# Experimental combat dressing...thoughts?



## Ex3 (Feb 8, 2014)

@Firemedic suggested I post this.  I know very little about such things, it seems like it would be a good idea.  It looks like a large dildo, but that's just a bonus!

XStat is an investigational hemostatic dressing under development by RevMedx for the control of severe bleeding from pelvis or shoulder wounds not amenable to tourniquet application in adults and adolescents.

XStat works by applying a group of small, rapidly-expanding sponges into a wound cavity using a lightweight applicator. Two applicator sizes are under development: a 30 mm diameter applicator for larger wounds and a 12 mm diameter applicator for narrow wound tracks.

The XStat sponges are composed of standard medical sponge that is coated with a hemostatic agent and compressed. Each Xstat sponge contains a radiopaque marker for easy detection via X-ray.

In the wound, the Xstat sponges expand and create a barrier to blood flow, present a large surface area for clotting, and provide gentle pressure. No direct manual pressure is required.

In a preclinical model with aggressive non-compressible hemorrhaging, Xstat provided statistically significant improvement in hemostasis and survival 60 minutes after injury with a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared to conventional hemorrhage control dressings.​
http://www.revmedx.com/#!xstat-dressing/c2500


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## Muppet (Feb 8, 2014)

Ex3 said:


> @Firemedic suggested I post this.  I know very little about such things, it seems like it would be a good idea.  It looks like a large dildo, but that's just a bonus!
> 
> XStat is an investigational hemostatic dressing under development by RevMedx for the control of severe bleeding from pelvis or shoulder wounds not amenable to tourniquet application in adults and adolescents.
> 
> ...



I have not received other feedback since our conversation on facebook. Lets see what some experts think... 

F.M.


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## TLDR20 (Feb 8, 2014)

I saw this on Facebook or the chive last week and reached out to people who may know about it, if they respond I will post an AAR.


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## Muppet (Feb 8, 2014)

TLDR20 said:


> I saw this on Facebook or the chive last week and reached out to people who may know about it, if they respond I will post an AAR.



I am curious as to what the trauma docs at shock trauma (in the civ. world) would say with civ. paramedics when we place the applicator in the wound track. Think they will be pissed? I am pretty sure most places will not use this if they are urban since we are < (10) mins. from shock trauma in any direction. I have yet to pack a wound in the civ. world but even though it will save a life, I know a few docs at a premaddona trauma center around here that may cry like bitches because we packed a groin wound. Edit to add. I never experienced in 14 years of civ. paramedic life having to pack but one day it will happen...

F.M.


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## ZmanTX (Feb 8, 2014)

Firemedic said:


> I am curious as to what the trauma docs at shock trauma (in the civ. world) would say with civ. paramedics when we place the applicator in the wound track. Think they will be pissed? I am pretty sure most places will not use this if they are urban since we are < (10) mins. from shock trauma in any direction. I have yet to pack a wound in the civ. world but even though it will save a life, I know a few docs at a premaddona trauma center around here that may cry like bitches because we packed a groin wound. Edit to add. I never experienced in 14 years of civ. paramedic life having to pack but one day it will happen...
> 
> F.M.



In regards to your Department's procedures what are you taught to do in a situation with severe trauma to the pelvic/shoulder region?

I've read a little on this and I always think of PJ Jason Cunningham who suffered a gun shot wound in the pelvic region during Operation Anaconda. In a book that reviews the situation the doctor/surgeon responded that if he were shot right in front of the surgeons it would have still been a 50/50 chance that they could have/have not saved him.

ZM


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## Muppet (Feb 9, 2014)

Good question. For civ. paramedics in P.A., there are statewide A.L.S. protocols that cover trauma including the placement of T.Q.'s and clotting agents for trauma but that is not covered. I know and have practiced "packing" wounds for I am trained as a USAR and SWAT medic. When I was a Army medic in the 90's, we were not trained to pack wounds. Hell, back then, the use of T.Q.'s were still frowned upon. In response to your question. I would attempt to pack the wound and transport to shock trauma. I don't really care what the trauma docs think and if they wish, they can contact my medical director and he will cover me because he is also trained the same and WAY more than I am with the same training in regards to USAR / Tactical. So, Doc J., my director will say attempting to save the pt. was better than doing nothing and watching the pt. bleed out on the floor of the MIC.

