Major Blood Loss and the Traumatic Patient
Vol 21 No 4
Ever lose one to catastrophic bleeding? Ever have a bleeder that, no matter what you did, no matter how hard you tried, you just could not stop the major exsanguination that was going on? Even with the best of skills, the best of the direct pressure, elevation, pressure points, etc. that we utilize sometimes the effort is so time consuming, while we may be successful in stopping the bleeding (I have never failed for external bleeds, and I have had my hands deep into wounds, searching for that illusive spurter) the time and effort is often devastating to the patient even though we are triumphant none the less. Running helps, but even with rapid transport if you don't stop the bleeding, they die. IV fluid is only a stop gap, everyone knows that, it's the oxygen carrying red blood cells that are the key to survival and without those all is lost! Hell, they will start to bleed back IV fluid, and that's a waste of time. That's not to say IV fluid does not have its place, it does, but time should never be wasted on the scene starting IVs, but I know, I know, I'm preaching to the choir now. We all know to move it and not play around on the scene when it comes to traumatic patients!
In the early days of EMS, yes I know, I'm dating myself again because I was there, we took a lot of the skills and techniques that were applied on the battlefields in Korea and Vietnam and applied them to the streets of the nations EMS systems. Now military usage and advanced technology are again playing apart in the EMS arena. For several years the military has been using a product that facilitates clotting of open bleeders. Using advanced hemostatic nano-technology (how's that for a mouthful!) it assists in clot formation of severe bleeders much faster than traditional methods alone. Known as Quick-Clot? or Trauma-dex, the product is a technological leap above simple gauze and pressure bandaging. What is does really is very simple from a physiology standpoint. When in direct contact with an open wound, the product acts like a molecular sieve, sifting molecules by size. QuikClot? is designed to adsorb the water molecules from the blood. The larger platelet and clotting factor molecules remain in the wound in a highly concentrated form. This promotes extremely rapid natural clotting and prevents severe blood loss. Furthermore, there is evidence that QuikClot? activates platelets, provides a surface for phospholipid binding and contains proprietary materials that assist in the clotting cascade, a total of four mechanisms of action that result in a strong effective clot. The process represents a new approach to hemostasis, which typically involves adding clotting factors rather than extracting elements to halt bleeding. QuikClot? helps create a stable, powerful clot, which stays firmly in place until it is removed in the emergency or operating room setting.1 That sounds like a lot of scientific jargon, but the realty is simple regarding water absorption and removal coupled with platelet binding to clot formation.
Are there any problems or side effects that the product generates? Well, no, not really. There is some residual heat that is generated from the exothermic reaction with the chemical but that is shown to be less than irrigation alone and considering that the product is biologically and botanically inert there is little chance for an allergic reaction.
The real good news is it may be coming to you! While it has been approved by the FDA since 2001, and the military has been using it in Iraq and Afghanistan since the fighting broke out there, now the Department of Homeland Security's Office of Grants & Training has recently added this 'hemostatic agent' to its 2006 Authorized Equipment List (AEL), qualifying QuikClot? for purchase using grant dollars, subject to each State's administrative agency's approval. That means when you apply for the DHS grants, you can use some of that money specifically for this device.
The product comes in two forms, the original (QuikClot?) is a granular material that is poured directly into the wound. A subsequent formulation and delivery system, QuikClot ACS? (Advanced Clotting Sponge) consists of beads of QuikClot? contained in a porous surgical fabric that allows the activated beads to come into direct contact with blood in a wound. The newer product has numerous features that improve its ease of use in certain settings. It also has the advantage of being able to be given to true 'first responders' such as police officers, security personnel, and even should be considered for lay personnel for inclusion in first-aid kits in areas where real help may not be readily available. This might really save some lives with some catastrophic bleeders that we might have lost otherwise.
OK, now where do we go? Project medical directors first, they are always the best to lead the charge. After all, they are the true heavyweights in the ring and they are the ones who need to go to the state bureaucrats and make them see the light and get the approved equipment lists changed. It really should not be that hard, especially with the DHS AEL having it there, but you know how the bureaucratic weenies can be. Then put it on the rigs. You may not have to go through all that trouble, especially with some of the legwork that's been done by the DHS, the FDA and the other upper echelon tiers. For all you know, it may be a listed item, and you don't even know it because the information has not trickled down the pipe yet. Find out.
You know I'm not big on waving flags about products in my column and I'm not one to write about products to sell advertising space, ever. I also will not take comments from vendors regarding their products, and the opinions are always my own and my editor has the right to print them or not. I will also tell you my editor has never chosen to temper my comments about a product even when my comments were less than favorable. That being said, I will tell you this one is a winner and one that is long in coming and should save a bunch of lives! Now where is that synthetic blood they have been promising? o
1. Z-Medica, 4 Fairfield Boulevard, Wallingford, CT 06492.