Israel trauma drsg.

[Dustdevil]

There were several such products in various forms that worked to varying degrees. Currently in use is the sponge version of QuickClot, which supposedly overcomes several of the functional problems of the powder. Among those problems, washout, wind and rotor blow, and exothermic reaction burns, as well as the ease of cleaning the wound later. We rarely used QuickClot in 06-08, having found more ease and success with the HemCon "shrimp" dressings. The QuickClot sponge was introduced after I left theatre, so I have no first-hand experience with it. However, it seems to be a good combination of the haemostatic properties with the benefits of gauze packing in a much easier to apply form.

The biggest problem I saw with QuickClot and other haemostatics was not the product itself, but the inappropriate application of them under stress. They were often applied to wounds that did not meet the criteria for use in the first place, and were applied hurriedly, without proper preparation. When the results were not what was expected, many of the failures were probably wrongfully attributed to the product itself. Consequently, the manufacturers have to dumb it down and make it idiotproof. Hopefully, they are achieving that.

Edited September 3, 2009 by Dustdevil

[medic82942003]

Thanks dustdevil, if you go to Close Protection UK forum, under medical training- mister piggy, under sedation of course. Gets his arteries cut by doctor. Then they show quick clot powder poured on . From what I gather you

are spot on with your assesment of powder. Many medics over there say use bandages before powder. All advise appreciated.

Regards.

Edited September 4, 2009 by medic82942003

[FireMedic65]

Thanks dust. I seen that miss piggy video, and that's what had me curious. Didn't know about all the complications.

[Doc D]

I am a combat medic in the US Army

The Isreali trauma dressing is more of a nickname. its actual name is ETB(Emergency Trauma Bandage) We use them, they are great for the pressure on the arterial bleeds, but the plastic used to secure and create the pressure of the dressing can break sometimes. Therefore we will use a tournakit to control the bleeding first then we will use the ETB after the wound is dressed and then we will take a tournakit off.

[tskstorm]

I am a combat medic in the US Army

The Isreali trauma dressing is more of a nickname. its actual name is ETB(Emergency Trauma Bandage) We use them, they are great for the pressure on the arterial bleeds, but the plastic used to secure and create the pressure of the dressing can break sometimes. Therefore we will use a tournakit to control the bleeding first then we will use the ETB after the wound is dressed and then we will take a tournakit off.

Are they used often or only with arterial bleeds?

[Doc D]

Are they used often or only with arterial bleeds?

Well thats hard to say. Every combat medic has their own ways. Tournakits are the best and preffered way to control the arterial bleeds in a limb. I guess the etb could be a substitute after packing the wound with kerlix or combat gauze(hemostatic agent). Even if the arterial bleed on a limb is already controlled with a tournakit i will still pack the wound with Kerlix or combat gauze(hemostatic agent) to keept dirt and debree from getting into it. Honestly, i would much rather use an Ace Wrap though, pack it, wrap it up tight with the ace then use like 6 inch medical tape to secure it. Im telling you that plastic knotch for holding the pressure cen break. I dont trust it, and its useless because the higher eschelon of care, in my case the aviation/flight medic is just gonna cut it off and use his own preffered dressing.

[Chief1C]

Goddamn power went out during an electrical storm... three hours ago...

PA is pushing TK and Hemostatic product use now. A lot of new providers think TK use is something that's just being introduced, but it was always taught, just looked down as a thing of the past. I "grew up" in EMS with a lot of really OLD providers, live in a very rural area, and have been trained in Wilderness medical care. I could make a TK out of just about anything that is pliable and can be drawn taut. Before, it would have been, direct pressure till you were out of strength, then a TK as a last resort. In our whole county, we were probably the only units to carry TK's, until about six months ago. However, they were likely from WWII, the old webbing and buckle type. I kept several for kicks. The SOF Tac. TK uses the same design, with a couple additions to make it work better. That's what we carry now. We're to use a hemostatic product, direct pressure. If that fails to work with in a minute, slap on a TK, wait five minutes, loosen the TK, and likely by then, the bleeding should be pretty well stopped. If not, I have some of my own methods that work pretty well. Like a tray of gauze squares, saran wrap, and a roll of elastic wrap. Laugh if you must, but it's worked for me before on a forehead lac. If you really want to get technical, you can "suture" the scalp, in the field, with the patient's hair by tying it together. It works.

