

I think you pretty much said it in this sentence :smiley:

Long and short of it is. If you commit to buying a piece of kit especially medical know how to use it!! Hemostatics are a great tool if you know how it works and how to wound pack.
 
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Specter

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Solid post, and advice. I am a former special ops medic (combat, tactical, remote and wilderness), and have used just about every type of hemostatic agent in the field and during live tissue exercises. I agree your statement - there is a technique to every type of hemostatic agent and control device and practice is necessary to use them effectively.
 

Gary Stevens

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I was originally going to reply to a post but felt this was a good opportunity to start a thread to provide some solid info on medical equipment.

So if I may start on the hemostatic (blood clotter) discussion and hopefully provide some clarity. Hemostatic agents such as your quick clot, celox etc, all work by very different mechanisms. All of which are not created equal. The budget constraint thoughts are valid for something you may not use everyday however, please do your research before purchasing.

QuikClot is arguably the most prevalent hemostatic agent available, and with that comes some blind attraction to it. I’m 100% a proponent of it, and have used it many times. With that it has taken a long time to understand the differences in mechanical and chemical means of bleeding control. A wound that requires packing (typically a site that doesn’t work with a tourniquet, base of neck, groin or armpit) are the ones that are best treated by wound packing. The skill of packing far outweighs the piece of kit you carry. Any hemostatic no matter how Gucci will not overcome inadequate technique. Hemostatic agents provide a chemical adjunct to your mechanical “packing of the wound”’ultimately you are trying to pack the wound bowl tightly to compress the vessel that has been interrupted. The chemical piece simply helps to promote the clot once it comes into contact with the interrupted vessel or immediate area around it. QuikClot works by pulling plasma (fluid) into the gauze allowing for better concentration of blood cells and clotting components. It then activates factor 12 on the intrinsic side of the cascade (nerd stuff). Take away from it is it’s not perfect, and WILL NOT work on people that are on anticoagulants.

Celox and some of the other products are a mucoadhesive that work independent of the clotting cascade and will work better on patients that are anticoagulated.

Long and short of it is. If you commit to buying a piece of kit especially medical know how to use it!! Hemostatics are a great tool if you know how it works and how to wound pack.

I guess I’m using this to open a discussion on medical kit and training, and happy to answer any other questions around that topic. My background is in military/austere medicine as well as flight and enroute Care. Hopefully I can help guide some people!
There have been similar threads about first aid that are interesting. Having been an NPS, California State Parks and MRCA volunteer for 15 years and trained and certified in first response first aid, what is always stressed is...DO NOT do anything that you are not trained for regarding a first aid incident. The subject you are discussing are for those that have the training to implement this, and not the general population of this forum. Not that I am trying to be a hard ass, but this important. No one should go out and buy this stuff without training in its correct use.
 
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RPilk

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Well written!!! this is something I am very preachy about, GET TRAINED!!!

A pile of people, even Paramedics, dont understand the clotting cascade or the effect anticoagulants have on quick clot.... or celox, and when is the appropriate time and place for each.
 

TrailBossTrauma

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Well written!!! this is something I am very preachy about, GET TRAINED!!!

A pile of people, even Paramedics, dont understand the clotting cascade or the effect anticoagulants have on quick clot.... or celox, and when is the appropriate time and place for each.
Agreed!! Blindly picking tools is not a good path forward for medicine. And like some above have said, it’s not the “goal” of this forum (agreed) but allowing access to good and valid information I think sure is. I’m simply dropping some nuggets for people to research on their own or ask questions
 
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TrailBossTrauma

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There have been similar threads about first aid that are interesting. Having been an NPS, California State Parks and MRCA volunteer for 15 years and trained and certified in first response first aid, what is always stressed is...DO NOT do anything that you are not trained for regarding a first aid incident. The subject you are discussing are for those that have the training to implement this, and not the general population of this forum. Not that I am trying to be a hard ass, but this important. No one should go out and buy this stuff without training in its correct use.
I don’t disagree, nor do I think your being a hard ass. I would however counter that the purpose of this forum is to provide valid information for others to learn from, pertinent to overlanding. I think this subject is valid for ANYONE who purchases or carries a first aid kit in their vehicle or on their person. Simply for the fact that knowing exactly what is inside that kit should be appropriately trained on before carrying and if they have questions either on what to purchase or how to train that this is somewhere guidance could be given.
 
