Woundstat, Quikclot, and Hemorrhage Control for EMS Providers

Listener Jerry from Australia asked me recently about any new news from the U.S. military on their discontinuation of the use of Woundstat late last year following findings of potential for the granules moving through the body and causing an embolus elsewhere in the body such as the heart or lungs.

I covered this back in Episode 165 of the MedicCast on EMS tourniquet use.

Here are some of the thoughts I had on this topic based on some other news and information I have received.

EMS Hemorrhage Control – Risk vs Benefit

Based on the findings from the Army Times article I covered in the episode above, the reasons for the stoppage make sense.  Like so much going on in a multisystem trauma patient, it is hard to pin down just what causes the balance to tip from life to death.  Hemorrhage is just one factor along with hypothermia, airway management, vital organ damage from initial injury and others.

The fact that the use of the wound stat and other quick clotting products have adverse affects always has to be weighed against the risks of using other methods to control serious bleeding.  For extremity trauma, rapid assessment and tourniquet application is still a better alternative with fewer negative outcomes when surgical intervention is available within 6 to 8 hours.  For central open wound hemorrhage, the possibility of a embolus forming following the use of granular products is a real possibility, based on the findings from military study and autopsy.

Hypertonic IV Fluid Use and Volume Replacement

The latest trend that seems to show promise is to use hypertonic IV fluids to bolster BP and fluid volume in the field.  It requires less volume to be carried by the medic and the short term fluid shift provided seems to be similar to the application of isotonic crystalloids.  Again, this is all based on rapid evac to a surgical center for definitive treatment.

Remember to always follow your own medical direction and protocols, of course.