quick clot vs cello vs celox rapid

[zacbol]

The chitogauze performed better by 8% but somehow QuikClot is better? Because 8% more deaths? Because science? Did I do the math wrong? I know Celox Rapid works twice as fast as Combat gauze from QuikClot.

Fair question. I only pasted the section with the conclusion. Too lazy to format (I'm just pasting from Word so it's going to be hard to read) but here's the rest of my notes from that portion of the class. Basically, there were questions about methodology/validity of the studies for the chitogauze results which is what the '???' was meant to indicate.

o USAISR Model

* Us Army Model

* 6mm laceration in femoral artery

* Free bleeding and agent applied into blood pool

* No more than two applications of agent

* Did the bleeding stop, re bleeding, alive at 180 minutes

* 100% fatal with ‘standard’ gauze treatment

o Combat Gauze

* Kaolin coated 50% rayon, 50% polyester non woven gauze

* The Co TCCC hemostatic agent of choice at this time

* Evidence

* USA ISR Protocol (6mm Fem Artery Punch)

o 20 of 25 applications – pigs survived three hours

o 0 of 25 applications resulted in initial hemostasis

o $40 a roll – 2014 government pricing

* NOT super impressive

* The Israeli Experience in the Gaza Strip

* Only used by paramedics and physicians

* 13 casualties treated with Combat Gauze

* 79% effective in controlling bleeding

* In 3 ineffective cases the site of bleeding wasn’t accessible to the gauze

* Do we KNOW these guys were going to die otherwise? No, not really.

o HemCon Bandage

* Fairly rigid Chitosan dressing forms a mucoadherent physical barrier at the site of injury

* Truly the first hemostatic agent developed

* Standard US Army hemostatic agent from 2003 to 2008

* Multiple animal studies, two clinical human studies suggested efficacy

* Evidence

* USA ISR Protocol (6mm Fem Arty Punch)

o 2 of 41 successful applications – pigs survived three hours

o 6 of 47 applications results in 2 hour survival with 6mm femoral artery laceration

o Abandoned by DoD in 2008

o 4 x 4 cm bandage costs $149

o IT DOESN”T WORK

o QuikClot

* Zeolite is a hard granule that quickly absorbs water from blood to concentrate elements of coagulation at the site of bleeding

* The secondary US Army hemostatic agent from 2003 to 2008, for use if Hemcon failed or wasn’t available

* Unable to control hemostasis in USAISR model - all pigs die repeatedly

* USAISR – No further testing, it doesn’t’ work

o Celox

* USA ISR Protocol (6 mm fem arty punch)

* 6 of 16 applications – pigs survived three hours

* 7 of 16 applications resulted in initial hemostatis

* 19 of 26 additional pigs surived a 6mm arty punch two hours (10/20 celox trauma gauze)

* $23.59 for 35 gram packet, Celox Rapid $40.00 a roll

* Celox Gauge can be used if Combat Gauze is not available

o WoundStat

* Granular blend of smectite mineral and a super absorbent polymer

* Briefly adopted in 2008 but abandoned because of stroke risk

o ChitoGauze

* Chitosan coated rayon polyester blend of non-woven gauge

* USA ISR Protocol

* Worked “as well as Combat Gauze” in 7 pigs

* Two studies to date – 14/20 pigs survived 150 minutes

* $49.52 a roll 4 inch wide, $28.00 if three inch wide

* Some questions about methodology/results

o Hemostatics Summary – 2 or 3 hr survival & 4 or 6mm femoral artery laceration

* Combat Gauze: 46/63 pigs survive

* ChitoGauze: 28/35 pigs survive???

* Celox (all types): 34/52 pigs survive

* HemCon Bandage: 7/51 pigs survive

* QuikClot ACS: Worse than Hemcon

* WoundState: Clots well, destroys arteries

o I’m confused….

* Combat gauze is the TCCC hemostatic dressing of choice. Chitogauze and Celox Gauze may also be used if CG is not available

[Hmac]

I'd bet real money that the OP will save just as many lives from civilian penetrating trauma with celox as he will with Combat gauze.

[zacbol]

I'd bet real money that the OP will save just as many lives from civilian penetrating trauma with celox as he will with Combat gauze.

Well, that's the thing. Mike Shertz, who taught the TCCC class from which I'm pulling these notes, was pretty indifferent to hemostatics in general, saying it won't hurt to have them but in an IFAK constrained by cost or size it'd be one of the first things he'd leave out. Side note, he also doesn't think much about chest seals either, actually thinking them more harmful than helpful since open chest wounds are generally a problem, but in using a chest seal you may *cause* tension pneumothorax.

What I really enjoy is that for any of these topics, he shared extensive info on the available literature. Personally, I find this stuff intrinsically interesting, in many ways more so that all the gun minutiae that people argue about. I just shared because i had the notes handy and figured it might be helpful and/or simply interesting to some, as it was to me.

