Hemostatic Agents: Myths, Lies, Facts & Applications

Teaching Hemostatic Agents: Etc. at Paul-E-Palooza 2012

When I stepped up to the plate and offered to teach at the first annual Paul-E-Palooza (Paul Gomez Memorial) Tactical Conference, there were already a passel of medical instructors presenting, and the suggestion was made by one of the organizers, Sherman House, that a block focusing on hemostatic agents would be good.
In the following weeks, I began taking the hemostatic material already standard in our Self Care in the Tactical Environment course and reworking it for a stand-alone block. As this refocusing progressed, I tried to narrow in on what I thought the community needed to learn about these life-saving materials. Immediately, several issues with the community understanding of hemostatic agents emerged. For every knowledgeable comment on a website, forum or blog about hemostatic agents, there were several more displaying gross ignorance, mythological thinking, and in some cases, out and out lies. Discussing this with Ian Wendt of Special Circumstances Inc., we found this to be a shared frustration, and one Ian had been working on trying to correct in his own work. The need was obvious: Any block of instruction, specifically on hemostatic agents, had to be one dealing with and dispelling the monumental amount of bad information which has been propagated about hemostatic agents. Only then could real training on the use of these materials occur. Ian signed on as collaborator and co-instructor, and we got the ball rolling. The result was a block titled Hemostatic Agents: Myths, Lies, Facts and Applications, which we described thusly:
A no-nonsense short-form overview of hemostatic agents, in particular those of interest to pre-hospital emergency care in the Tactical, Outdoors & Adventure communities. This lecture will introduce students to the basics of clotting action in the body, the hemostatic agents relevant to the aforementioned communities, the mechanisms of action of those products, their performance and role in comprehensive trauma kits, and the fundamentals of their application. Along the way, this block will address the known issues with these agents, as well as raise and dispel the many myths and misunderstandings prevalent in both professional and layman end-user communities.

Our intent had been to film the lecture and training block at Paul-E-Palooza 2012, and edit that into a web-friendly lecture and instructional video. Unfortunately, due to technical errors (not being smart enough to turn on the camera properly), we were unable to document that block of instruction. To correct this, we got together again after returning home to New Mexico, and shot a new reel specifically for online distribution.
Continuing our collaboration, the video has been hosted by Special Circumstances Inc. via YouTube, and is embedded on both our sites. Click the Play icon below to watch this presentation.

The following is a list of recommended studies, from which we drew in creating the material presented above. If you have questions or want to get more depth of knowledge, these will be a great place to start:

Comparison of Celox-A, ChitoFlex, WoundStat, and Combat Gauze, etc.  – https://bfelabs.files.wordpress.com/2012/09/j-1553-2712-2011-01036-x.pdf

A New Hemostatic Agent: Initial Life-Saving Experience With Celox (Chitosan) in Cardiothoracic Surgery – https://bfelabs.files.wordpress.com/2012/09/a_new_hemostatic_agent.pdf

Novel Haemostatic Dressings – https://bfelabs.files.wordpress.com/2012/09/a_new_hemostatic_agent.pdf

Experience with Chitosan Hemostatic Dressings in Civillian EMS System – https://bfelabs.files.wordpress.com/2012/09/tccc_brown_chitosan_dressings_j_emerg_med_2009.pdf

A Complication of Intracorporeal Use of Quikclot for Pelvic Hemorrhage – https://bfelabs.files.wordpress.com/2012/09/tccc_plurad_quickclot_for_pelvic_hemorrhage_j_trauma_2009.pdf

Celox (chitosan) for haemostasis in massive traumatic bleeding: experience in Afghanistan –https://bfelabs.files.wordpress.com/2012/09/celox__chitosan__for_haemostasis_in_massive-99858.pdf

Comparative Testing of New Hemostatic Agents in Swine Model – https://bfelabs.files.wordpress.com/2012/09/gettrdoc.pdf

Journal of Prehospital Combat Casualty Care Apr/Jun 2011, containing Evaluation of Topical hemostatic Agents for Combat Wound Treatment – https://bfelabs.files.wordpress.com/2012/09/2011aprjun.pdf

Safety Evaluation of New Hemostatic Agents, Smectite Granules, and Kaolin-Coated Gauze in a Vascular Injury Wound Model in Swine – https://bfelabs.files.wordpress.com/2012/09/hemostatics.pdf

Summary of Hemostatic Agent Studies revised – https://bfelabs.files.wordpress.com/2012/09/hemostatic_agents_cat_.pdf

QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses –https://bfelabs.files.wordpress.com/2012/09/rhee-_jot_april_2008-_quikclot_use_in_trauma_for_hemorrhage_control.pdf

Biomaterials for Hemorrhage Control – https://bfelabs.files.wordpress.com/2012/09/taat10i1p27.pdf

A Case Series Describing Thermal Injury Resulting from Zeolite Use etc. – https://bfelabs.files.wordpress.com/2012/09/a-case-series-describing-thermal-injury-mcmanus-et-al1.pdf

Survey of Current Hemostatic Agents – https://bfelabs.files.wordpress.com/2012/09/05-kheirabadi-survey-of-current-hemostatic-agents.pptx

Comparison of 10 hemostatic dressings in a groin puncture model in swine – https://bfelabs.files.wordpress.com/2012/09/comparison_of_10_hemostatic_dressings1.pdf

Hemostatic effect of a chitosan linear polymer (Celox) in a severe femoral artery bleeding rat model under hypothermia or warfarin therapy – https://bfelabs.files.wordpress.com/2012/09/hemostatic_effect_of_a_chitosan_linear_polymer_420.pdf

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot –https://bfelabs.files.wordpress.com/2012/09/portsmouth_study_-_acad_emer_med.pdf

In a few days, I’ll be following this post up with a longer article on hemostatic agents, that addresses the above material, with more proper citation of scientific sources, as well as getting into even more that we didn’t have time to cover in either our original presentation, or the above video.