Hemostatic agents.

Muppet

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Greetings all:
To the medical professionals or anybody for that matter:
What are you guys / girls using regarding hemostatic agents and what do you think about them? I have been to multiple sites ( product ) but I would like the "end user" thoughts. My commonwealth / state is in the progress of updating our pre-hospital standing orders to include hemostatics and the local powers to be ( medical directors / chiefs ) are stuck as to which product is the best. Hopefully I can offer imput to the higher since the decision is made @ the local level ( from a list of products from the state ). Any imput would be greatlly appreciated.

P.S.: If this thread is old, I will draw fire elsewhere.
F.M.
 

Sunny

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hemostatics

I like the z-med combat gauze and hemcon. I carry both and use for differant types of bleeders. You have got to get training and pratice with both.
 

Sunny

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the quick clot sponges work well for cavity bleeders like aux. pockets gun shot wounds. the z-med combat gauze works just as well if not better. the combat gauze has many more application. i am not sure where you work as a paramedic but how many gun shot wounds have you seen in the last year. of the gsw how many are of a caliber of 7mm or above. dude i think quick clot would be a waste of money. money would be better spent on king ltd advanced airway.I know i have missed my fair share of in field intubations. some stats. say that up to 20% of advanced airway received in the er are misplace. let me get off my soapbox, if you have specific questions about heme control products please forward.
 

medic101charlie

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the quick clot sponges work well for cavity bleeders like aux. pockets gun shot wounds. the z-med combat gauze works just as well if not better. the combat gauze has many more application. i am not sure where you work as a paramedic but how many gun shot wounds have you seen in the last year. of the gsw how many are of a caliber of 7mm or above. dude i think quick clot would be a waste of money. money would be better spent on king ltd advanced airway.I know i have missed my fair share of in field intubations. some stats. say that up to 20% of advanced airway received in the er are misplace. let me get off my soapbox, if you have specific questions about heme control products please forward.

We carry King Airways as well.

These decisions are above my paygrade.

I use what is issued.


Jim
 

Muppet

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I work just outside of Philadelphia so we get our share of GSW's, mostly small arms but we have had a rash of gang shootings (assault type weapons) moving up from Phila. and Trenton. We also carry King LTD and perform M.E.I. (Etomidate). I don't know what the state will approve but I know that they are going to approve several types of hemos. It is up to the induvidual counties / squads to adopt what they think is "best". Leave it to a "commonwealth" to make things difficult.
Now on my "soapbox". How can medics miss tubes anymore with the advent of ETco2 adapters on the 12-leads? I do agree that "we, the profession" needs more practice in intubations. Ask the M.D's on here They will tell you. They need > 50 tubes in order to be called proficient. Off my soapbox. Thanks for the reply.

F.M.
 

Sunny

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Easy devil doc, I was trying to give fire medic my opinion not tell anyone how to do there job.

Moving on, research for yourself I have always been taught that most inexperienced shooter will tend wound victims in the hip. They will push the weapon and throw the round low and left “the gangsta blam...blam...phenomena" this is for the FBI typical seven yard gun fight.
I myself have not had good luck with the packing the QC sponge in the irregular tracking cavities caused by the abnormal cavitations of rounds impacting the multi-angled bones of the hip.

Now if you have victims taking rifle round to center mass from trained/street hard shooter QC sponges can be useful. QC sponges are much more user friendly than hemcon. This is what I train my non-medic operators to render buddy aid with.

If this all sounds like BS or you have different opinion/information I would love to hear about it. I am always looking to improve.
 

Doc P

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Combat gauze works GREAT...and it is very easy to use for many types of wounds. The problem with Hemcon (which works great as well) is that it needs to be placed on the source of the bleed (i.e. the vessel) and thus requires more training.
 

medic101charlie

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Easy devil doc, I was trying to give fire medic my opinion not tell anyone how to do there job.

Moving on, research for yourself I have always been taught that most inexperienced shooter will tend wound victims in the hip. They will push the weapon and throw the round low and left “the gangsta blam...blam...phenomena" this is for the FBI typical seven yard gun fight.
I myself have not had good luck with the packing the QC sponge in the irregular tracking cavities caused by the abnormal cavitations of rounds impacting the multi-angled bones of the hip.

