Just got back from a military training course on trauma this weekend. Had lots of good info, but thought I'd distill some of it down for those of you into FAK's.

1. Celox, QuickClot, and the like are being phased out of military stocks. Apparently, in addition to the exothermic issues, there are reports of soldiers dying 1-2 years out from pulmonary emboli, attributed to the product. So, they're using their remaining stock, and using the Israeli bandage and the H-bandage (http://www.galls.com/style.html?assort=general_catalog&style=FA216)

2. Tourniquets are being used in a BIG way in Iraq/Afghanistan. And apparently causing a big percentage drop in fatalities due to exsanguination. So a few of them might be worthwhile, since trends from military medicine eventually trickle into the civilian world. A couple styles are being used, but in a pinch, a belt or a 'kerchief with a stick can do the job. Combat first aid isn't ABC's, it's CAB.

3. If you can get into the course, PreHospital Trauma Life Support would be a worthy use of money. I know a few community colleges offer these types of courses. Some might be open to enrollment of pre-health students only, but maybe one could audit the course. If nothing else, buy the book. Lots of good info. I took the Advanced version, but wouldn't recommend that unless you're real comfortable with your skills (have the PHTLS book from a decade back). It's also a good course cuz it distills lots of basics without having to go through an EMT course (another worth the price course)

4. Burns and compartment syndrome really suck. I'll be adding a few scalpels to my big kit.

Hope some of you get use from this info.

Hi MDinana,
Thanks for sharing!

good information, thanks for posting

Do you have any reference for this? While certain hemostatics (WoundStat) use has been discontinued, hemostatics and specifically hemostatic bandages are still recommended when pressure dressings won't control the bleeding in situations where tourniquets would not be effective or cannot be applied.

I can not attest for what is currently being taught in CLS courses or other military medical classes, but I do know that the most recent set of TCCC Guidelines still recommend the use of CombatGuaze or similar hemostatic dressings. Other military and non-military studies recommend the use of Chitosan based hemostatics like Celox and Hemcon, especially the hemostatic dressings with Chitosan.

I would personally recommend against the use of hemostatic powders simply because they are pain in the arse to use and can cause complications if used incorrectly or when not necessary. Hemostatic bandages are still an outstanding adjunct to bleeding control when other methods don't work.

If there is a study or data supporting the discontinuation of ALL hemostatics, I would be interested in see it.



Tourniquets have even made their way back into civilian EMS. We recently did a mini-study to choose a tourniquet to place into service locally, an article discussing the results of the study should be up on equipped.org soon.

I can't point to any specific source (yet) for the info, other than my instructors - most of whom were Army or AF medics, or Navy corpsmen. We were taking PHTLS, TNCC, or ATLS depending on our provider level, so a higher echelon of care (for the most part) than what the medics are getting. I'll see if I can dredge up some references in the next couple of days on this info.

One thing I realized - there's something called "Combat gauze" still being used by the military that's apparently a QuickClot product with impregnated propriarity anticoagulant. That's still in use/approved. This is probably what you're talking about.

I have yet to see a tourniquet in civvie use, but in all fairness I've been off the streets about 5 years now.

Sometime last year, National Registry changed the "Bleeding, Wounds and Shock" practical skills sheet to include tourniquets for all levels or EMT providers. I would guess that it will take a few years before it trickles into actual widespread use in the field.

Interestingly, while CombatGuaze is a QuickClot product it appears that it uses a different hemostatic agent rather then the older QuickClot formula that produced heat and subsequently caused burns. I have not used it at all, but to quote a medic who has "it is the s#!t, night a day difference compared to the old stuff".

Hemostatics work, loose granules can be a problem when miss used. WoundStat is garbage and should be thrown away, this specific agent HAS been found to travel through the blood stream and cause emboli and was removed from TCCC guideline and military service in 2008/2009.

If there is anything worse than a loose cannon on the decks, it would be a rusty loose cannon..

