Hemostatic Dressings

[Simusid]

The last post I saw on this subject was http://emtlife.com/showthread.php?t=15188&highlight=hemostatic and was just about a year ago. I'm wondering what if anything has changed in the community.

They are allowed in the MA protocols and I've asked our General Manager to order a small quantity each for our two trucks. Total cost is about $150.

I'd like to know if anyone has firsthand experience with them. I'm sensitive to the fact that it may be difficult/painful to remove from the wound at the ED. I'd like to think that our people are smart enough to use them only when they are called for.

 

[usalsfyre]

Do you have modern tourniquets (CAT, ect) as part of your equipment? Is the early use of tourniquets supported in your standing orders?

There is more evidence behind tourniquet use than there is for hemostatic dressing use. Don't be afraid, if possible tie the bleed off and move on. Anything else (elevation, pressure points, hemostatic dressings) maybe wasting time and blood the patient doesn't have.

 

[ZombieEMT]

Hemostatic Dressings were covered in my training class, but like my instructor said, they are not used much in the field and not used at all by many agencies.

 

[Phlipper]

There is more evidence behind tourniquet use than there is for hemostatic dressing use. Don't be afraid, if possible tie the bleed off and move on. Anything else (elevation, pressure points, hemostatic dressings) maybe wasting time and blood the patient doesn't have.

For an extremity, I get that. Makes sense to me. But what about bleeds in areas where direct pressure and elevation isn't possible (torso?) or an injury in which a severe bleed is occurring and tying it off isn't working (femoral artery?)? Would it then become a question of 'How far away is the hospital?" or some other calculus?

I have spoken with a few guys back from the sandbox who swear by Celox and QuikClot, including correspondence with one young man who was very happy to get a dose of the old QuikClot powder, burns and all. He attributes his survival to it. So I carry a couple of the sponges and a pack of gauze in my range bag. I'd use it in a heartbeat for a GSW to the torso or an artery that wasn't clotting if we were out in the boonies. But for a municipal BLS/ALS service with hospitals nearby I'm not sure I understand everything that should be considered before using hemostatics. I'd imagine the need to use hemos from a truck would be pretty rare, would it not?

 

[TransportJockey]

Why wouldn't direct pressure be possible on a torso? Just wondering.

 

[Phlipper]

Why wouldn't direct pressure be possible on a torso? Just wondering.

I meant to write "when tying off isn't possible" in response to

There is more evidence behind tourniquet use than there is for hemostatic dressing use

Of course direct pressure is possible.

For a thru-and-thru liver/portal circ., abdominal evisceration w/obvious gastric artery bleed, etc. you can't put a tourniquet on it. And it seems to me, and I have been told by those who've done lots of it, that being able quickly pack these kinds of torso injuries with hemo gauze is a godsend.

That's why I carry it in my shooters bag and why I sought out training from guys who've used it in the Sandbox.