External Hemorrhage Control – Evidence Based Pre-hospital Guidelines
External hemorrhage is recognized as one of the main causes of potential preventable death following severe injury but the choice of treatment and what first aid kit to carry can be confusing for law enforcement and other emergency services.
Lessons learned from the military on external hemorrhage control are beginning to be adopted in the civilian community. The American College of Surgeons Committee on Trauma have published evidence-based recommendations for what to use. Here is a summary of their recommendations concerning hemostatic agents.
1: They advise that topical hemostatic agents use be expanded to include all prehospital personnel, including emergency medical responders.
2: Use topical hemostatic agents in combination with direct pressure, to control significant hemorrhage in a pre-hospital setting, for junctional and torso wounds where sustained direct pressure alone isn’t effective or practical. There is consistent data showing reduced hemorrhage with these agents compared to standard gauze.
3: Hemostatic agents should be in a gauze format that supports wound packing. This recommendation was based on the military experience and the animal studies suggesting that products that allow packing of the wound have superior hemorrhage control.
4: Only products that are effective and safe in a standardized laboratory injury model should be used. They identified the U.S. Army Institute for Surgical Research model.
Training recommendation: topical hemostatic agents should be used under clinical practice guidelines and following product specific training, and should be expanded to include all pre-hospital personnel, including medical responders. Also that hemostatic agent training for pre-hospital personnel should include proper wound packing and pressure application techniques.
This kind of evidence based review is really important as emergency services look at the military experience and work out what training and equipment they need, so we welcome and strongly support these guidelines.
Celox Gauze and Celox Rapid Gauze meet all of the criteria above and Celox Gauze has been approved by the CoTCCC for US military use. Our training material is also available for units to meet the ACS training recommendations.
