DOD was using the sponge, which was packaged in a thin, flat package, for individual first aid kits. I have been issued Celox and a different brand (maybe same company but different packaging). You have to be sure that you remove as much blood and liquid from the site before you place it or it will form a nice barrier over the wound without stopping the bleeding. Just a quick swipe with one hand to wipe off the blood and quickly place the sponge over the wound, preferably right against the bleeder. It is not a magic fix, but I have seen it stop arterial bleeding before.

As an old gaffer who got his training and experience in the pre-Celox era, I find this a most informative thread. Maye it's time to scrape away some of the rust. Keep talking...

Is this the stuff you are talking about (see 2nd picture in this post)?

http://ilbob.blogspot.com/2012/03/walmart-shopping-trip-today.html

It appeared recently in the sporting goods section at my Walmart.

This is a great post.

I am starting to see some folks coming out against clotting agents.

What's up with that. Do they have a valid issue?

Izzy, I'll be checking your blog.

Blake

www.outdoorquest.blogspot.com

There is no reason to not use hemostatics, especially the hemostatic gauze products. As I stated in my previous post, it was a single product "WoundStat" that was causing secondary emboli NOT Celox or QuickClot (although QuickClot has had other issues that have been remedied).

Like Chaosmagnet said, Celox-A is packaged in a syringe designed to be injected into penetrating trauma when pressure and tourniquets are ineffective... It works and there have been no instances of secondary emboli.

Not sure I agree with this approach. If a wound is truly life threatening and the standard methods of hemmorage control (direct pressure, elevation, tourniquets, etc.) are not working, why not use the Celox. If you choose not to use the product based upon the admonishment to “do no harm” and the patient dies, you are not fully utilizing the resources available. The use of Celox in life threatening situations is exactly why the product was created.

Pete

Yes, you do not want it in your eyes, it clots. No permanent damage, you just can't see for a while. You also do not use the clotting sponge by itself. You still need to put a pressure bandage over the top, it makes the pressure bandage much more successful. If you have bleeding that bad, seek professional medical attention as soon as possible, it is not a permanent solution. When you remove the clotting sponge it will likely begin to bleed again. We used them in conjunction with a tourniquet and a pressure bandage, it just increases the chances of success. In fact, the tourniquet is the first thing I am going to slap on if the bleeding is that bad, then the clotting sponge, and then cover it with a pressure bandage. It is not something I am going to use unless it is a life threatening or very dangerous situation. Find some of the new research on tourniquets, they are not a dangerous as used to be taught.

Now that I have a bit more time to type, let me elaborate on a few points.

Hemostaics have been around for a long time, but there is a realitivly short history of there use in the "field" by military and civilian EMS propviders and an even shorter history of there use by laypersons in first aid. However, because of the wars in Iraq, Afganistan and other theaters huge amounts of data have been recorded during that short history allowing quick changes in products and protocols. The United States and the United Kingdom have done a significant amount of research on trauma patient managment during these past 11 years of combat and that research has changed how we treat trauma patients from first contact in the field to the rehab facility post-hospitalization. Permissive hypotension, tourniquets and significant changes for traumatic brain injury patiets join the use of Hemostatics as new ideas that affect the EMS and First Aid relm of trauma patient care. Hemostatics is the most insignificant of that list.

Of all the changes in pre-hospital trauma patient care, hemostatics and tourniquets are uniquely product driven. Hundreds of new tourniquets and dozens of new hemostatics have hit the market since 2003, not all of them were good.  Today there are basically two Hemostatics still on the civilian market, Celox and QuickClot (there are a few others, but these are the common products). While Celox is offered in a number of forms, from loose granule to rolled gauze, QuickClot is only avalibe to civilians in gauze sponges or rolled gauze (although granules are still avalible for "professional" use). 

QuickClot recieved a bad reputation early on due to the original formula causing and exothermic (creating a lot of heat) reaction on contact with fluids. Imagine getting a substance like that in your eye, as a number of Soilders, Marines, Sailors and Airmen did. It was also noted to cause burns to some patients, and was ineffective at low tempatures. Quickclot changed their formula and released the Combat Gauze to remedy this and there have been no reports of QuickClot being anything but safe and effective since these changes.  

The product that has given Hemostatic's reputation the biggest black eye is WoundStat. At one time, WoundStat was the perfered hemostatic (granules) product approved for use by CoTCCC (Commity on Trauma Combat Casulty Care). WoundStat didn't cause the exothermic reaction that QuickClot caused, so it was seen as an improvement.  However, overtime it was noticed that patients who received WoundStat were developing secondary emboli. Initially, this was thought to be do to the granules  migrating from the wound site. Researched reviled what was actually happening was Woundstat caused damage to the blood vessels at the wound site which in turn caused clots and plagues to break free and cause the emboli after WoundStat was used. There are ALOT of anecdotal information about Hemostatic granules being "sucked" into neck wounds and other large vessel bleeds, but nothing that can be verified.

The issues with early QuickClot and WoundStat are what have fueled the "Hemostatics are Unsafe" idea that has become so prevalent on the internet and in the EMS community. While WoundStat is absolutely unsafe and any remaining stock should be trashed, the QuickClot on the market today is completely safe and effective. Sadly a lot of the confusion is caused by under qualified instructors repeating myths and rhetoric. 

So if you have extra money to invest in first aid supplies, hemostatics are a good investment if you already have tourniquets in your kits. Tourniquets are an other topic all together, but simply put they work and are safe. If you don't have some, I highly recommend either CAT, SOF-T or McMillian mechanical tourniquets or Tk4 elastic tourniquets. For hemostatics, my first recommendation is Celox Gauze (roller). This recommendation is based on there being no documented cases of negative side effects with the use of Celox and witnessing it work. I recommend the gauze for three reasons; it is easier to keep in a wound, adds to the packing of the wounds and powders tend to go flying when excitedly opened by an inexperienced person. I would also have no problem with QuickClot gauze in my kit or being used on me... I just prefer Celox. 

As for the use of hemostatics in bleeding control, they should be the last resort in most cases. If you look at the protocols that I posted above, you will see that direct pressure is still the primary method of bleeding control and "consider" hemostatics comes farther down the list. So, from a practical point of view to me that means I am going to only use hemostatics when I don't believe that pressure, tourniquets and packing the wound will be effective. I have never had to use both a tourniquet and hemostatics on the same wound (not to say that there haven't ever been patients that have required both). For most people, the hemostatics in their kits will need to be replaced due to expiration not use.

Nice summary, Alan.

Check your military surplus store in military towns, like here at Ft. Bragg, and you can find the CAT and SOF-T tourniquets. I have been able to find current, unopened trauma kits with the tourniquets for $10-20.