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Given the rise of chitosan-based gauze and the efficacy of the QuikClot family of gauze products, the gain in space savings from these types of gauze(s) over the traditional counterparts like the Israeli or Oales has me thinking about what/why I would still carry something old-school. Why would one still carry an old school gauze bandage or kerlix over the modern hemostatic? Is cost the only factor? How much bleeding does the average hemostatic gauze package stop before being overwhelmed? Is there any field studies or side by side comparisons on something like a GSW and the efficacy of a Israeli vs a packet of Quikclot Combat Gauze LE?
This is the video that has kind of started my thinking on this.
Admittedly, trauma medicine isn’t my field so I can’t attest to the evidence base on gauze vs medicated gauze although I’d like to see some abstracts. I have each type in my kits – Quikclot in two, unmedicated gauze in all four.
However, there a variety of wounds one may encounter, abrasions and burns come to mind, for which a hemostatic gauze wouldn’t be beneficial, but a preferably nonadherent dressing would be. Additionally, the majority of lacerations and punctures people fall victim to don’t require wound packing.
I’ve become a fan of H&H compressed gauze and mini compression bandage due to their small size. I’m sure NAR and others have similar products.
I keep pressure dressings because they’re useful in situations where wound packing wouldn’t be necessary. Also, they can keep pressure on packed wounds after you’re done packing.
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I can see a few reason for a compression bandage over or in addition to hemostatic gauze.
– From what I understand, to be effective hemostatic gauze must touch the source of the bleeding which means you must actually be able to see where it is coming from and push the gauze into that spot to make it effective. The pressure from a compression bandage can help stop or at least slow bleeding even if the internal source is not touched.
– A compression bandage covers the wound which will help to keep it clean.
– Compression bandage can be used for wounds other than traumatic bleeds even as an ACE/elastic bandage.I could see potentially carrying both but would not eliminate a compression bandage in favor of only a hemostatic dressing.
The bandage keeps pressure on the packed wound once you’re done. It works on all the types of wounds that don’t require packing. It’s cheap in comparison to hemostatics.
Joe S said: ↑
The bandage keeps pressure on the packed wound once you’re done. It works on all the types of wounds that don’t require packing. It’s cheap in comparison to hemostatics.
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this is true. when using the quick clot combat gause, or similar packing materials ( even the plain old H&H gause) your still required to hold pressure for 5 to 10 minutes to ensure that the hemostatic agent or the clotting can start to take effect. once this is done, a trauma dressing will assist to keep the packing material in place as well as providing proper wound coverage.As others have said, both work well in conjunction with each other.
That said, if I had to choose one, I’d probably go with the trauma bandage because it is more versatile and because it’s so much cheaper, you can carry more for the same price. In a full size trauma kit I run one haemostatic gauze and two or three pressure dressings.
Good answers. To keep it simple, I’d just add that you need to keep in mind the difference between a dressing and a bandage. Israeli and OALES are combination dressings (applied to the wound), and bandages (hold dressings in place). Hemostatic gauze is not a bandage, and doesn’t take the place of one.
I’d also second what maillet282 said about time; An Israeli or OALES is much faster to put on and have it stay than a hemostatic gauze dressing, which you would then have to bandage (with an Ace wrap or similar). I had a situation recently where I needed to get my patient out of Dodge in a hurry, and a TQ and Israeli were very quick to put on. I simply didn’t have the time to fart around with a hemostatic dressing.
