Thread: QuikClot-- worthwhile to include in first-aid kit?

The subject header pretty much says it all -- prompted by the WildSnow.com Denali team first-aid kit post, and my upcoming trip to the relatively remote Glacier Peak, thinking about some proprietary-type products to add to my kit, and wondering if QuikClot is a worthwhile addition (as opposed to just relying on old-fashioned bandages, dressings, direct pressure, etc.).
If so, is the 25g package sufficient? And any sense in paying extra $$ for the silver version with supposed antibacterial benefits?
Also, any other propriety-type specialized-use products worth considering?
How about these? --
[ame="http://www.amazon.com/gp/product/B0006ULI1Y"]Amazon.com: 3M Steri-StripTM Skin Closures, 1/4" x 3" - 3/Pk: Health & Personal Care[/ame]
[ame="http://www.amazon.com/gp/product/B0006GE5N6"]Amazon.com: Water Jel Burn Jel, Pain Relief 25 ea: Health &…[/ame]
http://www.rei.com/product/738645
For the latter two items, the "minor" description makes me skeptical of its utility.
(Also, in case it matters any, my level of ongoing training is NSP OEC, but I also took a WEMT module, although that was, yipes, almost half a decade ago.)

I think it would depend on the types of injuries you, or a member of your group, might reasonably suffer. Quick Clot may be essential on the battlefield and would likely serve useful in the event of an earthquake, but I wouldn't include it an my climbing or camping or BC kit. How often is someone impaled with an ice ax?

Those skin closures are money, though. I've been using something similar in my FA kit for over twenty years.

I've been wondering about QuikClot myself, although I think Viva is right.

And yeah, Steri-Strips are fucking awesome. Tincture of benzoin is useful too, often in conjunction with aforementioned strips.

Quick Clot is nasty stuff-effective but nasty. I'd carry it.

Check it-test on a hog with femoral artery cut. Not PETA friendly

[nomedia="http://www.youtube.com/watch?v=e9xvIbKBJn4"]YouTube- Field eXpedients: Quik-Clot Life Saving Powder-and Now Gauze[/nomedia]

MF

Originally Posted by Viva

Quick Clot may be essential on the battlefield and would likely serve useful in the event of an earthquake, but I wouldn't include it an my climbing or camping or BC kit. How often is someone impaled with an ice ax?

Lets see :
-falling and impalement on stumps,poles,picks..
-Lacerations from knives & axes
-natives shooting arrows & throwing spears..uh..wait?


I guess it is quite depending what you are doing? If I would be climbing (or hunting,or skiing with whippets) I might be tempted with those. Or if if handling axes would be daily (long canoe trips etc..) with the risk of mishaps.
But for my normal meadow skipping,hmm?Don know,not that they weight too much. I+ll just use my Loctite to glue shit together...

Jonathan, That comment caught my attention too, and I think I may pick some up.

[blog]
When I was a teenager, a friend cut himself on a backpacking trip with a pocket knife resulting in a nasty arterial bleed. We knew instantly we needed to evac him. We were about 10 miles from a road/our car in the Adirondacks. He bled through every bandage we had and into the t-shirt supply before we could get the bleeding under control with pressure and elevation. We decided he couldn't hike out, because the activity kept increasing the bleeding, so we rigged him into a pack and took turns hauling him out. This plan was good for the first few miles until we reached a long stretch (miles) of recent heavy tree fall.

Through this section he had no choice but to walk. By the time we made it to the trailhead he had bled through every piece of absorbent clothing we had, and was slipping into shock. It took another 30 min on the road before we go him to a clinic.

When we debriefed from the incident with one of the group's dad, an MD, we determined our medical kit needed a clotting agent. He hooked us up with something from the ER, which may have been Quikclot. He encouraged us not to use it before trying to manage bleeding with bandages, and that using it should be an automatic evac, because of high infection risk. [/blog]

Evac'ing a heavy bleed through difficult terrain can be really difficult, and having an overkill treatment option would have been nice. When it comes to the weight and space equation I use the mantra, "if it can be fixed with a band-aide, it doesn't need to be fixed", and plan to cover real emergencies.

Hmmm... I've got a couple of packets, but don't carry them around for ski touring. They are great for gunshot wounds and other holes in your body. Tourniques are much better for arterial bleeding IMHO. The stuff does not weigh much, but does take-up some "cube" space.

I have got a lot of first hand experience with quickclot and it is great stuff for certain applications. If you have quickclot in your medkit, you need to make sure you know how to use it!!!!!!!!! It isn't as simple as pour it on and it will stop the bleeding. It has to be applied correctly in order for it to be able to work.

