No matter what survival scenario you envision, few come without a real risk of major trauma, and with it, bleeding. One of the most important medical supplies to have on hand in times of trouble would be those items that can help you control hemorrhage. In studies of casualties in the recent wars, 50% of those killed in action died of blood loss. 25% died within the first “golden hour” after being wounded. Indeed, with many injuries, a “platinum 5 minutes” may determine life or death.
The battle to prevent deaths from hemorrhage has been waged throughout history. The Egyptians mixed wax, barley, and grease to apply to a bleeding wound. The Chinese and Greeks used herbs like bayberry, stinging nettle, yarrow, and others for the same purpose. Native Americans would apply scrapings from the inside of fresh animal hides mixed with hot sand and downy feathers. These treatments would sometimes save a life, sometimes not.
In modern times, the control of major hemorrhage rightly belongs to the emergency physician, paramedic, trauma surgeon, and other trained medical personnel. Our focus, however, is when you find yourself without access to modern medical care. In these circumstances, you may be the highest medical asset left, and it pays to have some tools that will help you stop bleeding. In a recent article, we discussed one of these tools: tourniquets and their use in survival situations. Today, we’ll discuss compounds produced specifically to produce clotting.
HEMOSTATIC AGENTS
In the last decade or so, there have been advancements in clotting agents (also known as “hemostatic agents”). Knowledge of their appropriate use in an emergency will increase the injured patient’s chance of survival. These products are used in conjunction with direct compression on the bleeding wound. Ideally, a hemostatic agent should:
- Stop a major hemorrhage within two minutes of application
- Be applicable through pools of blood
- Be packaged ready to use
- Simple to use
- Store well for extended periods of time
- Be affordable
- Have little risk of infection or embolism (blood clots that travel to other areas of the body)
Although there are a number of hemostatic agents available on the market for your medical storage, the two most popular are Quikclot and Celox. They are two different substances that are both available in a powder or granule form and a powder-impregnated gauze.
Quikclot originally contained a volcanic mineral known as zeolite, which effectively clotted bleeding wounds but also caused a reaction that burned the patient and, sometimes, the medic. As a result, the main ingredient was replaced with another substance that does not burn when it comes in contact with blood.
The current generation of Quikclot is made from Kaolin, a naturally-occurring mineral that was the original ingredient in Kaopectate. It does not contain animal, human, or botanical components.
Contact between kaolin and blood immediately initiates the clotting process by activating Factor XII, a major player in hemostasis. The powder or impregnated gauze is applied directly to the bleeding vessel along with pressure placed on the wound for several minutes. Quikclot is FDA-approved and widely available; the gauze dressing is easier to deal with than the powder, but can be relatively expensive. Quikclot has a shelf life of 3 years or so, less if the packages are left out in the sun. It’s uncertain exactly what effect the passage of time has on the product.
One negative with Quikclot is that it does not absorb into the body and can be difficult to remove from the wound. The material is known to become hard when left in too long and bleeding may restart when removed. This occurs less often if you use the gauze dressing.
In the The Journal of TRAUMA® Injury, Infection, and Critical Care , (Volume 68, Number 2, February 2010), the kaolin gauze was found to be as safe as standard surgical gauze.
Celox is the other popular hemostatic agent, and it is composed of Chitosan, an organic material taken from purified shrimp shells. Despite this, the manufacturer states that it is safe to use in those allergic to seafood. This product is made up of high surface area flakes. When these tiny flakes come in contact with blood, they bond with it and form a clot that appears as a gel. Like Quikclot, it also comes in impregnated gauze dressings, which are, again, relatively expensive.
Unlike Quikclot, Celox will cause effective clotting even in those on anti-coagulants like Heparin, Warfarin or Coumadin without further depleting clotting factors. Chitosan, being an organic material, is gradually broken down by the body’s natural enzymes into other substances normally found there. Like Quikclot, Celox is FDA-approved. This study by the U.S. government compares Celox favorably to some other hemostatic agents: https://www.ncbi.nlm.nih.gov/pubmed/18211317
Both Quikclot and Celox gauze dressings have been tested by the U.S. and U.K. military and have been put to good use in Iraq and Afghanistan. The US Department of Defense’s Committee on Tactical Combat Casualty Care (CoTCCC) has added CELOX™ Gauze to its guidelines for control of hemorrhage as approved hemostatic agents for military use. The “Rapid” version significantly cuts down the amount of compression time required. Expiration dates are similar to Quikclot.
One additional benefit of Celox gauze is that it serves as a reasonable gel-like burn dressing when moistened with water or saline solution.
To see both Quikclot and Celox in action (warning: graphic in nature):
Although effective, you shouldn’t use these items as a first line of treatment in a bleeding patient. Direct pressure, elevation of a bleeding extremity above the heart, gauze packing and tourniquets should be your strategy here. If these measures fail, however, you have an effective extra step towards stopping that hemorrhage. Be sure to include one or both in your medical supplies.
It’s important to make certain to avoid getting hemostatic powders into a patient’s eyes or airways. Also, removal from the wound is usually recommended no longer than 24 hours after application.
Let’s not forget natural remedies that may help stop mild-moderate bleeding. Certainly, if a disaster has long-standing consequences, the supply of commercial hemostatic agents will diminish, and it’s important to know what plants may provide medicinal benefits.
Cayenne Pepper powder at levels above 35,000 Scoville (heat) Units has a coagulant (clotting) effect, although it may cause a burning sensation. Too much stronger, however, and it can get into the medic’s eyes and cause irritation. Black pepper has also been used in the past to help control hemorrhage. Apply either of these in a good quantity to the bleeding area and apply pressure with a gauze dressing. For major hemorrhage, however, the commercially produced products like Celox or Quikclot are superior.
The medic is most effective when they have the right tools. Accumulate a supply of hemostatic agents now and you’ll succeed, even if everything else fails.
Joe Alton, MD
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