Controlling Bleeding in the Field: Hemostatic Powders and Dressings Debut in the Prehospital Setting☆

Article Outline

• References
• Copyright

While Americans continue to debate the war on Iraq, battlefield personnel are exploring several technologies that are currently making their way through the Food and Drug Administration (FDA) process to the streets at home for treatment of patients with severe bleeding. These “hemostatins” seek to achieve the same effect with different materials and in different ways. Some add coagulants at the wound site; others constrict bleeding arteries near the wound and activate platelets to stop bleeding. Their efficacy has been studied with animal models,¹ and they are now being used in clinical settings.

TraumaDEX consists of an engineered biopolymer, microporous particle that is designed to act as a sieve to dehydrate the blood and thus serve to accelerate the natural clotting process. The manufacturer recommends removing existing clots from the wound and sprinkling the material directly on the wound surface, then maintaining manual pressure for 30 to 60 seconds while the material and the body’s own platelets become activated. For more information, visit the Web site http://www.traumadex.com/.

Quik Clot is a chemically inert granular powder that has the appearance of cat litter.² The mechanism of action is unclear, although some supporters theorize that an exothermic reaction effectively cauterizes the wound. However, printed materials from the manufacturer claim that the material absorbs excess water from hemorrhagic fluid, allowing platelets and other clotting factors in a higher concentration to provide hemostasis. The material has been tested on swine models; human studies are relatively limited. Removal of the product, a refined volcanic mineral called “zeolite,” is accomplished through surgical irrigation or debridement in the hospital setting. This feature may be considered a disadvantage for use, especially if experience shows that granulomas or abscesses have a tendency to form around residual particles inadvertently left behind. For more information, visit Web site http://www.z-medica.com/.

HemCon contains a specific form of chitosan developed from chitin, a natural polymer found in shrimp shells, other crustaceans, insects, worms, fungus, and mushrooms. The HemCon bandage was invented through a research grant from the US Army Medical Research and Material Command. It is not sprinkled into a wound; rather, the 4-inch square fibrin bandage can be applied almost single-handedly to the surface of a wound. Persons with a shrimp allergy are not adversely affected by the application of the product because chitin is not a factor in shellfish anaphylaxis. Visit Web site http://www.hemcon.com/.

Rapid Deployment Hemostat (RDH) Bandage. The FDA issued a market clearance last December for this new trauma dressing made from marine micro-algae designed to stop hemorrhaging by inducing blood clot formation in seconds. The RDH bandage stops bleeding by causing red blood cells to form a plug as they come into contact with the algal compound. The formation of the red blood cell plug leads to a high local concentration of platelets and clotting factors, resulting in the formation of a normal blood clot. The RDH Bandage is the result of a 3-year effort between the Office of Naval Research and Marine Polymer Technologies, a Massachusetts Company. An added feature of the bandage is that the material easily can be separated from the clotted surface of a wound 10 to 90 minutes after application without causing rebleeding. This feature is attractive to the Navy & Marine Corps because injured persons usually are transported away from the battlefield to a trauma hospital for surgery. The bandage is much cheaper to produce because of its source and ease of manufacture. It is not derived from human or animal sources, and thus it presents less of a risk for disease transmission.

Other products that promote hemostasis presently are in development, but they contain clot-inducing proteins that are derived from human blood. With such products, there is a risk of disease transmission.

Crosseal is one such product. A new fibrin sealant bandage, it consists of a coating of dried fibrinogen and thrombin over a fabric base made from the same absorbable material that surgeons use for internal stitching. The clotting properties of the bandage are not activated until it connects with the blood of a wound. Fibrin is the major component of a blood clot. It is produced when one plasma protein, thrombin, interacts with another protein, fibrinogen. Fibrin sealant is created when these 2 proteins are combined, forming a strong biologic sealant.

Spun from strands of fibrinogen 1000 times thinner than a human hair, the fabric could be placed on a wound and never taken off, minimizing blood loss and encouraging the natural healing process. The new mat could be placed directly on the bleeding site to start the clotting process, then, depending on the nature and severity of the wound, it could be left there to promote healing and eventually be absorbed by the body, according to the researchers. It potentially could be used for anything from a minor cut to a battlefield wound, where it is vital to stop bleeding immediately while waiting for transport to a distant hospital. It comes packaged in a single-use kit of 2 packages, one package containing one vial each of frozen sterile solutions of Biological Active Component and Thrombin and one package containing a sterile spray application device. The 2 components are mixed and applied topically. Because this product is somewhat cumbersome and, technically, a blood product, it is not likely to be used in the prehospital setting, but it may prove to be useful in the emergency department for hemorrhagic wounds. Visit Web site http://www.crosseal.com/.

As with any new product or device, EMS practitioners should check with local protocols and regulations and search out up-to-date reports of their use and efficacy in actual clinical practice in EMS settings before incorporating them into practice.

Back to Article Outline

References 

1. Alam HB, Uy GB, Miller D, Koustava E, Hancock T, Inocencio R, et al.  Comparative analysis of hemostatic agents in a swine model of lethal groin injury. J Trauma. 2003;54:1077–1082 June
   • View In Article
   • MEDLINE
2. Healy M. Life saving clotting powder headed to stores. Pittsburgh Post Gazette 2003 July 23. Available from: URL: http://www.post-gazette.com/pg/03203/204247.stm
   • View In Article