CCJA Med Training AAR (note this was a free class for Alumni)

[chuckman]

If the military is capable of making procurement decisions based on flawed conclusions when it comes to weaponry, it's certainly capable of the same it comes to medical gear. I've actually seen that happen first hand as you get whiplash when things move into and out of inventory. Don't even get me started on vaccinations.

I know we have had some words, but dude, that is some Grade A, Mark 1 Mod 0 no-BS comment there. Concur a million percent.

[DCJS Instructor]

John,

I'm not sure I get you....you said: "You're passing off questionable information and instead of answering questions directly you simply got defensive."

So I show you where the info came from.....then you say:
"The directive doesn't indicate what those studies are nor does it offer any information that allows one to gauge the risk involved"

Bro no offense but I think I 'm going to go with what the guys in Tampa & Joint Special Operations Medical Training Center (JSOMTC) tell me.

We will have to agree to disagree...

Tom Perroni

[DCJS Instructor]

I know we have had some words, but dude, that is some Grade A, Mark 1 Mod 0 no-BS comment there. Concur a million percent.

I would agree as well!

[DCJS Instructor]

[Gutshot John]

I asked for a clinical study, not a DOD directive.

I'm sure you know what a clinical study is. It allows HC providers to properly ascertain the risk involved.

From an earlier post:

If you have some clinical research that shows how thermogenic Quik Clot kills more people through thrombosis or burns than it saves through hemorrhage control, I'm all ears.

Just because the DOD says it's so, does not make it so. No offense, even if there is a remote chance of thrombosis, are you going to let someone bleed to death because you only have the granulated stuff?

[DCJS Instructor]

John,

Again MY POINT is this:

The information given to my students was questioned.....

I gave you the origin of said information.....Joint Special Operations Medical Training Center (JSOMTC).

Since we teach for and too the USSOCOM guidelines we will continue to teach said information. I am sorry YOU do not agree with what is being taught. I think your point has merit...However you are not the Military PHTLS training authority. I must use the guidelines given to me by my client.

No offense or attitudes from me... however buy what authority do you give your medical information? I posted mine..... (JSOMTC).

There is a world of difference from being a civilian medic and a military medic....while I respect your EMT-P status...It carries no weight in the world that I teach and operate in for the Military/ TCCC/LTT-MPHTLS. Now if you had an ATP card…that’s a whole different situation.

While I respect your passion and beliefs on the topic, we will have to agree to disagree.

[Gutshot John]

Besides being a civilian paramedic, I was a Hospital Corpsman with the FMF, during which time I was a Jungle Warfare, Survival and Medical Instructor at JWTC Okinawa (Camp Gonsalves), I am TCCC certified, I have actually taught 18Ds and I have worked in inventory/procurement for Marine Battalions/Regiments, so I might know a thing or two about military medicine.

Additionally the AAR and other attendees of the class were not USSOCOM/18Ds, so while you might teach those guys, this thread references civilian medical training and techniques such as NeedleDs and while appropriate for 18Ds are not appropriate for the people you taught and open them and yourself to significant potential liability if they do something wrong.

That said you're getting defensive rather than actually paying attention to the question at hand... since the goal is to inform people, let's put the other stuff aside, disregard all the above conversation and answer three basic questions:

1. Name a clinical study that demonstrates a bona-fide/significant risk of thrombosis from the use of quik-clot?

2. Why does a minuscule risk of thrombosis from granular QC outweigh the risk of death from acute shock?

3. Why would you, individually, not use granular QC if faced with a patient suffering from acute traumatic shock?

They're legitimate questions and I think many here would benefit from those answers and would give a good idea as to your thought process, methodology and value of the training you offer.

[DCJS Instructor]

in December 2008 Dr. Bijan Kheirabadi of the US ARMY Institute of Surgical Research (USAISR) presented that WoundStat had a high incidence of blood vessel Thrombosis and damage to the vessel wall. This was presented at the Special Operations Medical Association meeting last year.

Woundstat treatment of the injured vessels resulted in development of occlusive thrombi in carotid arteries (7 of 8) and jugular veins (6 of 8) two hours after surgical repair and blood reflow. There was evidence of Woundstat residues and emboli in the lungs of two animals.

his further research into this was presented at the TCCC meeting in San Antonio, Feb 2009 were he presented the histology from the Woundstat-treated vessels in his recent study demonstrated evidence of endothelial toxicity.


Update on Hemostatic Agents
Dr. Bijan Kheirabadi - USAISR
LCDR Walter Carr/Dr. Francois Arnaud –
Naval Medical Research Center (NMRC)
MSG Chris Murphy – Combat Applications Group

A number of new hemostatic agents have recently become available. These new agents have undergone testing both at the USAISR and at NMRC. The findings from these studies were presented to the Committee on TCCC (CoTCCC) on 1 April 2008. Three different swine bleeding models were used: a 6mm femoral artery punch model at USAISR and a 4mm femoral artery punch as well as a femoral artery/vein transaction model at NMRC. Both the NMRC and the USAISR studies found Combat Gauze and Woundstat to be consistently more effective than the hemostatic agents HemCon and QuikClot recommended in the 2006 TCCC guidelines. No significant exothermic reaction was noted with either agent. Celox was also found to outperform the current agents, although it performed less well than WoundStat in the more severe 6 USAISR model, where 10 of 10 Woundstat animal survived, 8 of 10 Combat Gauze animals survived, and 6 of 10 Celox animals survived. The reports detailing this research will be available shortly from USAISR and NMRC.

MSG Chris Murphy from the Combat Applications Group presented a combat medic perspective on this issue and noted that his experience has caused him to prefer a gauze-type hemostatic agent rather than a powder or granule. This preference is based on his observation that powder or granular agents do not work well in wounds where the bleeding vessel is at the bottom of a narrow wound tract. A gauze-type hemostatic agent is more effective in this setting. This preference was echoed by other members who are combat medics or corpsmen. Combat Gauze was also noted to be more easily removable from the wound site at the time of surgical repair.

Following the presentations, COL Holcomb recommended that the CoTCCC recommend Combat Gauze as the first-line treatment for life-threatening hemorrhage that is not amenable to tourniquet placement.

[Gutshot John]

Thank you. Not so hard was it?

Although relevant to Woundstat I'm curious as to how one gets 7 of 8 carotid arteries and 6 of 8 jugular veins occluded by thrombi along with pulmonary embolism and yet still 10 of 10 animals survived.

I do appreciate you taking the time to providing the relevant information.