SOS24 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…

Jedi5150 said: ↑
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.
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this is where I learned and I have used combat gauze. and I still carry combat gauze in my IFAK, Front line, and med bag just in case one of my casualties needs it. although I am a Medical Technician and am trained on using it

going to break down your post for my next comment.

Joe S said: ↑
I could not find it just now, but there was a study that found that while there was a difference between hemostatics versus standard gauze, it was not as big as many presume. That tells me that most of the work is done by the pressure of packing. That tells me that if even if the magic powder isn’t working, the cloth still is. If it’s working partially, I want to pack in more gauze, and apply more pressure. I wouldn’t pull out the gauze, potentially removing any clotting, as well as essentially removing ALL pressure on the site, after having potentially caused slightly more trauma from the packing, unless I was in an OR, with extra blood available, and an ER doc looked at me and said, “OK, unpack it”.
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the idea behind removing the old packing material is for 2 reasons. 1 the Kaolin in the combat gauze has already been activated and will no longer be effective with the new bleed. 2 if initially properly packed and the wound has begun to bleed again due to the clot being dislodged from moving the casualty your going to want to regain control of the artery ( or bleeder) with direct pressure then repack while applying direct pressure with the packing material.

Joe S said: ↑
My qualifications in the medical field: none. But I read the papers, and talk to medics and Corpsmen who have done the dirty work in awful conditions. I think a lot of people miss what these discussions are about. If you’re packing a wound, it’s because you have a horrible, potentially lethal penetrating wound. You use your fingers to jam fabric down into the fresh hole just torn into someone’s flesh. It’s not gentle, it’s not pretty and it’s painful. It’s just better than them dying. Then, you probably have to move the patient under far from ideal conditions in a chaotic environment. Because your getting them to a trauma surgeon, who they really need to see. Your job is just to attempt to keep them alive until then. That’s hard enough .
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reading and discussing with medics and corpsmen about how this stuff is used can be a bit of an issue. similar to posts and threads like this where people will read and take it as the exact how to complete a task. ( potentially a delegated medical act where ever your located). if people are really interested on how to properly pack and what’s the best way to do it is that “you” ( Generalising not specifically referencing Joe S) should take an approved and accredited Stop the Bleed course that is COTCCC compliant.

as for myself, this is what I have been taught on what to do regarding massive Haemorrhages that can not be stopped by a TQ also what I have been teaching . I have been using and packing CAT TQ’s, SOF-TW, and Combat Gauze in my Med bag as a medic for close to 10 years ( since I’ve deployed to Afghanistan). again my best advice is for people to take the training if you want to carry and use these specific medical devices.