Now if you have victims taking rifle round to center mass from trained/street hard shooter QC sponges can be useful. QC sponges are much more user friendly than hemcon. This is what I train my non-medic operators to render buddy aid with.

If this all sounds like BS or you have different opinion/information I would love to hear about it. I am always looking to improve.

Didn't mean to come across so terse. Sorry about that.

Unfortunately, I left my urban 911 service before the widespread use of HemCon or other types of hemostatic agents. My current service is a rural/suburban 911 and Critical Care service. We do but 10-20 shootings a year, between the two counties I work for.

Our owner likes to have the flashy "cool guy stuff" so he bought HemCon as soon as it came out and put it on the choppers (which aren't even certified for AMS yet) and the critical care service. I think they used it once for an arterial bleed on a 45 minute critical care transport to a trauma center.

This ia good thread and full of good info.

Thanks for your service, Sunny.


Jim
 

Muppet

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I agree. Thanks for all of the info. I throught nobody was going to reply when I posted. While I am here. What tourniquets do you Medics pefer? That is also part of our updated S.O.P's. I guess the state finially realized that T.Q's do not cause harm when applied correctlly / 10-15 min. ride to a Level-1 Trauma. I have read that the CAT was cheap and that the SOF-T was o.k. How tru is that?

F.M.
 

surgicalcric

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CAT's: fairly inexpensive but they have had issues with some of the plastic parts on them breaking when used on larger/more muscular patients where more pressure is required.

SOFT-T's: good but a bit more expensive than the CAT. They also dont work well on upper extremities on thin/less muscular patients. They also dont have the issues of durability which the CAT does.

MAT, only used in training but I am very skeptical of the plastic ratchet. The release button and the buckle have been the cause of a couple loosening after application. (I wont use them)

LBT Ratchet, great for legs. They take up a bit more room in our kit so they are saved for the Aidbag. I carry two.

There are several other TQ's but I dont carry them/use them.

Crip
 

medic101charlie

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CAT's: fairly inexpensive but they have had issues with some of the plastic parts on them breaking when used on larger/more muscular patients where more pressure is required.

SOFT-T's: good but a bit more expensive than the CAT. They also dont work well on upper extremities on thin/less muscular patients. They also dont have the issues of durability which the CAT does.

MAT, only used in training but I am very skeptical of the plastic ratchet. The release button and the buckle have been the cause of a couple loosening after application. (I wont use them)

LBT Ratchet, great for legs. They take up a bit more room in our kit so they are saved for the Aidbag. I carry two.

There are several other TQ's but I dont carry them/use them.

Crip

Taking this conversation further IRT TQs, do you operators/medics carry different types of TQs? Or do you stay with one type? I have read where operators carry TQs on their persons for self care and buddy care. Is this personalized or unit dependent?

I hope this is not OPSEC, but I was just curious.

On another note, I did some research on the combat gauze and have forwarded to our clinical director for further action.


Jim
 

surgicalcric

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I carry a CAT centerline on my armor and a SOFT-T in my IFAK; the same is true for everyone on my ODA.

As for what I carry in my aidbags/on my person, I dont carry any CATs in my kit. They are all SOFT-T's and LBT ratchet TQ's, this is depending on which bag I grab leaving the door (which is dependent on the mission.)

Remember, your job is very different than mine and there are TQ's on the market that may better suite your needs and those of your patients than me and my situation. What we carry is often limited by size/weight. Whereas you have a bus to carry your equipment around in. FWIW, when I am home I enjoy greatly the room and carrying capacity of the ambulances in my FD.

HTH,

Crip
 

medic101charlie

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I carry a CAT centerline on my armor and a SOFT-T in my IFAK; the same is true for everyone on my ODA.

As for what I carry in my aidbags/on my person, I dont carry any CATs in my kit. They are all SOFT-T's and LBT ratchet TQ's, this is depending on which bag I grab leaving the door (which is dependent on the mission.)

Remember, your job is very different than mine and there are TQ's on the market that may better suite your needs and those of your patients than me and my situation. What we carry is often limited by size/weight. Whereas you have a bus to carry your equipment around in. FWIW, when I am home I enjoy greatly the room and carrying capacity of the ambulances in my FD.

HTH,

Crip

Thanks for your input.

Jim
 
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