Quikclot is ONLY for massive bleeding and should ONLY be used in the Armpit, Groin, or Neck for massive bleeding. Quikclot should NEVER be used for bleeding in the arms or legs. For massive bleeding in the arms or legs a tourniquet should be used.

Interesting & helpful discussion, thanks for all the feedback everyone. (And that Daks story is pretty scary -- those long approaches there can put a party very far from help.)

AKPogue, do you think that QuikClot is being oversold? I mean, the website is pretty breezy, making it sound like applying a band-aid. Do you know of any online tutorials as to proper application? (Maybe I skipped over it, but the consumer website seemed rather fluffy.) And why the contraindication for limbs?

Re Steri-Strips, what size (or assortment of sizes) would be good to bring along in a weight-conscious first-aid kit? Any cuts would be from the usual suspects (ski edges, ski poles, ski pole self-arrest grips, ice axes, boot crampons, ski crampons).

There are a variety of hemostatic agents available and there are variety of implimentations available from each manufacturer.

It is a battlefield miracle. The sacrifices and learning experiences of the US Serviceman over the last few years has lead to great advancements in the treatment of trauma, some of which trickles down to the civilian world. Among those are field use hemostatics and a reevaluation of tourniquet use.

For skiers, I think impregnated bandages/guaze like ActCel, Hemcon, Celox Guaze, and Quickclot Gauze are more suited to the likely injury types seen and are less likely to see improper use than the powder and granular forms like traumadex, quickclot, and celox .

These aren't cheap to stock and are unlikely to be used. The nicest thing about them is even though virtually all bleeding from sports accidents can be stopped by traditional means, if you know them, hemostatics do it faster, again if you know how/wwhen to use them, and they function better under stress of self extraction.

That said your money is better first spent on a Wilderness First Responder or at least an Adanced Wilderness First Aid Class.

I carry celox (free sample) and actcel (cheaper), but I've only used it once... at my place on myself to stop a knife cut in a hurry (worked) for convenience's sake (had to catch a plane). I've only had three prehospital patients in 6 years that would have benefited: car wreck, motorcycle, wreck, powerboat wreck. None in the backcountry.

Originally Posted by Jonathan S.

AKPogue, do you think that QuikClot is being oversold? I mean, the website is pretty breezy, making it sound like applying a band-aid. Do you know of any online tutorials as to proper application? (Maybe I skipped over it, but the consumer website seemed rather fluffy.) And why the contraindication for limbs?

To tell you the truth I have no idea how it is being sold in the civilian world. So not sure if it is being oversold or not. Quikclot does work!!! Try youtube, as most everything you could ever see for trauma has been put on there for people to see the proper application.

In the civilian world and especially in the backcountry world, you really aren't going to have the kind of injury that is going to need a tourniquet. A tourniquet is being taught as the first line of care in massive bleeding in a extremity in a combat environment. One of the reasons for that is the massive damage caused by a blast wound. You will have arteries and veins completely shredded so putting direct pressure really doesn't apply, so in that case you go directly to a tourniquet. Can't put a tourniquet on a groin, armpit, or on the neck(well you can put a tourniquet on a neck but that wouldn't be good for the patient ), so that is where quikclot or something similar comes into play. It shouldn't be used elsewhere because that is where direct pressure and tourniquets are for.

I only have actual experience with quikclot, I have been trained in hemcon, quikclot acs, and quikclot combat gauze. I carry quikclot combat gauze and quikclot acs because that is what I have been able to acquire. Combat gauze is what the Marine Corps is using as their first line. I have never heard of ActCel but the little research I have done on the internet seems that it works, but Summits post is the first I have heard about it.

Other improvements that have come about is a bandage like this.
http://www.cinchtight.com/html/h-bandage.html
The do a really good job of providing direct pressure, is also really durable and can provide almost as much pressure as a tourniquet. If space and weight is an issue compressed gauze and a roller bandage are really hard to beat.

To echo what summit said I carry celox in those small packets. Expensive but I haven't used it yet.

I carry a small skin stapler too instead of steri strips. Have practised with it but never used it.

Also forgot this. Some good info for people in the backcountry. Got to warn you there are some gruesome pics. Definitely not for the squeamish.
http://www.naemt.org/education/PHTLS/TCCC.aspx

anybody use feminine hygiene products ,I have heard some folks carry them in 1st aid kits ...they are after all designed to deal with bleeding ?

Originally Posted by XXX-er

anybody use feminine hygiene products ,I have heard some folks carry them in 1st aid kits ...they are after all designed to deal with bleeding ?

Have heard about that but have been told not to do it. Something about what they are made of doesn't go well with wounds. Can't remember exactly but figured with all the training I have had if they were a good idea than they would have been pushed. One thing I have been told for a small wound that is hard to push in gauze is a foley catheter. You can insert the end with the balloon on it into the wound and then inflate the balloon. If the wound is bigger than you just insert another one.

