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Use of Hemostatic Dressings in Civilian EMS
Your BLS ambulance is dispatched for a hunting accident in a rural area. You and your partner arrive on scene to find that the patient is a 50-year-old male bleeding uncontrollably from the right side of his groin due to a rifle injury. He_s conscious and alert upon arrival; however, he_s tachycardic and hypotensive from continuous blood loss. You apply gauze and direct pressure to the wound and decide to immediately transport this patient due to significant blood loss.To get more news about IFAK pouch, you can visit rusuntacmed.com official website.
Despite continuous direct pressure and pressure over the femoral pressure point, the bleeding continues. Your partner suggests a tourniquet, but the wound is high in the groin, and it_s impossible to get a strap above the bleeding site. What_s your next move?
Overview
One of the greatest threats with traumatic injury is massive bleeding (1). The basics of hemorrhage control continue to be direct pressure and ultimate surgical control. However, even with experienced providers, many patients still die of unrelenting hemorrhage.”?
In the military setting, where hemorrhage accounts for approximately 50% of all combat fatalities, adjuncts to direct pressure in the field include tourniquets and new hemostatic dressings. These adjuncts have proven invaluable for treating severe hemorrhage in soldiers injured during operations in Iraq and Afghanistan (2).
As of January 2008, 3,905 U.S. soldiers have been killed and 28,822 seriously wounded in Operation Iraqi Freedom alone. Combat wounds are often devastating and associated with massive tissue damage. New hemostatic dressings were specifically developed to address these types of wounds, taking into consideration the environment where they would be used.
In the U.S., however, where many trauma fatalities are also the direct result of exsanguination, there has been little change in hemorrhage control protocols that most often include only direct pressure and standard dressings. The success of these new hemostatic dressings on the battlefield should prompt all EMS agencies to consider their use in civilian practice.”?
Several similar dressings have been introduced during the past few years that have shown promise. All of them are bulky and serve to fill the space of large wounds. Most of the agents absorb water in some capacity, acting to concentrate the clotting factors in the blood and aid clot formation. Some of the most advanced dressings are engineered with human coagulation factors implanted into the dressing to promote fibrin formation, the last step in clot formation. The variation among available products lies in their substance (granular or solid), size and flexibility.”?
The ideal hemostatic agent would require little to no training, be in a pre-mixed, non-perishable state and have the ability to effectively control hemorrhage from any source. In addition, advantages would include being inexpensive, posing no risk to life or limb, and remaining stable and functional at extreme temperatures.
Currently, no single product meets all of these ideals; thus, the decision to use one product or formulation over another is an art as much as a science. The vast majority of these dressings are FDA approved as over-the-counter agents for external use. The following is an overview of the most commonly used products and formulations and their applications |
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