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As of this update, there's been a lot of research done thanks to military medicine about hemostatic agents. They come in a different form than we might see out here where it's in bulk in the military setting. And we might see it integrated into even something as little as a one by one gauze bandage. In this case, the actual hemostatic agent has been impregnated into the bandage itself. And it's meant for just small venous bleeds and capillary bleeds. But in arterial bleeds or in abdominal explosive types of accidents, we see it come in packets as a powder. And it can be basically opened and poured into the hard to control bleeding abdomen or wound and helps to coagulate that bleeding. So it will clot that off and give us some time 'til we get them into a surgical center where it can be controlled through surgery and repair. It's something we need to be aware of. It does come into two different forms, powder and impregnated in the actual bandages themselves. And it is meant to be used when normal bleeding control methods are not being as effective or when we see delayed response from emergency medicine. Or we may be far off in distant areas. Wilderness medicine, forestry, mining, and we have a delay of extrication of the victim. So just something we need to be aware of. Now in this update training that hemostatic agents are available and they're commercially available for use when we're maybe having difficulty controlling bleeding in the normal traditional methods.
A hemostatic dressing is any dressing treated with an agent or chemical that assists with the formation of blood clots. Much like tourniquets, hemostatic dressings are used with direct pressure to help control severe, life-threatening bleeding.
Hemostatic dressings are usually only considered an option if:
- The bleeding is life-threatening
- The standard procedure of direct pressure failed
- The injury is located where a tourniquet wouldn't work, such as the torso, abdomen, groin, and neck
- A tourniquet was unavailable or ineffective
How to Provide Care
After you make sure the scene is safe, proceed with the following steps.
- Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol.
- If the victim is conscious and not in shock or showing signs of other life-threatening injuries, ask him or her to help apply pressure to the wound.
- Once you determine that direct pressure alone isn't working, and you've decided against using a tourniquet, apply a hemostatic agent or dressing to the wound followed by more direct pressure.
Pro Tip 1: Hemostatic agents come in powders and dressing pads of numerous sizes. For large open wounds, you can pour the powder into the wound which will help speed up blood coagulation and clotting. If you're using hemostatic dressing with a large open wound, make sure you pack the dressing deep into the wound and apply continuous pressure until the bleeding is controlled.
Hemostatic agents are an ideal option when EMS services are delayed or unavailable, perhaps in a wilderness setting, or when normal bleeding control options are ineffective. And like tourniquets, when it comes to hemostatic agents, you're just trying to buy some time before getting the victim to a surgical center for proper care.
A Word About Internal Bleeding
Internal bleeding is the blood loss from veins, arteries, and capillaries into spaces inside the body. This can be caused by injuries like blunt force trauma and fractures, but also due to certain medical conditions.
Internal bleeding can also include external bleeding from the same incident. Consider how a knife wound could cause both internal and external bleeding simultaneously.
Common signs of internal bleeding include:
- Discoloration of the skin
- Bruising and tenderness
- Nausea, vomiting, or coughing up blood
- Discolored, painful, tender, swollen, or firm tissue
- Victim protectively guarding the injury area
- Rapid pulse or breathing
- Moist, cool skin
- Pale or bluish skin
- Drop in blood pressure
If you suspect that someone is bleeding internally, call 911 immediately and help keep the victim as still and calm as possible to reduce the heart's blood output. Also keep an eye on the victim for any signs of shock.
Pro Tip 2: When internal bleeding is from the capillary blood vessels, the result is bruising around the wound area and is not serious. To reduce discomfort for the victim, you can apply an ice pack to the area.
Like internal bleeding, injuries requiring a hemostatic dressing should be considered serious. And as with all bleeding injuries, you simply want to find the bleeding and stop the bleeding, by any means necessary.