A Warning Re Quikclot

[rik_uk3]

The problem when you get professionals talking about EMT, is that the conversation ramps up to advanced techniques. Best practice for an experienced professional isnt the same as best practice for a layman. While the kit itself isn't difficult to use, the hard part is knowing when it's right to use it and that isnt just a question of training, it requires experience too. Whether it's CAT keys, intra-osseous devices or haemostatic agents, they are all simple to use and require little skill to apply, but knowing when to use them requires assessment skills that are far outside the remit of the layman and even trained first aiders. It takes years of exposure to real world scenarios to gain the experience for assessments to become instinctive. You cant teach experience and you cant read experience. You only get it by doing it - a lot. It's the inappropriate use of such things as CAT keys and QC that cause problems. They have their place and are useful tools for the experienced technician, but for the inexperienced and untrained - which means most of the people on this forum, they can be and often are just a liability. We should be advocating simple techniques and basic first aid every time.

Another good post Martyn. The problem is people always have to go one step further here. Someone asks "Whats the best jacket, my budget is £100" the replies come in "This ones great only £195, this ones better £350". Same with first aid, starts off simple then along they come.... "I've been a ^&*() for 30 years and in my experience"

When I was nursing I was suture trained but would I do that now? No. When I worked in dialysis I was inserting perhaps 18 lines a day but would I do it now? No. You loose your touch, your feel for somethings when you are not doing it daily so I will keep my kit simple and my techniques basic happier in the knowledge that the likelihood of harming a casualty is reduced.

 

[BoonDoc]

The problem when you get professionals talking about EMT, is that the conversation ramps up to advanced techniques.

Good point. Let's face it. All of the cool-guy stuff that one can carry in their FAK will not be used as much as the plasters and crepe rolls.

It is the basic stuff that really saves a life. CPR is done by just about everyone. It keeps people alive long enough for the cool-guy stuff to arrive.

Most of the injuries that we face in Bushcraft or Hillwalking can be treated with a 16 hour Red Cross or St. John's course.

There are a lot of advanced practitioners who don't focus on the basics because it's "boring". But we practise the basic stuff a lot more than the tourniquets, haemostatics and innerosseous devices.

Find a friend of family member that you can practise the basics on. There should be one hour spent each month putting on the sling and swath, ankle strapping, paper sutures and plasters.

 

[Martyn]

Martyn I think you make some excellent points but you did lump three disparate things together there and some techniques require more training/experience than others. I know it is perfectly possible to teach appropriate use of a tourniquet to the inexperienced as part of a 2 day or longer course and more and more courses do, fortunately now, include this. I think this is an excellent idea and real progress eg the off duty Police officer who saved the passenger on the July 7th tube train by use of a tourniquet.

That's a fair example, but without knowing exactly what injury he was treating, it's difficult to determine the level of assessment he applied. If it's a traumatic amputation for example, it's a bit of a no brainer. But again, how often do we actually have suicide bombers blowing peoples limbs off? The use of tourniquets has fallen in and out of favour on a regular basis. Do you apply and leave it on, do you apply and release etc. What about the application above an arterial bleed - is it really life over limb? Or could the limb be saved by the application of direct pressure, rather than using a tourniquet at all? If you get that wrong, you could either loose the limb unnecessarily, or loose the life when it could have easily been saved.

You see my point? You can teach someone how to put one on a cas in 5 minutes, another few hours to cover the obvious situations, but then there is a gulf of grey in the middle that requires a pretty extensive knowledge, skill and experience base to make a good clinical judgement. It's experience that is hard to acquire, you cant read it, you cant teach it and most people here wont ever get it.

 

[Graveworm]

Tourniquets have fallen in and out of favour partly based on a lack of real information but they are definitley in favour at the moment. I've just uploaded the latest PHTLS advice and findings which has been the advice for over a year here
As always if you haven't been trained then don't do it but if direct pressure doesn't work almost straight away, or it's obvious it wont work (and let's be honest here it doesn't often with arterial bleeds except for very minor ones) then get a tourniquet on before shock sets in, the risks are very very low, also if you are dealing with multiple casualties it's a quick fix that lets you save as many as possible. The limit is now accepted to be 2 hours after which you need to decide whether to loosen or leave it, even then the limb is still not automatically lost, short of necrosis there are basic IV treatments that have saved the limb and patient after 4 hours.

