The Decision-Making Process for Wound Clotting Agents

Advanced hemostatic (wound clot) dressings and agents have proven to be a critical component of EMS and fire service trauma kits as well as law enforcement officers’ individual first-aid kits. So, selecting the best dressing for your needs is a decision to thoughtfully consider.

The major brands (Celox, QuikClot and HemCon) will all work in a three-minute “hold in place” product model. But rarely do we have the luxury of a three-minute stay and treat environment at active shooter or other mass casualty incidents.  So, product review must be a multifactorial decision.

Hemostatic technology and capabilities have advanced considerably over the past few years. In addition, this is no longer just a pure “clinical data” argument, as the stakes are considerably higher in deployment of these products in the tactical law enforcement environment. While budgets and personal experience are relevant decision-making points, there are a set of key variables to consider.

Despite the rapid increase in acceptance in the tactical law enforcement communities, a standardized, quality decision-making process that focuses on the three key variables of the clinical, tactical and economical aspects hasn’t existed. So, what follows is a non-biased set of standards (benchmarks) to assist you in your decision-making process for these products.

1. Clinical Considerations
Sufficient data now exists to evaluate the performance of wound clot products in the context of survivability and total blood loss.

Most of this data has been performed on products using three-minute “hold” times after dressing application. However, some dressings now dramatically reduce the need for three minutes of post-application compression because they can control active bleeding in seconds rather than minutes.

So, the primary clinical concerns for those in the tactical space are mechanism of action (how it works) and time to hemostasis (how fast it works).

Mechanism of clotting agent action: Stopping the flow of blood is paramount. The faster bleeding is stopped (hemostasis), the less blood is lost and there’s less chance of a patient going into difficult-to-manage or irreversible shock.

Some products rely on or are dependent on the body’s clotting factors and ability to form a stable clot. These are the mineral-based ingredients such as Kaolin (Combat Gauze) and Smectite (WoundStat).

Other wound clot products work independent of the body’s intrinsic clotting pathway. These are the chitosan-based products such as Celox and HemCon’s ChitoGauze.
The bottom line is that relying on the body’s ability to provide the factors necessary to stop bleeding can be problematic in a life or death environment. If an emergency care provider comes across a casualty with diminished clotting capabilities due to hemorrhage and the person is taking aspirin or using blood-thinning prescription medications like warfarin (Coumadin), products dependent on the patient’s body systems will be less effective than those that aren’t.

2. Tactical Considerations
Data from recent mass violence and active shooter events presented in this supplement demonstrate that you don’t have three minutes to hold pressure on wound clotting agents or bandages because these events are high-speed scenarios where seconds–not minutes–matter.

The concept of tactical hemostasis is centered around “hands free–faster.” As stated, although multiple products can stop bleeding in a three-minute model, several wound clot products can stop bleeding faster, thereby freeing up the hands of emergency providers to treat other wounds or treat other casualties. Perhaps more important is the ability to free up the hands of law enforcement officers’ to “fight back” when under fire. So, the products that free up the caregivers’ hands the fastest, can dramatically impact the casualty or rescuer’s safety and security.

3. Economic Considerations
Economic considerations round out the decision-making process. Product cost and shelf life represent a “cost per month” for products that may sit unused in kits and vehicles for extended time periods. The longer the shelf life, the more the savings on restocking expense.

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