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Good start on a great conversation. I see so many people pack a stuffed med bag with hemostatics, air ways, chest seals, and decompression needles with zero training outside of a YouTube video and a bag dump thread from AR15.com.

Consistant training is key.

Skills are perishable.
 

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I carry impregnated gauze and have had to use it before. I cannot stress the importance of training with it enough. Take a foam football and make a hole to the center then put your fingers in it and pull apart a bit till there are various cavities within in. A chicken with skin works well too. Now use some rolled or compressed gauze and see just how much of rolls it takes and how hard It is to get it packed on the wound. Packing is a skill that is perishable and must be practiced every so often. If it’s still bleeding, you pull it out and start over. A tourniquet is by far and away one of the most simplistic tools to keep people from dying from exsanguination.
 

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I have a personal pet peeve. I am diabetic. There is a serious danger out there due to lack of knowledge concerning diabetics. If a diabetic is unconscious, it is most likely due to low blood sugar unless they are having a seizure with the accompanying convulsions and spastic movement. The problem is that the first reaction to finding out a person is diabetic is to search for their kit and dash headlong into wanting to give them a shot. Nine times out of ten, a diabetic with a problem will be due to low blood sugar due to too much insulin. If you give them a shot of insulin to "fix" them, and you will most likely kill them. Call 911 first. If you feel confident, perform a finger stick and measure their level with their equipment. The normal reading range is 80-120 with anything between 60 and 300 being good enough not to cause issues and the problems you are seeing. If the numbers are lower, check their kit and see if they have any emergency sugar/medical equivalent and put it in their mouth. In a pinch, a coke or anything sweet can be used. It just won't react as quickly. The problem comes when the numbers are too high. This is when a shot is required, but the problem is how much to give. Too little and it will have little to no effect, and too much can kill them. Unless there are instructions in the kit, wait for professional help. Because of my condition, the amount I would need will kill 90% of the people, so let the pro's handle it.
 

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One of the best classed I've taken on this was a stop the bleed class. We had a Navy Corpsman give our class and he was awesome. Did it for Team Rubicon and also had RWB group with us. Highly recommended.
 

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So for a kit I would start with having just simple things that you have in your medicine cabinet at home, tylenol, benadryl, ibuprofen, bandages. From there escalate. I suggest a course such as Stop The Bleed and being familiar with tourniquets, creating makeshift ones, and evaluation of effectiveness of the placement. I recently saved a shot police officer on the side of the free way, unfortunately I was on my motorcycle and only had my trauma shears but was able to make some make shift TQs to save his life. I'm Registered Nurse and if your LEO please carry a TQ on your person. Had I not been there a by stander while trying to help placed a tied sweater around the officers leg several inches below the entry wound, along with not being nearly tight enough to be effective to occlude the vessel. Point is there is a lot you can do with a little and it comes down to knowledge.

Graphic Video Warning Blood is visible, not sure if allowed but its for training.


 

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Dailysynchro: I’ve seen that video, YOU ARE A HERO! Absolutely performed under pressure and saved that officer’s life. Well done!
 
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Jim SoG

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While I agree proper training is best and needed, there are those who will be out in a remote area with a kit and may not have the proper training or techniques and they can save a life... and should try if no help can be contacted. That being said there are some great videos here on OB by doc (Pinned to top of forum) and will for sure help get you started, there are a variety of topics covered.

That video is a great example of grace and skill under pressure!

Jim