Oh and PS the Police officer was a she.

 

[SI-Den]

couple of bits to add to this 'short' thread ;-)

I'd agree with all thats been said on training / experience, i'm ex RAMC (16 yrs ago!) and to say im rusty on some my skills would be an understatement! so if your not trained & current i'd stick to the basic stuff and do that well.

lastly, I picked up a surplus US army personal medical kit - mostly out of interest, and it does contain QC gauze. The kit also has 'first aid' booklet which i found interesting.

Under traumatic wound treatment it states the following:

1. stop bleeding using conventional methods (direct pressure, elevation, pressure points)

2. wrap with compression bandage, if no compression bandage is available hold pressure with conventional gauze

3. if bleeding is still uncontrolled with conventional methods apply CAT or improvised tourniquet

4. IF bleeding continues after applying tourniquet apply hemostatic gauze (Quick clot)


I listed the above to show that even in a military manual from an issued first aid kit the use of QC is the last method to be used after a tourniquet!!

Den

 

[DocDC]

All the haemostatic (stopping bleeding) products in the world are not magic pixie dust. They are part of a bleeding control "toolbox" in which each technique or product is taken out and used depending on the bleeding problem confronting you at the time.

These techniques consist of:

1. Pressure point control.
2. Direct pressure. Rarely is this done properly though, particularly in arterial bleeding.
3. Packing.
4. Application of an effective pressure dressing.
5. Elevation.
6. Traction (if appropriate to the injury).
7. Splinting.
8. Haemsotatic agents of which the most useful is a gauze type agent; either Combat Gauze (Z Medica) or Celox Gauze. The powders are pretty much obsolete due mainly to the difficulty of using them effectively and they really need 2 people to do the job properly!
9. Tourniquet. Tourniquets are without doubt "IN" if there is an arterial bleed to a limb and you have a commercial arterial tourniquet, and you have been trained to use it properly. There are so many protocols for using this and is a discussion in itself.

All these are part of the "toolbox" and what you select is based on your ability to assess the problem before you, your knowledge and skills and the kit you have available to you at the time.

FLAPS: is a mneumonic carried out in the primary survey when the mechanism of injury suggests there might be a chest injury. Thus:

F = Feel the chest wall for point tenderness.
L = Look at the chest for signs of injury such as open wounds, abrasions, pattern markings from clothing, seat belts etc
A = Check the armpits, because these are often overlooked in the stress of the situation.
P = Percuss the chest, if you have a stethascope or listen for wounds that suck air in and out.
S = Sweep the back for evidence of bleeding, because this is sometimes forgotten and victims bleed out from unidentified wounds on the back.

TWELVE is another mneumonic that helps to identify critical physiology that may be occurring within the chest and neck. It is not done in the first primary survey, but is applied in the secondary survey if any findings or mechanisms of injury suggest thorax involvement. I would say that this is reserved from medical professionals or those trained to interpret the findings.

ABCD is rapidly moving to CABCD where the first C is catastrophic bleeding (arterial bleeding) to arms or legs. This is a rapid check only to reveal or eliminate. If found, then rapid treatment is indicated before Airway is managed. If not then one continues as before with Airway etc. First Person On Scene new manual revision now includes the CABCD protocol. I suspect other courses will follow suit in time.

First aid in the wilderness IS different particularly in a life threatening situation. Pre-hospital care in increasingly evidence based and there is a particular genre specialising in wilderness first aid and medicine. Protocols taught on your regular first aid course may not cut it when the chips are down in the cold and wet and the ambulance in more than an hour away.

 

[Big Stu 12]

Yes right time frame but wast invented for wounds.

ATB
Duncan
from tapatalk phone

Was it not the Vietnam war that it was first used for wound repair by the Yanks...????

 

[DocDC]

QUICK CLOT once introduce to fluid of any kind will generate a heat approximate to that of a boiling kettle of water for approximately 15 seconds. It is made of sand, magnesium and iron. The chemical mix is what generates the heat and the sand aids coagulation of the blood. Once applied correctly the excess granules must be washed clean from the wound to avoid any potential for embolisms.