Originally Posted by AKPogue

Have heard about that but have been told not to do it. Something about what they are made of doesn't go well with wounds..

Always ?

THe WFR class I did had a handful of special forces guys in it for whatever reason. They all carried quikclot and some pretty cool fast tourniquets for their respective uses. They all really liked the quikclot product fwiw.

Originally Posted by XXX-er

Always ?

Well if it is all you got then I would use it. However, there is so much out there I don't see any reason to carry them especially since their application is limited.

You should bring it.

The ability to treat heavy bleeding in the backcountry could save someone's life.

AKPogue, wondering if you could elaborate on the reasons behind using a tourniquet instead of quicklot? Just curious as from my understanding if a tourniquet is used it's very unlikely the limb will last more than a few hours, 6 at most. If for some reason it was required in a backcountry emergency wouldn't quickclot be better in regards to limb preservation? Thanks

This thread has a lot of discussion about tourniquets and hemostatics:
http://www.tetongravity.com/forums/s...t=62355&page=2

Here is a copy and past of one of my posts on that thread that seems relevant, although the information is 2.5 years old:

Originally Posted by Summit

Originally Posted by dirtybryan

Wondering what Summit has after drilling the PTHLS guy.

The instructors were extremely knowledgeable about many things, but didn't claim to be the best experts on this topic.

In terms of general external hemorrhage control, PHTLS is advocating, instead of the old,
1. Direct Pressure/Pressure dressing
2. Elevation
3. Pressure Point
4. Tourniquet

Now according to (COTACS):
1. Direct Pressure/Pressure Dressing
2. Tourniquet
3. (Hemostatics in certain circumstances)

Make sure you know what your are doing with a tourniquet. Here is a refresher for you prehospital providers:

Originally Posted by PHTLS 6th Ed. pg 182

Sample Protocol for Tourniquet Application

1. Attempt at direct pressure or pressure dressing must fail to control hemorrhage.
2. A commercially manufactured tourniquet, blood pressure cuff, or "Spanish windlass" is applied to the extremity just proximal to the bleeding wound.
3. The tourniquet is tightened until hemorrhage ceases, and then it is secured in place.
4. The time of the tourniquet application is written on a piece of tape and secured to the tourniquet ("TK 21:45" indicates that the tourniquet was applied at 9:45PM)
5. The tourniquet should be left uncovered so that the site can be monitored for recurrent hemorrhage.
6. Pain management should be considered unless the patient is in Class III or IV shock.
7. The patient should ideally be transported to a facility that has surgical capability.

This is what .mil is using http://www.narescue.com/Product1.asp...&Product_ID=20 You can put it on yourself one handed!

As far as hemostatics and using tourniquets for long periods (anyone here should read this

Originally Posted by PHTLs (6th Ed) p 182, 189-190 Shock

Topical Hemostatic Agents....
The data demonstrating the effectiveness of the HemCon dressing and the QuikClot often include injuries (e.g. liver and aortic trauma) that correlate poorly with the types of injuries that prehospital care providers encounter. To date, no published data exist about the use of topical hemostatic agents in the ivilian setting, and only anecdotal reports exist for the military experience. A prehospital care provider might be tempted to delay transport to use one of these novel but unproven tecnologies. In the civilian setting, no data shows that these products are superior to direct pressure and rapid transport to an appropriate receiving facility. Application of HemCon and QuikClot may be appropriate in a prolonged-transport situation.

..........

Direct pressure is impractical during a long transport, so significant external hemorrhage should be controlled with pressure dressings. If these efforts fail, a tourniquet should be applied. In situations where a tourniquet has been applied and transport time is expected to exceed 2 hours, attempts should be made to remove the tourniquet after more aggressive attempts at local hemorrhage control. This can be accomplished by removing the pressure dressing from over the wound once the tourniquet has controlled the hemorrhage. Next, any blood clot is manually wiped from the wound. A topical hemostatic agent (first a HemCon dressing, followed by QuikClot if HemCon fails) should be applied and a pressure dressing reapplied. The tourniquet should then be slowly loosened while observing the dressing for signs of hemorrhage. If no rebleeding occurs, the tourniquet is completely loosened but left in place in case hemorrhage recurs. Conversion of a tourniquet back to a dressing should not be attempted in the following situations: (1) presence of Class III or IV shock; (2) complete amputation; (3) inability to observe the patient for rebleeding; and (4) tourniquet in place longer than 6 hours.

Considering that most places I could forsee the need for a hemostatic agent would involve prolonged extrication, I might bring it into the game earlier than PHTLS recommends if it is me and my buddies.