Now, there are military and prolly a civ. or 2 medical providers on here that may have packed a wound or 2 in their time. Hopefully, they will add to this.

F.M.


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## Ranger Psych (Feb 9, 2014)

It's obviously more geared towards a military environment, specifically use on patients with extended time/distance from surgical care. Having said that, I've packed wounds, many here have packed many more (or I got to repack their initial work in some cases). It's a functional manner (packing) of promoting hemostasis. This being tied in with chitosan though, as well as with the applicator? If it promotes coagulation and helps stop bleeding out as well as lessens the necessity of TQ's due to inability to stop bleeding otherwise (ie, you can back off sooner to allow extremity circulation because the wound's bleeding is controlled) then I think it'd be feasible... and a damn good thing.

besides, the shit's all going to get cleaned out when debriedment and surgery occurs for more definitive wound care at the CASH or whatever forward element ends up seeing them after evac from point of injury.


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## amlove21 (Feb 17, 2014)

Zach M said:


> In regards to your Department's procedures what are you taught to do in a situation with severe trauma to the pelvic/shoulder region?
> 
> I've read a little on this and I always think of PJ Jason Cunningham who suffered a gun shot wound in the pelvic region during Operation Anaconda. In a book that reviews the situation the doctor/surgeon responded that if he were shot right in front of the surgeons it would have still been a 50/50 chance that they could have/have not saved him.
> 
> ZM


Not to nit pick- but I am going to nit pick. Jason was shot underneath his plates in his lower back. Capt Self made the decision not to do buddy transfusions of blood (very interesting discussions came of this), and therein lies the shitty situation of more blood out, less blood in, and waiting too long. 

This almost exact same product, Celox-A, came out years ago. They have only changed the way the hemostatic looks. No more powder, lots more sponges. I carried the Celox-A for a long ass time, for those deep, non-compressible wounds. I moved away from them, and I don't think I am too hip on this either, to be honest.


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## Ranger Psych (Feb 18, 2014)

Not to sidetrack, but what were the discussion points for/against a buddy transfusion?  

I had PRBC on-hand when I deployed to Iraq and if the situation had dictated (and the supervising physician had said to) we would have hit them up. Buddy transfusion is a whole different goat roll and the only arguments I'd have would be the degredation of teammates otherwise having to take care of them as well as the lack of proper typing (and all of it's ensuing issues therein).  Shit, get a speedball dropped with what you need if there's something that's doing a ferry to-from somewhere.


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## ZmanTX (Feb 18, 2014)

amlove21 said:


> Not to nit pick- but I am going to nit pick. Jason was shot underneath his plates in his lower back. Capt Self made the decision not to do buddy transfusions of blood (very interesting discussions came of this), and therein lies the shitty situation of more blood out, less blood in, and waiting too long.



Just did some more research and you are correct, although there are several descriptions of the event saying he was shot in the stomach which is why I made the mistake. Also with you moving away from the Celox-A what is the preference in the community that is used now for wounds that happen in areas like the pelvic/shoulder region? Or your preference?


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## amlove21 (Feb 18, 2014)

Zach M said:


> Just did some more research and you are correct, although there are several descriptions of the event saying he was shot in the stomach which is why I made the mistake. Also with you moving away from the Celox-A what is the preference in the community that is used now for wounds that happen in areas like the pelvic/shoulder region? Or your preference?


Yea, no worries, that wasn't a shot across your bow or anything. He was hit in his lower flank and had insult through his retroperitoneal area into his lower thorax/abdomen. To be honest, the "shot in the stomach" thing still plays, since technically he was wounded in his stomach. The entrance wound was above his belt line, under his kit. For us PJ's, the wound is a source of- I don't know if pride is the right word. He was shot where he was because he was kneeling over a patient trying to help. And that's fucking badass. Read more about Jason here.  

As for the Celox-a switch- I moved away for a couple reasons, #1 of which is the need for multi use kit. I can use combat gauze (or any gauze for that matter) on a multitude of wounds. The applicator (all powder really) was really tough, unless you were jamming that thing way into a wound track and slamming the plunger home. And if you think about the way to properly pack a wound (find the wound, visualize the bleed, pack at the bleed point), the applicator was just an added step. I had to use gauze anyway- to find the bleed- and then jam the applicator in, only to follow on with gauze again? 