I am definitely a tourniquet fan. The new stuff they have on the market is just the bee's knee's. Progressive Medical has a nice selection!

[tskstorm]

Well thats hard to say. Every combat medic has their own ways. Tournakits are the best and preffered way to control the arterial bleeds in a limb. I guess the etb could be a substitute after packing the wound with kerlix or combat gauze(hemostatic agent). Even if the arterial bleed on a limb is already controlled with a tournakit i will still pack the wound with Kerlix or combat gauze(hemostatic agent) to keept dirt and debree from getting into it. Honestly, i would much rather use an Ace Wrap though, pack it, wrap it up tight with the ace then use like 6 inch medical tape to secure it. Im telling you that plastic knotch for holding the pressure cen break. I dont trust it, and its useless because the higher eschelon of care, in my case the aviation/flight medic is just gonna cut it off and use his own preffered dressing.

Okay so its just a preference thing. Thanks.

[Doc D]

Goddamn power went out during an electrical storm... three hours ago...

PA is pushing TK and Hemostatic product use now. A lot of new providers think TK use is something that's just being introduced, but it was always taught, just looked down as a thing of the past. I "grew up" in EMS with a lot of really OLD providers, live in a very rural area, and have been trained in Wilderness medical care. I could make a TK out of just about anything that is pliable and can be drawn taut. Before, it would have been, direct pressure till you were out of strength, then a TK as a last resort. In our whole county, we were probably the only units to carry TK's, until about six months ago. However, they were likely from WWII, the old webbing and buckle type. I kept several for kicks. The SOF Tac. TK uses the same design, with a couple additions to make it work better. That's what we carry now. We're to use a hemostatic product, direct pressure. If that fails to work with in a minute, slap on a TK, wait five minutes, loosen the TK, and likely by then, the bleeding should be pretty well stopped. If not, I have some of my own methods that work pretty well. Like a tray of gauze squares, saran wrap, and a roll of elastic wrap. Laugh if you must, but it's worked for me before on a forehead lac. If you really want to get technical, you can "suture" the scalp, in the field, with the patient's hair by tying it together. It works.

I am definitely a tourniquet fan. The new stuff they have on the market is just the bee's knee's. Progressive Medical has a nice selection!

SOF-T is alright, but we use CAT Tournakits (Combat Application Tournikits). I dont understand why the hell people are so scared of those things. It takes 6 hours for a tournakit to cause tissue damage and 8 to cause nerve damage. Back when i was on the EMT side of my job, before moving to combat medicine they taught us Direct Pressure, Elevate, Push the arteries or something like that. Improvisint tournakits is pretty easy. A belt can be a semi-effective tournakit, but you can make a good tournakit from cravats and a stick, or cravats and tounge depressors.

[chbare]

I dare say that caution with tourniquet application would be the prudent pathway to follow. I would even go so far to say that most injuries can be managed with a pressure dressing. If a tourniquet is needed, so be it; however, it seems many providers treat nearly any wound as a nail that can only be treated with the sledgehammer of a tourniquet. I still think a provider should utilise good judgement rather than treating every seemingly serious injury with the same tool. It's like we have developed a tourniquet euboxia so to speak. This is especially true in the civi setting where we encounter much more blunt trauma cases.

Regarding haemostatic agents, I am absolutely not impressed. If you cannot get the agent to the source of bleeding, you are screwed. If you can reach the source of bleeding, is a haemostatic miracle substance actually required? Had a patient with the "Blackhawk" down injury and haemostatics were completely ineffective. American contractor decided being American meant getting through Afghan police blocks without the typical posturing, discussion, and liberal amounts of *%+# sucking required to grease the wheels of corruption. He was fired upon and took a 7.62*39 through his proximal femur and pelvis. Bloody mess, multiple failed attempts with haemostatics prior to arrival, we arrived and simply packed with pressure and attempted to control while we flew to a military hospital for surgical hemostasis.

Take care,

Chbare.

Edit: spell check cannot tell the difference between homeostasis and haemostasis.

Edited June 1, 2010 by chbare