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Blood Clotters

SWAT medics report their findings on high-tech hemostatic dressings used to stop bleeding when seconds count.

August 01, 2004  |  by Dr. L. Heiskell, Dr. B T. Olesnicky, & Dr. S. Vail


Rapid Deployment Hemostat Bandage, or RDH, is manufactured by Marine Polymer Technologies in Danvers, Mass. The material used to promote blood clotting, poly-N-acetylglucosamine (p-GlcNAc), is derived from single-cell algae found in the ocean.

The RDH Bandage enables field personnel with minimum training to rapidly and efficiently stop arterial and other hemorrhage resulting from extremity trauma. The development of the RDH battlefield dressing is the result of a successful collaboration between Marine Polymer Technologies and the Office of Naval Research.

When the RDH Bandage comes in contact with blood, it stimulates platelet activation, which leads to the secretion of a substance known as Thromboxane. The Thromboxane stimulates the constriction of blood vessels near the wound, which helps slow blood flow there. According to literature from Marine Polymer Technologies, the mechanism of poly-N-acetylglucosamine applied directly to the bleeding wound via a bellows applicator. TraumaDEX is packaged in sterile .5-gram, 2-gram and 5-gram applicators that are small, extremely lightweight, and fit anywhere in your trauma kit.

To use TraumaDEX, remove any excess blood from the wound site using a bandage or gauze. Apply the TraumaDEX powder to the bleeding source and immediately apply direct pressure.

The St. Paul (Minn.) Department of Fire and Safety Services paramedic units are currently using TraumaDEX to assist in wound management with severe bleeding in the pre-hospital setting. Other studies on the effectiveness of TraumaDEX include the Mayo Clinic and the Minneapolis Medical Research Foundation. However, results are not available.

TraumaDEX does not cause an exothermic reaction, so there is no risk of secondary burns to the skin as is found with QuikClot. Also unlike QuikClot, TraumaDEX is reabsorbed naturally by the body within hours and does not need to be washed out of the wound prior to definitive wound repair. It is also very reasonably priced. The 0.5-gram package is $7, the 2-gram package is $15, and the 5-gram package is $25. TraumaDEX is biocompatible, and there is no risk of transmission of disease or immune response. The shelf life for unopened packages is three to five years.

Urgent QR

Urgent QR is manufactured by Biolife LLC based in Sarasota, Fla. The material is composed of a non-toxic polymer and a potassium salt along with a bovine based thrombin material. The following information was supplied in monograph, prepared by John W. Roberts, PhD, director of technology, at Biolife.

According to company literature, Biolife’s initial core brand is QR (Quick Relief) powder, a wound dressing and highly cost-effective topical powder that stops bleeding instantly. It also acts as a protective barrier and bactericide to protect wounds.

There are several other products, each with a specific use. For example, Super QR is for major or severe wounds, Urgent QR is for minor wounds, Nosebleed QR is for nosebleeds, and Oral QR is for oral wounds and to stop bleeding due to oral surgery and tooth extractions.

Product literature supplied by Biolife states a 96-percent success rate in an ongoing clinical study treating lacerations, nosebleeds, skin tears, punctures, and abrasions. Normally, for minor wounds, no covering bandage is required.

Clinical evaluation trials of QR were studied by David Letts, M.D., at the Sarasota Medical Center in Sarasota, Fla. However, no results have been published.

QR Powder works independently of the normal blood clotting mechanism of blood clotting. QR Powder was tested by an independent FDA-licensed testing laboratory and showed neither toxicological nor allergenic effects.

Urgent QR is available either in four, 30, or 100-blister packs per box. All versions of the QR products are packaged in hermetically sealed blisters to maximize product shelf life. The cost, according to company literature, is around $1.70 for the consumer in a 30-blister pack and around $2 for the professional product in a 30-blister pack.

What Works?

Each hemostatic dressing is derived from a different source. One is derived from algae, one from potato starch, another from lava rock, another from the thrombin in cow’s blood, and yet another from marine exoskeletons (chitin).

And they come in different forms: Some are powders and other are bandages. But all of these products have at least one thing in common: Their manufacturers claim that they work in seconds.

The question law enforcement agencies must ask is, “Do they really work?” and what should they consider for purchase and distribution to patrol officers?

Unfortunately, there are conflicting reports in the medical literature regarding what bandage is the most effective. Some product literature from the manufacturers claims the U.S. Military has had extensive success using their products in the field. In our investigation this was found not to be true.

This issue is further clouded by conflicting reports and anecdotal evidence obtained from personal interviews with surgeons, emergency physicians, nurses, and Navy Corpsmen who treated combat casualties during the war in Iraq.

Unlike drugs that require years of testing and approval by the FDA, the manufacturers of hemostatic dressings are not required by law to conduct extensive research to support their claims.

After conducting our review, it is the opinion of the authors that more scientific studies should be conducted by independent agencies and organizations that have no financial relationships or conflict of interest with the manufacturers.

When these studies are completed, the medical community will have a better picture of which product is the most effective and cost efficient.

Useful Tips

If you do choose to use one of these dressings, you can use certain techniques to ensure you get the best results possible and enhance their efficacy.

It stands to reason that if the bleeding is under high pressure or very brisk, none of these products is going to work. You’ll need to apply direct pressure to the wound or to a pressure point above the wound. If you get the bleeding slowed with a pressure point, you might be able to get the wound dry enough to apply the material into the wound and allow it to work. After the dressing is complete, the tourniquet or pressure point may be released.

What would make the ideal hemostatic agent? It should be inexpensive, not cause allergic reactions, not need to be washed out, and able to be delivered into any kind of wound. Above all, it should work and not cause any harm.

There is one thing we do know and that is that the time-honored method of using direct pressure and a tourniquet for a bleeding injury really works. It seems prudent that a police officer should use the simplest and easiest technique in the field for hemorrhage control.

We recommend that law enforcement agencies proceed with caution before spending valuable resources on the new blood-clotting agents available until further studies are done and stick with old-fashioned direct pressure and tourniquets.

Lawrence E. Heiskell, M.D., FACEP, FAAFP, is a practicing emergency physician, a reserve police officer, and a tactically trained SWAT team physician with the Palm Springs (Calif.) Police Department, as well as a member of the Police Advisory Board.

Bohdan T. Olesnicky, M.D., is a practicing emergency physician who serves as a tactical medic and SWAT team physician with the Clifton (N.J.) Police Department and the Saint Barnabas Healthcare System Special Operations Division in Livingston, N.J.

Sydney J. Vail, M.D., FACS, is the director of trauma & trauma critical care at the Carilion Health System Level 1 Trauma Center in Roanoke, Va., and a member of the Tactical EMS Support team for the Salem (Va.) Emergency Response Team.

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Comments (1)

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AL Lawrence @ 4/21/2012 7:37 PM

I think Hemcon is a great product but it's very cost effective especially if it's not used in a six month period.

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