For part 1 of this series, click here.
One of the most important skills for the family medic to master is the ability to rapidly stop bleeding (also known as “achieving hemostasis”). In survival scenarios, bleeding can occur from various sources: anything from a fall on uneven terrain to a hostile encounter with another group.
NON-PLANT BLOOD CLOTTERS
Last time, we discussed some plant-based options that, along with direct pressure, might help control bleeding. While a number of plants are reputed to have hemostatic properties, you might be surprised to know that the two main products used in the expensive commercial blood-clotters are actually 1) a type of fine clay and 2) the shells of shrimp and other crustaceans.
Kaolin clay is the main ingredient in the popular commercial hemostatic agent QuikClot. Kaolin was once the main ingredient in the anti-diarrheal drug Kaopectate (it’s now Bismuth Subsalicylate, the same ingredient used in Pepto-Bismol). Contact between kaolin and blood immediately initiates the clotting process by activating Factor XII, a major player in the cascade of events that stops hemorrhage.
Kaolin is commercially available for purchase in powder form. Apply the clay powder directly to a bleeding wound or onto a dressing and then on the injury. Kaolin dressings can be improvised by coating cotton gauze or cloth in kaolin, dipping in water, and allowing to dry. Like the commercial version, firm direct pressure on the area for several minutes is required for full effect.
It should be noted that kaolin does not cause burns when used. This is the reason that QuikClot switched to it years ago after bad experiences with the former main ingredient (known as zeolite).End result using different materials as a template. From left: lap sponge, triangular bandage, gauze roll, bed sheet
Chitosan is a naturally occurring part of the exoskeletons of crustaceans like shrimp. Processed in a way that prevents reactions in those allergic to shellfish, it’s highly effective as a blood-clotting agent and can be found in products like ChitoSam, Celox, and others.
When chitosan products come in contact with blood, they bond with it and form a gel plug which acts as a clot. Unlike kaolin, chitosan doesn’t use up the body’s clotting factors, something beneficial to those who may have a deficiency of these important substances. A victim on a blood thinner like Coumadin will still benefit from chitosan.
Chitosan can be purchased as a powder. Use vinegar to moisten gauze pads and dip both sides into a bowl of the powder just like you would bread a piece of chicken. Use a dehydrator or oven on low heat to make your own hemostatic dressings. Alternatively, freeze and, then, use dry ice in a covered container with holes to achieve a similar effect.
Kaolin clay, animal, or botanical products may be the answer to bleeding control in some cases, but certain other common items have the potential to staunch blood loss. As mentioned in part 1, your results may vary, especially with significant hemorrhage.
Like some astringent plants, applying ice to a wound will constrict small blood vessels. In minor bleeds, ice might allow a clot to form more quickly while reducing swelling. Wrap some ice with a barrier like a clean, dry cloth and place on the wound with pressure to avoid traumatizing skin.
Some antiperspirants contain aluminum chloride, another astringent that might constrict small blood vessels. Aluminum chloride as low as 5 percent concentration exerted a hemostatic effect through a chemical reaction and was deemed effective in a 2015 study. Aluminum sulfate, the ingredient in styptic pencils to treat bleeding from cuts incurred while shaving, is a related product.
For shallow cuts, petroleum jelly may be an option to slow bleeding. You may have been a spectator at a boxing match where the manager treats his fighter’s injuries with it. Apply a layer on a minor bleed with direct pressure. Once the bleeding has stopped, blot the jelly off and clean the wound.
Another improvisation meant to stop bleeding is the “tactical tampon.” There’s a persistent notion that this feminine sanitary product is an excellent addition to your medical kit. There are many, usually second-hand, accounts that these items saved the life of a soldier because a savvy medic made sure to have some on hand.
Despite testimonials to the opposite, I don’t believe this would work. Why not? After all, it might be the right size to plug a bullet hole. When a projectile strikes soft tissue at high speed, however, it creates a channel through which the projectile travels. As a matter of fact, it causes two channels: A permanent one caused by the actual path and a larger, temporary one caused by the energy wave released into the body by the round’s impact. Vessels and organs affected by this secondary shock wave might not be in the direct line of the permanent cavity (and the subsequent tampon placement), but can be damaged and easily bleed.
Bullets traveling at high speeds go deeper into the body than a tampon can reach. Plugging a hole, even one that looks like it could fit a tampon, doesn’t stop the hemorrhage inside. It just pools internally or finds an exit wound. The tampon would just conceal the bleeding, not stop it. Even the most absorbent tampon can only handle about 15 milliliters or so of blood. The rest has to go somewhere. Just because you don’t see a hemorrhage doesn’t mean it isn’t happening. “Successes” in the field were, probably, nightmares for the surgical team after tactical evacuation.
That doesn’t mean a tampon is completely useless from a medical standpoint. A tampon might work to help stop a nosebleed. Of course, it would work for its intended purpose as well.
Are the above improvised strategies as good as having high-tech commercially-made hemostatic dressings? Unfortunately, no. None of these improvisations would have the standardized production process that a commercially-manufactured dressing like QuikClot, Celox, or ChitoSam would. But if the commercial items run out and the options mentioned here are all you have, it could still make the difference between life and death.
As Teddy Roosevelt once said, “Do what you can, with what you have, where you are.”
Joe Alton MD
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