Anyway, I just switched over to z folded Combat gauze as my primary hemo.


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## amlove21 (Feb 18, 2014)

Ranger Psych said:


> Not to sidetrack, but what were the discussion points for/against a buddy transfusion?
> 
> I had PRBC on-hand when I deployed to Iraq and if the situation had dictated (and the supervising physician had said to) we would have hit them up. Buddy transfusion is a whole different goat roll and the only arguments I'd have would be the degredation of teammates otherwise having to take care of them as well as the lack of proper typing (and all of it's ensuing issues therein).  Shit, get a speedball dropped with what you need if there's something that's doing a ferry to-from somewhere.


Well, at the time there weren't a lot of dudes carrying blood. PJ's, specifically a guy named Pat Harding, were the first to carry blood products back into the battlefield, and Robert's Ridge was the prime motivator. Since then, blood has been carried on nearly every PEDRO or PJ op since. I know for sure it was in the helo on every mission out of Bastion for at least 3 years, and that's a lot of missions. 

Captain Nathan Self has said in a couple of interviews since that at the time, he needed every gun he had to get off Takur Ghar. The subject of buddy transfusions had come up, specifically from a medic (Devereaux) that knew Jason wouldn't survive his wounds. Capt Self had to make that call, and he did it under fire. We just didn't have enough experience at war- remember, this was 2003. I can't think of a single person I have ever talked to faulted Capt Self for that. He was dealt the worst possible situation, and he got most of his men home alive, which is a credit to him. 

Anyway, a lot of studies have been done since then- most notably the Norwegian MJK, who did some pretty extensive testing on their operators to see if losing a unit (or two) of blood really effected performance that much. They found, pretty impressively, that it doesn't, or at least it doesn't to the point of "losing a guy", or taking him out of the fight. 

You can get away with type, not cross 1 time. Meaning, if you're A pos and I am A neg, I can get your blood one time without a 100% chance of total reaction. You still have to type the whole team (which I always do when supporting). I carry buddy transfusion kits as well. It's definitely in extremis, but it's not as bad/dangerous as it's made out to be. I actually attended the Fresh Whole Blood Symposium where this stuff was studied- one of the most interesting nerd trips I heave ever taken.


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## ZmanTX (Feb 18, 2014)

amlove21 said:


> Yea, no worries, that wasn't a shot across your bow or anything. He was hit in his lower flank and had insult through his retroperitoneal area into his lower thorax/abdomen. To be honest, the "shot in the stomach" thing still plays, since technically he was wounded in his stomach. The entrance wound was above his belt line, under his kit. For us PJ's, the wound is a source of- I don't know if pride is the right word. He was shot where he was because he was kneeling over a patient trying to help. And that's fucking badass. Read more about Jason here.
> 
> As for the Celox-a switch- I moved away for a couple reasons, #1 of which is the need for multi use kit. I can use combat gauze (or any gauze for that matter) on a multitude of wounds. The applicator (all powder really) was really tough, unless you were jamming that thing way into a wound track and slamming the plunger home. And if you think about the way to properly pack a wound (find the wound, visualize the bleed, pack at the bleed point), the applicator was just an added step. I had to use gauze anyway- to find the bleed- and then jam the applicator in, only to follow on with gauze again?
> 
> Anyway, I just switched over to z folded Combat gauze as my primary hemo.



Good info, and thank you for the link.


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## Ranger Psych (Feb 19, 2014)

amlove21 said:


> Well, at the time there weren't a lot of dudes carrying blood. PJ's, specifically a guy named Pat Harding, were the first to carry blood products back into the battlefield.



Erm, maybe not as a general rule but there were some mustard stain wearing bags o PRBC for Obj Rhino...

Other than that, makes sense as well as I support the battlefield commander's decision. Higher? fuck em. Dude in the shit? He knows the deal.


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## amlove21 (Feb 19, 2014)

Ranger Psych said:


> Erm, maybe not as a general rule but there were some mustard stain wearing bags o PRBC for Obj Rhino...
> 
> Other than that, makes sense as well as I support the battlefield commander's decision. Higher? fuck em. Dude in the shit? He knows the deal.


