View Single Post
Old 06-23-2008, 21:39   #52
Join Date: Apr 2008
Location: Philadelphia area
Posts: 8
Originally Posted by Surgicalcric View Post
You may need to do a lil research on the effectiveness of hemostatic agents outside the confines of the ER/ED or civilian EMS. Out here where bright lights and cold steel may be more than a day away Hemostatic agents have saved many lives and the benefits are more than a fair trade for the little weight.

Surgifoam/surgicel has its place in the spectrum of care. Replacing QC, Hemcon, etc in the combat setting isnt it...
The study I am basing this on is referring to field use, not ER. I left my hard copy at work, and will reference it directly tomorrow. The point I was getting at was that twenty years ago MAST was the next big thing, and in theory they work great. In practice MAST did not make a realistic difference in patient outcome, and it took years of collecting data to prove that. The same goes for aggressive fluid resuscitation. Two large bore IV's pouring in Saline were the norm for a good period of time. It is no longer the standard of care, after decades of studies.

I have read Blakes report on tactical care in 2007, and just rechecked the section on hemostatic agents, specifically in the 64 uses of HemCon in combat situations. What I think Blake fails to take into account is the body's natural tendency to shunt off peripheral bleeding. There is nothing to say these wounds would not have eventually stopped bleeding with a pressure dressing. Incidental field data (with 6,000+ wounded in 2007 alone) of a sample of 64 uses may or may not be considered definitive. In Alam's article “Hemorrhage Control in the Battlefield: Role of New Hemostatic Agents” hemostatic agents are given a favorable review, but it is noted that clinical data is mixed, including two parallel studies on a chitin dressing that produced opposite results. It should also be noted that many of these studies observed the effectiveness of hemostatic agents on thoracic and abdominal injuries as opposed to peripheral vascular bleeding. This leads to higher overall success rates, while in my opinion diluting data on realistic field applications.

I like the extended transport time argument for things like PO antibiotics, advanced orthopedic care, and as justification for carrying extra rehydration fluids and effective volume expanders. But the long term data shows exanguination happens in the first 5 minutes, making it a short term problem, the patient with massive peripheral bleeding is either going to be stable or dead in a very short period of time.

Originally Posted by Surgicalcric View Post
A BP cuff is considerably larger than a TQ and as such would add bulk to the IFAK and weight too. One TQ is also NEVER enough. Two is one, one is none and sometimes more are needed..
I agree a BP cuff is larger than a TQ, but I think the BP cuff serves a variety or roles, as opposed to one filled by a TQ. I understand the need for redundancy, and I think the individual might be best served with a variety of equipment, and given the ability to prepack, I would take a cuff first and a TQ second.
VXMerlinXV is offline   Reply With Quote