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This was another article from JEMS, please note the authors. This article was on hemostatic gauzes and their uses. This is another product and treatment not yet easily available to EMS agencies or even some ER's. The use of these gauzes does save lives but regular kerlix gauze also works well and has been proven to be very efficient. This is something our Advance Care Providers are teaching now and maintain their own skills to maintain proficiency.

Use of Topical Hemostatic Dressings in an Extended Field Care Model. Welch M, Barratt J, Peters A, Wright C. J Spec Oper Med 2021;21(4):63-65.

The proper application of hemostatic agents can be a lifesaving intervention for exsanguinating external hemorrhage. Packing wounds not amenable to tourniquet placement, especially in junctional areas (neck, shoulder, axilla, and groin), is a well-practiced skill by both military and civilian providers. Multiple studies and articles have validated the efficacy of hemostatic agents.

Military forces operate in all areas and conditions. As military operations shift to austere environments, evacuation of casualties to definitive care becomes longer and involves greater distances. An unanswered question is whether or not the homeostasis achieved using homeostatic agents will last long enough for the injured to reach higher levels of care or will bleeding resume due to the prolonged transport time and movement while in transit?

The authors examined how long Celox gauze, a hemostatic agent commonly used by the British and US military, would curtail hemorrhage using limited resources. The authors had access to a single anesthetized swine which was previously used by another team and treated surgically for a simulated thoracic injury with minimal blood loss. For this study, the animal received bilateral femoral arteriotomies. Army physicians packed both surgical wounds with Celox gauze. Hemostasis was achieved and the packed wounds were wrapped tightly with standard gauze. The animal received fluid therapy and standard anesthetic sedation for eight hours before being euthanized. During that eight-hour period, the dressings were checked every two hours for a return of bleeding or leakage.

There was no reoccurrence of bleeding seen. The swine’s vital signs remained predominantly normal, although the blood pressure did vary slightly, which was attributed to the medications used for anesthesia. After euthanasia, the dressings and Celox were removed. There was no obvious adverse reaction to the skin, blood vessels or wound around the surgical incisions. A basic autopsy was also performed to assess for thoracic bleeding from the prior surgical study and no bleeding or adverse effects were seen.

By using bilateral femoral arteriotomies the authors were able to study two junctional wounds on one animal. They acknowledge that more research needs to be completed with more than one test subject and two test sites. Further research needs to be done using different hemostatic products, various lengths of time, and a mobile environment to simulate patient movement and extended transport times and distances to higher levels of care.

This limited research does suggest that hemostatic agents, in this case Celox gauze, can be effective in maintaining hemostasis for longer than the acute phase of wound care without causing tissue damage to the surrounding structures. This study has important implications, not only for the military, but also for the use of these agents in civilian prehospital care in rural and wilderness settings which involve prolonged transport.



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