TRAINING BULLETIN #158

Transcription

1 TRAINING BULLETIN #158 Quick Clot Combat Gauze And Hemostatic Dressing HEMOSTATIC DRESSING I. Introduction Hemostatic dressings are designed for the control of traumatic exsanguinating external hemorrhage, which is unable to be managed by direct pressure and/or tourniquet application. The Los Angeles Fire Department (LAFD) has purchased QuikClot Combat Gauze - LE Vacuum Packed & Z-Folded Hemostatic Dressing for use on both Basic Life Support (BLS) and Advanced Life Support (ALS) resources. II. Features QuikClot products are impregnated with Kaolin, an inert, naturally occurring substance that works by interacting with a protein found in the blood, which promotes acceleration of the body s existing clotting capabilities. It also helps foster platelet adhesion at the wound site for clot formation without producing heat. QuikClot Combat Gauze LE is sterile gauze 3 wide by 4 yards in length and is in a z-fold format to facilitate wound packing. It is flexible and absorbent, conforms readily to the injury site and will not break down or fall apart under pressure. It comes sealed in a vacuum-packed, plastic pouch with tear points for rapid opening. The distinct packaging will facilitate differentiation from the standard 4 x 4 or roll gauze.

2 III. Indications for Use/Contraindications QuikClot Combat Gauze LE is indicated for pre-hospital use, to control traumatic exsanguinating hemorrhage in external wounds that are not amenable to direct pressure and/or tourniquet placement. The following are the most common anatomic locations where QuikClot should be considered: 1. Axillary wounds 2. Wounds to the groin (femoral artery) 3. Neck wounds Remember that bleeding from most wounds can be controlled with either direct pressure and/or tourniquets. QuikClot should be considered for wounds with profuse bleeding and where a tourniquet is not an option. Direct pressure and elevation should be the first steps in bleeding control, followed by tourniquet application. If bleeding is not controlled, consider the use of hemostatic dressing. Hemostatic agents are not appropriate for use with vaginal bleeding or other forms of non-traumatic internal bleeding. IV. Application Expose injury and determine need for bleeding control, and locate the source of the most active bleeding. Apply direct pressure and elevate the injury site, if possible. If further bleeding control is required, apply tourniquet(s) per protocol, if possible. If additional bleeding control is necessary consider use of hemostatic gauze by following these procedures:

3 Step 1: Confirm product sterility by ensuring the outer package is not torn or punctured (products are single use only). Open the package utilizing a tear point and remove gauze. Keep the package to provide hospital staff with product removal instructions. Step 2: Apply the packing into the wound by gently inserting gauze, 1-2 folds at a time, into the wound opening until the wound cavity is filled ensuring that contact is made at the site of the bleeding blood vessel. Excess gauze should be used for application over the site of the packed wound. Step 3: Apply direct pressure on top of the packed wound and hold for three (3) minutes or until bleeding stops.

4 Step 4: Reassess wound for bleeding. If bleeding has stopped, leave gauze in place and wrap with sterile dressing. Alert hospital staff of the application of a hemostatic dressing and provide packaging for removal instructions. If bleeding continues after 5 minutes of direct pressure, consider application of a second hemostatic dressing. Remove initial Combat Gauze and re-pack wound with a new/sterile Combat Gauze. Application - Key Concepts: Assess patient and establish need for bleeding control of traumatic exsanguinating hemorrhage. Apply direct pressure, elevate affected area, and determine need for tourniquet, and place per protocol if appropriate. If bleeding continues, or unable to apply a tourniquet, apply hemostatic dressing. Open package, pack wound, apply direct pressure for at least 3 minutes, or until bleeding stops, and wrap with sterile dressing. Reassess patient status at least every 5 minutes. ALS/BLS transport, as required as per Department of Health Services Trauma Triage policy, Reference 506, and/or LAFD Patient Resolution Guide (PRG). V. Documentation Document the use of the hemostatic dressing under the treatment section. Narrative should include assessment findings, site/location of active bleed, steps taken to stop bleeding, and effects of

5 hemostatic dressing. VI. Distribution/Ordering Initial distribution will be two (2) QuikClot Combat Gauze to each BLS and ALS resource. The products shall be placed inside the Trauma Treatment and Evacuation Aid Bag, in the B/C (bleeding/circulation) compartment, as described in Training Bulletin 157. The replacement hemostatic dressings will be issued by the EMS Battalion Captains, to ensure inventory control and proper use. VII. Training and Support Initial training will be presented by Tactical EMS (TEMS) Specialists who will present a classroom session and skills verification. The EMS Training Unit may be contacted for ongoing training and support. EMS Battalion Captains will provide post-incident epcr review of ALL hemostatic dressing use, and will provide the replacement dressings. It is their responsibility to reaffirm and reinforce related policies and training materials as necessary. VIII. Conclusion Hemostatic dressings are an effective tool in helping trained members control severe external hemorrhage not manageable by other means. A video presentation of QuikClot products can be viewed at the Z-Medica training website by establishing a free account at: Commanding Officers shall document review of Training Bulletin No. 158 in Network Staffing under F-393, Code 11GF. The training session time is estimated at 1/2 hour.