There were certain missions- like Rhino- where you could request and get blood if the mission was approved for it. PJ's were the first to get a "blanket approval" or whatever you would like to call it to carry blood all the time. 

So yes, I meant as a general rule, and not to exclude other missions out of hand.


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## Ranger Psych (Feb 20, 2014)

I still have some C-5 crew that I have to choke out. Heading to OIF1 they wouldn't let me plug my blood refrigerator (120VAC) into the fucking bird and I had to run my vehicle batteries into the ground in order to keep the blood within temps (3kw inverter on the truck). Not a huge issue technically for me since dead vehicle drills were something we practiced for, but still an inconvenience. 

Fast forward to Invasion staging, Mechanics weren't happy about it since the batteries were totally shot, but when I handed them 6 extra batteries for them to install for me plus have spares down the line... all returned to balance.

Especially since the batteries came out of Moron's equipment.... You want to do a 4 day layover because "Something Broke and we don't know what"? Das ok, It's perfectly fine to leave a Ranger to his own devices for 4 days in a foreign country with civilian clothes...


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## DA SWO (Feb 20, 2014)

Ranger Psych said:


> I still have some C-5 crew that I have to choke out. Heading to OIF1 they wouldn't let me plug my blood refrigerator (120VAC) into the fucking bird and I had to run my vehicle batteries into the ground in order to keep the blood within temps (3kw inverter on the truck). Not a huge issue technically for me since dead vehicle drills were something we practiced for, but still an inconvenience.
> 
> Fast forward to Invasion staging, Mechanics weren't happy about it since the batteries were totally shot, but when I handed them 6 extra batteries for them to install for me plus have spares down the line... all returned to balance.
> 
> Especially since the batteries came out of Moron's equipment.... You want to do a 4 day layover because "Something Broke and we don't know what"? Das ok, It's perfectly fine to leave a Ranger to his own devices for 4 days in a foreign country with civilian clothes...


Did anyone take it up with the AF for future missions?


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## Ranger Psych (Feb 20, 2014)

Well, I told our Bn Surg about it, other medical elements we had around found out quickly so there were quite a few LtCol+'es with a case of the ass about it... but that type of interaction was also well above my pay grade, so if anything happened I wouldn't have known about it until next time I had to transport blood..


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## Brill (Nov 10, 2014)

Good video on some background.

http://video.pbs.org/widget/partnerplayer/2365365053/?start=0


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## Etype (Nov 10, 2014)

Looks like Celox to me (same thing, different delivery-probably work nearly the same on a wound), as was already said.  There's also a variety in the inventory that has several "pills" in a syringe, so it spits out a column of Mentos sized Celox tablets.

Our medics carry the Celox injectors, but our individual kits just have combat gauze.  You can do the same thing with gauze, plus more.  There are obviously situations where the injector/applicator might be better than the gauze, but you can still make it work.  A big strong assaulter can apply A LOT of direct pressure- a two-hundredandsomethingpound dude can compress a lot of bleeders till the professional gets there.


Ranger Psych said:


> Not to sidetrack, but what were the discussion points for/against a buddy transfusion?


Our medics had a pretty intense conversation on my last deployment about the feasibility of buddy transfusions.  I was in the TOC "checking emails" (youtube) while this was going down.  The criteria they pretty much settled on was deliberate security in place, this guy is expectant without the procedure and we are at troop strength (it wouldn't do much good to have 5 guys out, one guy giving blood to another leaving us at just above 50% strength).

The SEALs seemed to be much fonder of the concept.


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## amlove21 (Nov 15, 2014)

Etype said:


> Our medics had a pretty intense conversation on my last deployment about the feasibility of buddy transfusions.  I was in the TOC "checking emails" (youtube) while this was going down.  The criteria they pretty much settled on was deliberate security in place, this guy is expectant without the procedure and we are at troop strength *(it wouldn't do much good to have 5 guys out, one guy giving blood to another leaving us at just above 50% strength).*


 I have a much, much lower threshold for this procedure, to be honest. I bolded the above because the more research I see, and the more I hear really really smart docs talk about it (and then plagariaze their ideas as my own) the more I am simply not believeing the "2 guys go down from a blood transfusion" myth. I just don't see it to be fact.

200 lb dude in great shape (obviously no other confounding factors) giving up 450cc of blood isnt taking him out of the fight.


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