I’m no expert, I have received only basic field trauma response training. In the training I attended though, I was instructed if quick clot or it’s variants do not stop the bleeding for some reason, it is to be completely removed and a new one is to be packed into the wound. I was told this was not the case with traditional dressings and they could be packed in on top of one another. If that is correct, I wouldn’t think the advantages were all that much greater. I carry it anyway, along with traditional dressing vs, and a tourniquet. One is none…
huntnow said: ↑
I’m no expert, I have received only basic field trauma response training. In the training I attended though, I was instructed if quick clot or it’s variants do not stop the bleeding for some reason, it is to be completely removed and a new one is to be packed into the wound. I was told this was not the case with traditional dressings and they could be packed in on top of one another. If that is correct, I wouldn’t think the advantages were all that much greater. I carry it anyway, along with traditional dressing vs, and a tourniquet. One is none…
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I was taught to never remove a bandage packed into a penetrating wound until the patient reaches definitive care — but I’m no medical professional.chaosmagnet said: ↑
I was taught to never remove a bandage packed into a penetrating wound until the patient reaches definitive care — but I’m no medical professional.
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That’s what I’ve always been taught as well. But if hemostatic agents are an exception to the rule, I’d like to know about it. I’d be curious to hear the thought process behind it.huntnow said: ↑
I’m no expert, I have received only basic field trauma response training. In the training I attended though, I was instructed if quick clot or it’s variants do not stop the bleeding for some reason, it is to be completely removed and a new one is to be packed into the wound. I was told this was not the case with traditional dressings and they could be packed in on top of one another. If that is correct, I wouldn’t think the advantages were all that much greater. I carry it anyway, along with traditional dressing vs, and a tourniquet. One is none…
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I recently attended a Stop the Bleed course and the guidance was if packing with gauze did not work then tourniquet if in area that could and direct pressure. Nothing was said about removing.The problem with removing is that even though it may not completely stopping the bleeding, it may be partially working and removing it could cause the bleeding that is stopped/slowed to start again full force, which is why I’ve always heard to never remove, just add to.
But I am not a medical professional, so I would be interested in what their training is.
chaosmagnet said: ↑
I was taught to never remove a bandage packed into a penetrating wound until the patient reaches definitive care — but I’m no medical professional.
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When it comes to a hemistatic gauze. Once it’s been exposed to liquid( weather it’s blood or accideltuly dropping it in the mud while packing a wound) it will no longer be effective due to the agent being activated. Combat gauze will require the old packing to be removed and replaced with new stuff. And then a firm 5 minutes of pressure applied to ensure that it’s doing its job. If you have used the entire roll of combat gauze but there is still a larg space you can then substitute to a H&H kerlex style gauze to fill the rest of the hole. The Oales dressing comes with this extra packing material already available with in the bandage itselfSOS24 said: ↑
I recently attended a Stop the Bleed course and the guidance was if packing with gauze did not work then tourniquet if in area that could and direct pressure. Nothing was said about removing.The problem with removing is that even though it may not completely stopping the bleeding, it may be partially working and removing it could cause the bleeding that is stopped/slowed to start again full force, which is why I’ve always heard to never remove, just add to.
But I am not a medical professional, so I would be interested in what their training is.
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I did some looking into it (Like anything on the internet, take my opinion for what you paid for it:D); Removing a Combat Gauze dressing that has not effectively stopped the bleeding is currently being taught to both military medics and civilian paramedics, in at least some courses/ schools. Like maillet282 said, if the substance (kaolin) has been exposed to liquid and is no longer working, removing it and replacing with a new one might help. That said, removing the old one is against the manufacturer’s recommendation on their FAQ list:“More severe and traumatic wounds may require additional dressings. In such cases, multiple QuikClot® devices may be used. However, it is suggested that the first dressing used remains in place while a second is applied over the first. Do not disturb the clot that is forming under the first device. QuikClot® devices are single-use only.”
So apparently, we have to pick whether to follow current trends in medical training, or the manufacturer’s suggestions, which don’t match up.
To further muddy the waters, the quote I posted above from their FAQ page now reads:
“What if the wound bleeds through the QuikClot® device?
More severe and traumatic wounds may require additional dressings. In such cases, multiple QuikClot® devices may be used per the Instructions for Use.”…which is ambiguous. It makes me wonder if they changed the wording to be in line with current trends…
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