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#241547 - 02/20/12 07:19 PM Re: Does combat gauze really expire? [Re: Bingley]
Glock-A-Roo Offline
Old Hand

Registered: 04/16/03
Posts: 1076
I have some training on Combat Gauze (CG). A close friend is a MD who has done live tissue training with it.

We were taught that the main enemy of CG is moisture. Kaolin is the main ingredient of the hemostatic embedded in the gauze, and its interaction with the water in blood is a big part of why CG works. If the CG package gets ripped or has pinholes, it can absorb moisture from the air over time which will decrease the effectiveness. Keep the CG package protected inside another poly bag (loose, not vacuumed) or even just a heavy ZipLoc bag to enhance the wrapper's durability.

If your CG package looks beat up and has been riding in your blowout kit for 3 years, you should consider replacing it. But AFAIK it is not going to suddenly be inert the day after the expiry date.

To reiterate others' good advice, training is absolutely key, especially proper wound packing. Note that a good wound pack doesn't have to have CG or any other advanced hemostatic. In fact for many years a Special Forces medic's chief packing tools were big fluffy rolls of Kerlix and ACE bandages. If you had to, you could cut up a shirt or a set of curtains and pack that wound (after gaining initial bleed control as best you can). CG is just a modern adjunct that gives you an edge, but it is an edge worth having IMO.

Useful links:

Israeli military's experience with CG in a real operation

NAEMT TCCC complete curriculum

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#241557 - 02/21/12 12:06 AM Re: Does combat gauze really expire? [Re: Glock-A-Roo]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2208
Loc: Beer&Cheese country
I've used the older "bean bag" style of QC before in live tissue labs. One take-away is that you really need some regular gauze on hand to get out the pooled blood and find the actual bleeder, where the pressure needs to be applied. Trying to follow the pulsation of blood on your forearm just leads to blood being sloshed everywhere.

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#241561 - 02/21/12 03:16 AM Re: Does combat gauze really expire? [Re: Bingley]
Bingley Offline
Veteran

Registered: 02/27/08
Posts: 1580
Yes, I do have regular gauze in my kit! Again, cross my fingers.

I am conscious of the fact that technique matters a lot in stuffing the gauze, and I hardly got practice. This is on my "to learn" list (or maybe "to learn again"), but I need to cover regular first aid before considering the luxury of taking the somewhat costly courses for treating gunshot wounds.

Thanks for all the helpful information from everyone! In truth, shell casing burns (almost a certainty) will be much more likely in my civilian life. Hope things stay that way.

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#241564 - 02/21/12 06:51 AM Re: Does combat gauze really expire? [Re: Bingley]
Bingley Offline
Veteran

Registered: 02/27/08
Posts: 1580
I found a post which claims combat gauze is good for ten years after the expiration date, but I am afraid this is no better than a rumor, especially since the product hasn't been around that long.

http://www.survivalistboards.com/showpost.php?p=3481908&postcount=71

It would be nice if we knew the active ingredients and how long these things last in storage. There's science in here, and I'm sure there is an answer.

I'm sure I'm investing too much time and energy in this. People getting shot on the range accidentally is a very rare occurrence. Driving to the range is probably more dangerous.

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#241566 - 02/21/12 01:49 PM Re: Does combat gauze really expire? [Re: Bingley]
chaosmagnet Offline
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 3842
Loc: USA
Originally Posted By: Bingley
People getting shot on the range accidentally is a very rare occurrence. Driving to the range is probably more dangerous.


I'm sure you're right.

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#241573 - 02/21/12 04:47 PM Re: Does combat gauze really expire? [Re: Bingley]
Glock-A-Roo Offline
Old Hand

Registered: 04/16/03
Posts: 1076
Originally Posted By: Bingley
It would be nice if we knew the active ingredients and how long these things last in storage. There's science in here, and I'm sure there is an answer.


The ingredients of CG and the mechanism of action are not secrets. Kaolin is an inert substance and the chief thing that will ruin the CG dressing is exposure to moisture. This is from the manufacturer's website but it is common knowledge among the tactical medical crowd and there is no mystery.

"3. How are QuikClot dressings different from surgical gauze?

Although QuikClot dressings look like and are as intuitive to use as surgical dressings, they are impregnated with kaolin, an inert mineral that has been known for centuries to initiate the clotting cascade. While surgical gauze and manual pressure more often than not initiate the clotting cascade, this process is sped up in the presence of kaolin.

4. Do QuikClot dressings work on the clotting cascade?

YES. Contact between kaolin and blood immediately initiates the clotting process by activating Factor XII.