I am afraid that you are wrong on this point. QC granules are made of zeolite. Zeolite is a material that is found in volcanic material although of course in QC it is synthetically produced. If you look at zeolite under a microscope it resembles one of those plastic golf balls you can use in the house to practice your putting. When granules are introduced into a wound with blood present they raidly adsorb water (plasma) thus hyperconcentrating the clotting factors to produce encourage rapid clot formation. It is this rapid adsorption that causes the heat.

zeolite granules are not present in the Combat Gauze and that works in a different way, but that is another story.

 

[ScoobySnacks]

Martyn, interesting and informative posts there.

Just a point of interest, you were talking about ABCDE and DABCDE.

I was always taught the first, but recently have refreshed and the latter is now current. The way it was explained was, if there is bleeding present, especially arterial bleeding/spurting, you know immediately that the heart is still pumping effectively, and this tends to indicate at least partial blood oxygenation. Exsanguination from a big arterial spurt will cause hypovolemia, so trying to restore/assist breathing will be pointless. No point getting air/oxygen into the blood if there's not enough blood left to push it around the body.

I've never been tempted to carry haemostatics in a first aid kit, even though I do a lot of shooting on the hill. I've just never seen the point. I have sufficient cordage and bandage/gauze to knock up a tourniquet if absolutely necessary, and have been trained in their use, and in civvy street I don't see the advantage of chemical agents to encourage clotting. If I was in the field, and hanging around elevating and squeezing is likely to increase the risk to me, then something that I can apply that stops the bleeding very quickly is what I want, in civvy street that's not a risk, so there is no reason to risk the possible adverse reactions/side effects.

 

[rik_uk3]

Was it not the Vietnam war that it was first used for wound repair by the Yanks...????

"The original cyanoacrylates (the chemical name for the glue) were discovered in 1942 in a search for materials to make clear plastic gun sights for the war, when a team of scientists headed by Harry Wesley Jr stumbled upon a formulation that stuck to everything that it came in contact with.[SUP][1][/SUP] However, cyanoacrylates were quickly rejected by the American researchers precisely because they stuck to everything. In 1951, cyanoacrylates were rediscovered by Eastman Kodak researchers Harry Coover and Fred Joyner, who recognized their true commercial potential, and it was first sold as a commercial product "Eastman #910" (later "Eastman 910") in 1958." Source: blooming wiki so might be carp.

 

[Hawk]

Haven`t been on for ages, sorry.

Forgive me if im repeating something that has already been posted on this thread but its long and haven't read all the posts.

As well as the Military using Celox it is being widely distributed, along with CATs, Specialist dressings and Tranexamic acid to all UK ambulance services. This is in response to potential terrorist attacks. Its great kit but the sort of injuries its meant for explosions and high velocity rounds are extremely rare in normal civilian activities.

unless you swing a lot of axes or chainsaws i wouldn`t worry about it








------------------------------------------------------------------------
Author of; 'Wilderness and Survival Medicine' www.survival-medic.com

 

[Firefly1]

Hi Guy's,
Just thought i'd offer my penny's worth. As an ex forrester and as part of our FAK i always carried celot and paid a fortune for it in mid 90's. My old chainsaw mentor said "Why pay the money for this when a bit of forward planning why not use a clean disposable nappy" as this contains a large amount of super absorbent in a ready made hemostat pad. He knew this when a mate had kickback and the blade kissed his collarbone(wince), if it wasn't for his wifes quick thinking he would of been a gonner.
Just thought that this would make for some rumanating on the mans office.

Firefly1

 

[Graveworm]

This comes up a lot. Nappies and sanitary towels are absorbent and have a semi permeable membrane that is designed to transport fluid into the nappy away from the surface, this is not really good for clotting.

 

[Firefly1]

You read my mind as i forgot to say that i used to put sanitary towels in my bike helmet and it was the best and cheapest form to keep from getting pink eye from sweat.

also let it absorb a little water then put it the freezer for a couple of hours and bingo long lasting cool pack.

Firefly1

 

[mrcharly]

This comes up a lot. Nappies and sanitary towels are absorbent and have a semi permeable membrane that is designed to transport fluid into the nappy away from the surface, this is not really good for clotting.