So, I am a rusty loose cannon, seeking enlightenment...

Years ago, as an EMT primarily doing mountain SAR we treated numerous major wounds doing just fine with direct pressure and pressure points. At no time did we need to resort to a tourniquet. This included one situation involving an amputated arm (bad mistake with a rear rotor).

I recall talking with a fairly new paramedic friend and colleague, about the number of times he had used a tourniquet on the street. Drawing on about three years experience, he said he had never needed to use one.

Now I see a lot of excitement over the new clotting agents. I have no doubt they have value in a battlefield environment, but I, like many of us, am not on a battlefield.

Is it really worth carrying any of the clotting materials in a standard FAK, given that the vast majority of situations can be handled with direct pressure, and, in extremis, with the big T?

I'm in hikermor's boat - always willing to learn new lessons from deployment medicine learned the hard way, but for WFA scenarios we see pretty much the same lesson, direct pressure treats most major bleeding wounds (every one in my less than universal experience). That's not to say a tourniquet can't be applied in other scenarios, but I will be curious to see how or if the tourniquet advice could be applied in scenarios where you are 24 hours from better medical care. Meantime I would have a high level of confidence in stopping bleeding using non-TQ methods.

That said, I still stuck a tourniquet in the trauma bag kept in the car, but in 99% of auto accidents I would not be inclined to apply it.

A tourniquet is like a firearm, you never need one until you need it very badly and you need it RIGHT NOW!

I can think of 5 incidents of the top of my head where I would have used hemostatics if I had them and 3 cases where I had hemostatics and used them very effectively. All but one of those incidents were gunshot wounds. As for tourniquets, what we have been finding is that EMS providers working in an urban or suburban setting underestimate the need applying a tourniquet due to the proximity of hospitals.

It is not uncommon to see trauma patients brought into the ED with stacks of soaked through dressings. Pressure dressings are not always effective. They work for the majority of bleeds we encounter, especially the new dressings like Cinch-Tight, H-Dressing and Israeli dressings but sometimes a "bigger hammer" is needed.

I look at both these adjuncts (tourniquets and hemostatics) as some of the drugs we carry in our drug box... you use them rarely but when your patient needs them there is no replacement. They take up very little space and weigh next to nothing.

I have never thought there was a need for me to have quikclot or similar agents, in large part because of some of the downsides. I had also read a couple places where a number of EMS units had purchased these items and ended up never using them so decided to stop carrying them when they expired. I gather the proper application for them is very, very limited. There is also the issue that my opinion of an appropriate sized FAK is something that will fit in a sandwich sized zip lock bag. Quikclot will fit in such a bag, but not much else will, and I think there are more important things to have in a FAK.

For extremity bleeding issues, I have always felt if direct pressure did not work it is best to transition to the big T. I would give a major spurter about 20 seconds of direct pressure and if I could not stop it that way, it is on to something effective. The important thing IMO is that the guy does not bleed out before someone more competent gets there, or alternately you get the injured party to someone more competent.

I have never felt that I needed a fancy tourniquet either. The chance of me needing one is so low that I am willing to go with a piece of paracord and a pen. I can tie the ends of the paracord together in about five seconds and use a pen or something similar as a windlass to tighten it up. I know it is not ideal but it is better than letting someone, especially me, bleed to death before someone more competent and presumably better equipped is able to help.

I am intrigued somewhat by combat gauze. It appears to be something useful for deep penetrating wounds to the abdomen that you can't put a tourniquet on and direct pressure is pretty tough to apply. But these kind of injuries are very rare so I think I will pass on it for now, although I suppose I could be convinced.

I am not much of a FAK guy. My idea of a FAK starts with a couple of clean hankies (I am only sort of kidding about this). I rarely cover minor wounds with a bandage. They seem to heal faster if left open. I will use a bandage to protect a wound that might otherwise get further damage, or to keep it clean or dry.