[Hmac]

Well, that's the thing. Mike Shertz, who taught the TCCC class from which I'm pulling these notes, was pretty indifferent to hemostatics in general, saying it won't hurt to have them but in an IFAK constrained by cost or size it'd be one of the first things he'd leave out. Side note, he also doesn't think much about chest seals either, actually thinking them more harmful than helpful since open chest wounds are generally a problem, but in using a chest seal you may *cause* tension pneumothorax.

What I really enjoy is that for any of these topics, he shared extensive info on the available literature. Personally, I find this stuff intrinsically interesting, in many ways more so that all the gun minutiae that people argue about. I just shared because i had the notes handy and figured it might be helpful and/or simply interesting to some, as it was to me.

I find the general gun forum obsession with outfitting an IFAK in just the right manner to be intrinsically interesting, and frankly, a little silly.

I have no clue who Mike Shertz is, but I certainly do applaud his sense of practicality. I absolutely share his skepticism of hemostatics as well as his opinion on chest seals.

[zacbol]

I find the general gun forum obsession with outfitting an IFAK in just the right manner to be intrinsically interesting, and frankly, a little silly.

I have no clue who Mike Shertz is, but I certainly do applaud his sense of practicality. I absolutely share his skepticism of hemostatics as well as his opinion on chest seals.

Wasn't expecting people to know him, mention his name because I want to properly attribute the content. He's a former 18D, emergency physician, and on the guidelines committee for C-TECC.

In terms of IFAK contents, etc I'm not sure how it's any more or less silly than any of the other discussion that goes on on gun boards. Frankly, I think it's probably *more* likely to be practically used/valuable than 90% of the information discussed, which isn't to say it's a high probability. It's just that the rest is even lower. JMHO.

[Hmac]

In terms of IFAK contents, etc I'm not sure how it's any more or less silly than any of the other discussion that goes on on gun boards.

Absolutely agree with that.

Frankly, I think it's probably *more* likely to be practically used/valuable than 90% of the information discussed, ....

That...not so much.

[tacticaldesire]

That...not so much.

Why the skepticism? I too think that a civvy is far more likely to find a TQ and roll of gauze useful rather than a Glock and two 15 round mags of <insert hotly debated sd round here>. Both are important, but in a practical sense knowing the chances of needing either are fairly low, which is more likely to be used? My vote goes to first aid.

One can argue the usefulness of hemostatics, which is a valid argument. At the least it's another roll of gauze, at worst it is cost prohibitive for most people and can be left out. I think they are more useful in a situation where a medical facility is hours away vs. minutes for some people (i.e some combat situations, outdoor activities etc.) But I do think that in everyday life, most people would find that they use or would need a first aid kit before they needed their CCW.

[Hmac]

Why the skepticism?

Our opinions are shaped by our experiences. If you live in some area where EMS is hours away your experience might be different. In the scheme of things, that's going to be a rare scenario.

In decades as a trauma surgeon I can't think of a single time where A) I've wished that I had an IFAK with me and B) a patient has come into my ED where I've thought "Damn, if only there had been some civilian with an IFAK on the scene...". In the meantime, people on this and other forums will obsess about "what's the best chest seal?" or "what's the best tourniquette?", or "which is better - "Celox or QuikClot?".

Civilians treating penetrating trauma in the field is extraordinarily rare, and yeah, my opinion is that the need for civilians to have something other than a belt and a wad of kleenex is very, very low.

[zacbol]

Our opinions are shaped by our experiences. If you live in some area where EMS is hours away your experience might be different. In the scheme of things, that's going to be a rare scenario.

In decades as a trauma surgeon I can't think of a single time where A) I've wished that I had an IFAK with me and B) a patient has come into my ED where I've thought "Damn, if only there had been some civilian with an IFAK on the scene...". In the meantime, people on this and other forums will obsess about "what's the best chest seal?" or "what's the best tourniquette?", or "which is better - "Celox or QuikClot?".

Civilians treating penetrating trauma in the field is extraordinarily rare, and yeah, my opinion is that the need for civilians to have something other than a belt and a wad of kleenex is very, very low.

Certainly greatly respect your experience and expertise, but in this case your disagreement is pretty fundamental. There are other with similar backgrounds who disagree. I personally see little downside and quite a bit of upside to having basic supplies and some rudimentary training, even if it's unlikely I'll ever need it. It's pretty unlikely I'll ever need the gun I carry either, but I carry one nonetheless. Plus if you *are* around guns regularly, the odds of needing something to treating penetrating trauma go up quite a bit I think--even if still quite low. I'd rather not have to use an improvised solution if it was actually needed.

Absolutely agree that obsessing over details is not much use, but that's the raison d'etre of forums like this, it's rarely the subject/topics are all that important themselves. Basics are usually pretty simple and learning is outside of a forum like this. Most of the most accomplished people I have met/learned from don't even participate on forums, except very minimally. But forums wouldn't exist without unending obsession with irrelevant minutiae. It gives people something to do.

[Hmac]

There are other with similar backgrounds who disagree. I personally see little downside........

I completely agree with both of those points. I also acknowledge that "tactical preparedness" is kind of a hobby unto itself, and I am all in favor of people indulging their hobbies. In this case though, I'd add the caveat "as long as it doesn't hurt somebody". Because...training.