Would using disposable nappies outside against the wound be good for a pressure pad?

 

[MattB]

Interesting all the acronyms and medical stuff but it kind of comes down to (in my mind at least) if you are not trained to use or do something don't do it!!

There's an awful lot of detailed and useful posting on this thread (from Martyn in particular) but that's what it really boils down to.

I have a FAK with some triangular bandages, a few pads and a field dressing for if things go really wrong - because it's what I know how to use. Sutures may well be useful, but I can't imagine that they would be much use to someone with no idea how to employ them - so I don't carry them.

As many people have alluded to, the chance of finding a wound that is best treated by quickclot is very unlikely when out on the hill/woods/etc (although possible if you're out hunting with firearms) - start with the most likely things to happen, like finding someone who's having a heart attack. If you really want to spend some cash on first aid, go on a course - you'll be far more useful, and knowledge weighs nothing!

 

[worldwanderer]

The use of celox in the military is still very much a last resort kind of thing, direct pressure, pressure bandages and CAT all come before celox being used. In the UK you will rarely in a bushcraft situation need to go above applying pressure bandages, yes there are a few exceptions, there always will be. The use of CAT in the military has become popular as they allow the guys around the casualty to quickly continue the fight and get themselves and the casualty out of the s*** storm that they are in, also the design of the CAT means that there is reduced risk of permanent damage to nervous and vascular tissues. The protocalls for the military focus on injuries far far far more traumatic than you will see on civvy street, so they will be different and theyy wont always be suitable to be transfered to civvy street, I personally wouldn't use celox in civvy street or a CAT come to think of it, as the trauma that they have recieved wouldn't require it.
As for the use of intraosseous lines on adults, i can assure you, you do not ever want to have to put one in, having to put one in in the field is a very last ditch effort to save a life and if you are putting one in in the field you probably dont have enough fluids/ blood to pump into the cas.

As for my own personal views on quikclot, it is a dangerous product as a powder and should not be used, it can cause far more damage than the origonal wound, i know someone who has lost the use of an arm due to the use of quikclot to treat a GSW to the shoulder, the quikclot caused damage to the nerves that supply the arm, the surgeons that treated him were split as to wether or not he would have lost the use of his arm due to the traumatic nature of the wound.

Personally I would say as an average joe walking in the country side, do not do anything to a casualty that you are not trained to do. As an average joe you are trained to apply direct pressure, you are trained to elevate an injured limb and you are trained to call for help.

The views I express are from experience as a recent combat medic but I have very little in the way of civillian training and experience. there are far more experienced people out there such as Martyn and i would defer to him for the civillian side of it all.

 

[Graveworm]

Personally I would say as an average joe walking in the country side, do not do anything to a casualty that you are not trained to do. As an average joe you are trained to apply direct pressure, you are trained to elevate an injured limb and you are trained to call for help.

The views I express are from experience as a recent combat medic but I have very little in the way of civillian training and experience. there are far more experienced people out there such as Martyn and i would defer to him for the civillian side of it all.

Can I ask how recent? The current PHTLS handbook now is pretty clear, for an extremity bleed it is direct pressure, if that doesn't work, can't be used and or is unlikely to work then it's a tourniquet (It has been that way since 2009). Haemostatics are for when you can't use a TQ (But still for extremities). Elevation and indirect pressure are no longer endorsed as there is no evidence they work for haemorrhage control. "Pressure" bandages are great but you don't apply one to stop a severe bleed that a responder applying pressure with their hands on the pad of the dressing or otherwise can't. As an aside, (and like anything not as any kind of advice to deviate from your training ) IO and IV fluids in terms of trauma treatment are really for once you have stopped the bleeding to maintain permissive hypotension.
I am sorry to hear about your friend, just to be clear haemostatics are for when the alternative is bleeding to death, which is why, as always, training is important. That said nerve damage even from the 1st gen stuff (Withdrawn in 2008) was still pretty unlikely as it used to get to a max of about 60 degrees C, which is hot and can burn but is still lower than some the the temperatures used in heat therapy which is used to treat, amongst other things, nerve damage. The current quikclot and celox are not an issue.