View Single Post
Old 06-24-2008, 09:48   #55
Quiet Professional
Surgicalcric's Avatar
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
Originally Posted by VXMerlinXV View Post
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 as well read study after study of the effects of HCA's. My decision to carry and use them is based on the number of lives/limbs saved using HCA's here, where the rubber meets the road. In a couple decades we can revisit this topic as they have with fluid and the MAST. Today they are working.

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.
All bleeding eventually stops. There is nothing to say it would have stopped with the use of pressure dressings alone either. BTW, HCA's are used ICW pressure.

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.
How is the use of HCA's on torso injuries inconsistent with realistic field application? If I did a study on the efficacy of clamping extremity bleeders would the same data not be consistent with use in the torso/ABD as well? People can bleed out from torso wounds just as easily, if not more so due to the complexity of hemcontrol in these areas. In fact, it is easier to gain hem control in the extremities due to the number of available options at hand. Groin/axial bleeds are some of the most difficult to gain hemcontrol on without having surgical access/ligation/clamping available. The same holds true for intra-thorax/ABD bleeds.

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.
How long does it take to bleed out from a femoral artery or a brachial artery? Less than 5 minutes. The longer we fiddle-fuck trying things that may or may not work the more blood is being spilled in the dirt; once its gone its gone. So, for those areas where the EVAC is extended it is even more important to stop it FAST using whatever tools available. After I have it stopped and all other life threats are dealt with I can think about going back and downgrading TQ's to PDs and PD's to bandages...

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.
As for you carrying a cuff, you work in a different environment than we do; think about that. Based on years of "lessons learned" from the current conflicts, not to mention past conflicts, and drawing from my experiences in the civilian side (paramedic and trauma tech working in a L1 center) and my time as an 18D, I will take the TQ's, 2 please. They are light, small, and most importantly, they work. They are also not subject to atmospheric pressure changes..

In finishing, HCA's are but another tool for the tool box. They arent the be all, end all for hem control...but they are working and shouldn't be left behind, to save ounces, in hopes that a standard pressure dressing will work.

In EMS there is talk about the "Golden Hour" (the time from injury til arrival at a definitive care facility) and getting the patient to the "bright lights and cold steel" as soon as possible. On the battlefield the SF Medic is often times that definitive care; the bright lights and cold steel...



You are out of your lane...

It is obvious your ideas, methods, education, and surroundings differ from mine/ours somewhat, which is all well and good. However you need to consider your frame of reference and post accordingly. This is a very different world from yours, one I didn't fully understand when I was working in the civilian side of the house either. You are more than welcome to participate but dont fool yourself into thinking that you have any idea about what works and what doesnt, or what is a waste of space on the battlefield even if you have read a report or two...

"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc

Last edited by Surgicalcric; 06-24-2008 at 14:11.
Surgicalcric is offline   Reply With Quote