This reaction leads to the transformation of Factor XII, Factor XI and prekallikrein to their activated forms

In addition, Factor XII can activate prekallikrein even without kaolin, but kaolin presence markedly enhanced the rate of activation.

The activation of both Factor XI and Factor XII leads to the rest of the coagulation cascade.
"

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#241575 - 02/21/12 05:30 PM Re: Does combat gauze really expire? [Re: Bingley]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: Bingley
It would be nice if we knew the active ingredients and how long these things last in storage. There's science in here, and I'm sure there is an answer.

As others have pointed out, the clotting agent is no secret. Actually, my biggest concern about long term storage for a product like QCG is along the lines of what Glock-A-Roo already pointed out--less concern about the stability of the clotting agent, but whether the packaging can keep moisture out long term, especially when jostled and rubbed around in some FAK.

Just the other day, I opened a can of my favorite electrolyte drink and I knew this particular plastic tub had been sitting on the shelf for about two years. There's a foil seal and a dessicant pack inside the powder, but I was a bit disappointed to find the powder was rather clumpy from absorbing moisture. I don't think the amount of moisture affected the drink at all, but just disappointed that obviously moisture had gotten inside. It may be an anomaly, I don't know, but I'm pretty sure that simply sitting around for a while contributed to this result. If I had used it earlier, I have a feeling that it wouldn't have absorbed as much moisture. Now, perhaps a product designed for hard, military use is much better packaged, in which case maybe moisture seeping in is much less of an issue, but Glock-A-Roo's suggestion about storing the QCG inside another bag and let that take the abuse seems to be a prudent one, especially if you want to keep that QCG around a long time.

And I'll just throw this out since it hasn't come up yet, but if you or someone you regularly go to the range with is on some blood thinner (especially something prescription strength) then a clotting agent like kaolin may not help much. Something that doesn't rely on your body's natural clotting factors, for example, something that uses chitosan, may be more appropriate if you really, really want something with a clotting agent. I haven't checked Hemcon in ages, but they may have something out now like QCG that civilians can purchase. They used to only sell band-aids with chitosan to civilians at one point.

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#241577 - 02/21/12 06:25 PM Re: Does combat gauze really expire? [Re: Arney]
chaosmagnet Offline
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 3842
Loc: USA
Originally Posted By: Arney
And I'll just throw this out since it hasn't come up yet, but if you or someone you regularly go to the range with is on some blood thinner (especially something prescription strength) then a clotting agent like kaolin may not help much. Something that doesn't rely on clotting factors, for example, something that uses chitosan, may be more appropriate if you really, really want something with a clotting agent. I haven't checked Hemcon in ages, but they may have something out now like QCG that civilians can purchase. They used to only sell band-aids with chitosan to civilians at one point.


Thank you, I didn't know this. There are a lot of older guys in the leagues where I'm an RSO. I won't try to dig in to anyone's medical history at the range, but I'll remember to buy ChitoGauze in the future.

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#241583 - 02/21/12 08:18 PM Re: Does combat gauze really expire? [Re: Arney]
Glock-A-Roo Offline
Old Hand

Registered: 04/16/03
Posts: 1076
Originally Posted By: Arney
Just the other day, I opened a can of my favorite electrolyte drink and I knew this particular plastic tub had been sitting on the shelf for about two years. There's a foil seal and a dessicant pack inside the powder, but I was a bit disappointed to find the powder was rather clumpy from absorbing moisture. I don't think the amount of moisture affected the drink at all, but just disappointed that obviously moisture had gotten inside. It may be an anomaly, I don't know, but I'm pretty sure that simply sitting around for a while contributed to this result.


I've had this happen with VitaLyte (the artist formerly known as GookinAid) that was stored in my car kit. I thought the sugar had gummed up from the heat, but maybe not. Was your drink powder stored near any heat?

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#241584 - 02/21/12 08:28 PM Re: Does combat gauze really expire? [Re: Glock-A-Roo]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: Glock-A-Roo
I've had this happen with VitaLyte (the artist formerly known as GookinAid) that was stored in my car kit. I thought the sugar had gummed up from the heat, but maybe not. Was your drink powder stored near any heat?

Yes! It was a 1 kilo jar of Vitalyte that I've had for a couple years. But it was stored in a cool, dry cupboard this whole time so I don't think heat was an issue. I also opened a quart envelope of Vitalyte powder that was bought at the same time and stored in the same place and it was fine, so I can only assume that something went wrong with the factory seal on the kilo jar. Therefore the clumping seemed like a moisture issue to me.

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