While the Wilderness Medical Society does not have anything in their Practice Guidelines covering hemostatics, PHTLS does comment on modified wilderness care:

Originally Posted by PHTL 6th Ed - p 553 Wilderness Trauma Care

Hemostasis
Control of bleeding is part of the primary survey. On the street, arterial bleeding can kill. In the backcountry, however, even venous bleeding can kill, if it continues for a sufficient time; every RBC counts. Therefore, bleeding control, using standard measures such as direct pressure and elevation are as important or more important in the wilderness.

At times, however, finding a bleeding site to provide direct digital (finger) pressure over the "bleeder" (bleeding blood vessel) is no that easy. Direct digital pressure for 10 to 15 minutes is far superior to a pressure bandage at controlling bleeders.

Therefor, some wilderness EMS protocols suggest using a a pressure point or a proximal blood pressure (BP) cuff as a tourniquet for 1 or 2 minutes to control the bleeding initially. Then, after letting the BP cuff down careful, the location of the bleeder usually becomes obvious, and a gloved finger covered with a gauze pad (to prevent slipping can be carefully placed over the bleeder for 10 to 15 minutes. If the bleeder starts bleeding again, direct digital pressure for another 10 to 15 minutes almost always stops it.

Note that we are suggesting using a BP cuff tourniquet for only a few minutes. It is important to remember to let the BP cuff down and not use it by itself to stop bleeding; otherwise , the limb might develop permanent damage.

Various companies market special dressings and powders and other devices.

OK that section was clearly not as well written as the Shock section. Clearly the author was different or the editors paid less attention. Nevertheless, the protocol suggested is interesting and I would think it a smart idea to use hemostatic gauze with that digital pressure/short TK combo.

I'll probably be taking a tactical care course for funsies this summer and retaking PHTLS next summer (which has surely been updated by now). Perhaps someone who has the latest info will post?

Originally Posted by AKPogue

Well if it is all you got then I would use it. However, there is so much out there I don't see any reason to carry them especially since their application is limited.

I was waiting for someone to say " depends "

I like to recreate with a ER physician cuz buddy claims he carries 1st & last aid

Thanks Summit, that protocol makes sense.

Originally Posted by XXX-er

anybody use feminine hygiene products ,I have heard some folks carry them in 1st aid kits ...they are after all designed to deal with bleeding ?

I've heard a doctor with a lot of expedition experience recommend them as wound dressings.

Originally Posted by DownhillRider

AKPogue, wondering if you could elaborate on the reasons behind using a tourniquet instead of quicklot? Just curious as from my understanding if a tourniquet is used it's very unlikely the limb will last more than a few hours, 6 at most. If for some reason it was required in a backcountry emergency wouldn't quickclot be better in regards to limb preservation? Thanks

Using quikclot itself can be damaging to tissues because it heats up during the clotting phase. It can cause 2nd degree burns. Now using something like quikclot combat gauze doesn't involve any heat whatsoever and could be used. The most important thing is to stop the bleeding fast!!! A tourniquet is much faster.

With TCCC(PHTLS), a lot of that training is geared towards non-medical types. So we tend to simplify it as much as possible. Having them put on a tourniquet gets the bleeding stopped and saves the person. It is much easier to screw up stopping the bleeding with quikclot. More experienced medical personnel are taught to stop the bleeding fast and use a tourniquet. Unlike what has been taught before that once you put on a tourniquet you can never take it off. Well some are teaching that there is no reason you can't loosen a tourniquet. What is the worse that could happen? The bleeding starts again!! Well if the bleeding starts again just reapply the tourniquet. There are some more concerns than just that, but those concerns are for more experienced medical providers.

What you always have to consider is most medical training incorporates a broad aspect. So not everything applies to every situation. From my experience, the majority of injuries in a civilian situation aren't going to need a tourniquet. Gauze and an ace bandage will stop almost every bleeder. Look how many different ways you can use this bandage.
[nomedia="http://www.youtube.com/watch?v=wMRklQkfDLE"]YouTube- Emergency Bandage (Israeli Bandage)[/nomedia]

Originally Posted by Summit

I'll probably be taking a tactical care course for funsies this summer and retaking PHTLS next summer (which has surely been updated by now). Perhaps someone who has the latest info will post?

Summit, you can look here for the latest TCCC(PHTLS) guidelines. They came out a few months ago.
http://www.naemt.org/education/PHTLS/TCCC.aspx

Originally Posted by nickinbc

I've heard a doctor with a lot of expedition experience recommend them as wound dressings.

Why would you carry tampons for that unless you have women with you? Why would you stock a first aid kit with tampons? Gauze can be used for so many different things why would you limit yourself with tampons for just one limited application. When I carry stuff in my first aid kit, I try to carry stuff that has as many applications as possible because I have a limit to what I can carry.