Does combat gauze really expire?

After getting some training, I thought I'd add combat gauze to my kit in the extremely unlikely event that I or someone gets shot at the range. (Don't worry. I go to pretty safe places.) So I went shopping online, and after I got over the sticker shock, I noticed that the shelf life of these $50 packages seems to be three or four years!

With regular gauze I wouldn't worry about an expiration date, but since combat gauze is impregnated with a hemostatic agent, I am wondering whether this is a real expiration date (as opposed to legalese). Maybe the agent gradually decays over time. Does anyone know?

I know there is an old type of combat gauze that comes in rolls, and the newer type that comes in z-folds, is vacuumed sealed, and uses kaolin in the hemostatic agent (which apparently means it generates no heat = good for the users). I wonder whether there is a shelf life difference there, too.

A one-time investment of $50 that's good for the next 20 years, seems worth it. Throwing away $50 every few years, not so much. The risk of a gunshot wound for me is very remote.

Thanks for the help!

If it's remote I'd just get one and leave it at that, but honestly I have no good answer. If nothing else, it's more gauze if it's expired... right?

That being said, get some training. It's not like you put it on like a bandaid and Poof! bleeding stops.

one argument goes as follows: loss of sterility is event related, not time related. If the packaging is intact, the sterility will be preserved forever. As to the performance over time of the clotting agent, I am not entirely sure that clotting agents work when new. Direct pressure on the wound is very effective. Tourniquets are very effective, but tricky. Tying off bleeding vessels with surgical ligature is pretty much perfectly effective, but really really tricky. As MDinana suggests, raising your skill level is more effective than purchasing more fak stuff.

Actually, I did get training using some of the items typically incorporated in a blowout kit. That's what made me consider buying combat gauze in the first place. (I didn't know how expensive it was, otherwise I wouldn't have turned down the free offer of a kit in the course. The instructor had given me some other freebies, and I didn't want to seem greedy.) Sure, the training I got was very basic, and I'm looking to get more training in the future. But I'm not adding things I'm entirely unfamiliar with. Thanks for the advice!

I can't answer your question, but I can definitely commend you for getting training and thinking proactively about being equipped to save a life in the case of a traumatic injury.

Interesting observations. Most of my trauma experience was well before the rise of these various clotting agents, and we handled some very serious situations with plain old gauze and direct pressure.

It would be worth considering the response time to this particular shooting range by someone trained at the paramedic level or equivalent, because sometimes there is just no substitute for a functioning IV.

There is no cell reception at the range, and no landline. If something happens, somebody will have to be able to drive about five or ten minutes before getting reception. The ER is another fifteen minutes. I'm not sure whether the best move in a situation like this is to just go ahead and transport the wounded yourself, or to call and wait for the paramedics to arrive by the side of the road.

I have tried a signal booster at the range, but that wasn't enough.

Interesting situation. You are doing well to plan ahead. I would think it well to send someone down the road to make the 911 call while others begin treatment. The transport decision will depend upon the nature and extent of the injury. Sometimes improvised transport can make the victim worse, but not always.

I would suggest that in the context of an isolated range a decent FAK and training could be critical, so the value of the gauze increases

I'd also suggest that $50 spread over 3-5 years comes in at about 25cents a week? Don't what you shoot or how often, but I suspect the cost of guns and ammo is much higher, so if you look at it in context it might help

And if the range is shared, perhaps it should be a communal FAK?

Just thoughts, feel free to ignore

When I was trained on this, we were taught to weigh distance from the ER, paramedic response time and paramedic capabilities when deciding between MEDEVAC (calling for paramedics to evacuate the wounded) and CASEVAC (evacuating the wounded via any available vehicle).

If the local paramedics are professional, advanced and close by, in your shoes I'd consider either bringing the casualty to them or calling them to respond. If they're volunteers and only have BLS capabilities, or they're another twenty minutes away, I'd almost certainly elect for CASEVAC. One exception might be if the casualty has a spinal injury but is otherwise stable.

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

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.

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.

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.

I'm sure you're right.

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."

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.

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.

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.

That's a well thought out concern, but it looks like CG has that base covered too:

"Two-hundred (200) patients treated with aspirin, clopidogrel, LMWH and warfarin regimens were either treated with QuikClot Interventional (n=100) or standard manual compression (n=100) following catheterization by femoral approach. In the QuikClot Interventional group, hemostasis was achieved in a mean time of 5.4 minutes and all patients ambulated by 4 hours. QuikClot Interventional demonstrated advanced clotting and much earlier ambulation times in comparison to the standard of care (12 hours), especially for patients treated with anticoagulant therapies."

CELOX gauze is a competitor to CG, and I have read that CELOX is effective on patients using bloodthinnners as well.

Ah, interesting. That's a hot off the presses result (2011). I should look up the article some time.

The last time I had looked into this issue was quite some time ago and was back when powder and granules were still the main method of application. The research I saw back then didn't show that they worked well on people on anticoagulants (or else not much research had been done with anticoagulants yet--I forget what the situation was back then).

By the way, I was just looking and it seems that HemCon now sells their chitosan-impregnated trauma bandages to the public, but it looks like you have to indicate that you are expressly buying it for non-military use. (Over at one of my favorite first aid supply websites, there is a checkbox that says "I verify that I am purchasing for Non-Military Use.")

Celox is also another chitosan-based product besides HemCon. The fact that the chitosan-based bandages don't generate heat makes them more attractive to me. If used as directed, the exothermic products should be safe, but that's the problem with a real life emergency--they often don't go "as directed".

Wow, good information there! Who knew it was just the humble clay? (A part of me was like: what!??? Are you kidding me??? DIRT? DIRT?) I remember reading some British novels as a kid. They were unabashedly not very nice in their portrayals of the "natives" that the British Empire conquered. Anyway, I still recall this description about the supposedly ignorant, savage natives using dirt to dress battle wounds. The novel made fun of them, but heck, now we're putting kaolin clay in gauze!

It sounds like the short shelf life (3 years according to the manufacturer) had in mind the rigors of military use. If the main active ingredient is inert, then stored in good condition, combat gauze could last longer than three years. I'm not sure whether I'd take the risk myself, but it's good to know nevertheless.

Duh, I totally missed the fact that QCG now uses kaolin as the coagulating agent, not a zeolite-based agent anymore. (I need to read more carefully!) No wonder QCG performs differently on people taking anticoagulants than what I had read in the past about QuikClot. OK, now that makes more sense to me.

As an aside, the diarrhea medication Kaopectate (and other brands) used to use kaolin clay as their primary ingredient, so many of us have been benefitting from using clay for a long time. Kaolin was phased out of all of those meds back in the 90's IIRC, but most brands retained the "kao" brand names.

Too bad for future archaeologists; might have been a good source of human coprolites. They really were sh**ting bricks!

The Real question should be"Will I expire,If I use old combat gauze?"& my answer would be"As long as it isn't Used combat gauze,You should be just fine!"