# HEMCON for QUICK CLOT?



## DFW2T (17 Mar 2006)

I have read the forums and the pros and cons of QUICKCLOT.  I am wondering if anyone has used HemCon bandages and could they be considered a less invasive alternative to the QUICKCLOT.  Any feedback will greatly be appreciated.

Cheers 
DFW2T


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## JANES (17 Mar 2006)

I would love to reply with a very accurate and helpful post, but unfortunately I will be told I'm wrong and given another warning.  Sorry!


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## Armymedic (17 Mar 2006)

JANES, you could pm your helpful post and I could post it for you.

I don't have first hand knowledge of HemCon use. I played with it, but never used it. Everything I know is what I have read or heard from Marine Corpsmans I worked with in Afghanistan. 
Chitosan based dressing were tried by the US Navy and Marines. It comes in a 4x4x1/4 inch square wafer. To apply, you press the Chitosan against the area of bleeding.

As for invasiveness, you would have to press the dressing up against the bleeder.

For simplicity of use, Quicklot is easier (basically, just pour in), it is also cheaper. As for effectiveness, I believe they found Chitosan to be more effective, but that is in OR tests, and  I have no references handy. There are no immediate side effects with Hemcon dressings (they don't heat up and burn) but there is a small chance of someone with a shellfish allergy reacting poorly to the dressing.

My unsubstatiated opinion is that Hemcon would be more invasive as you need to push a chunk of the material into the wound and against where the bleeding is coming from.


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## DFW2T (17 Mar 2006)

Muchly appreciated....Janes, feel free to PM me.

Cheers


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## buzgo (17 Mar 2006)

http://www.medscape.com/viewarticle/498572

Here is some more info, pros and cons of Hemcon and Quikclot.

I think there was some talk over on Lightfighter about it too.


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## JANES (18 Mar 2006)

signalsguy said:
			
		

> http://www.medscape.com/viewarticle/498572
> 
> Here is some more info, pros and cons of Hemcon and Quikclot.



I feel the need to comment on this article.  The article is old.  

Ref the Hemcon (Chitosan), it is now available to foreign and non-military personnel (with a perscription!, how does that work???).  The other disadvantage is that it is relatively small and you need a few of them for a larger wound.  That can get expensive fast, not that cost matters given that situation, but for the people buying it, it does.  As soon as the dressing gets wet it sticks.  When it touches blood, it sticks.  It will adhere to the wound and start clotting.  Deep bleeder?  Who knows?  You can download their video on their website.

The article states Quick Clot is good for "intrathoracic" wounds.  I would question this as it is not for interenal use.  Probably not a god idea to get a funnel out and start pouring this stuff into someones chest through a bullet hole.  They might get a little heartburn.  I can see it being perfect for maybe an intercostal bleed or possible a subclavian bleed treated by pouring it on the surface, if the woud is open, but for an actual intrathoracic bleed, which sounds to be like you are pouring it inside the chest cavity, that sounds kind of scary.

Also Quick Clot has solved their cumbersome packaging issue.  

All the Red Cross Fibrin-based Dressings have been recalled.  When they were available, they cost about $1000 each.

Favtor VIIa is a long way off due to temperature stability and cost.

For all out there who are wondering which is better, the Hemcon or the Quick Clot, I would say they both have their disadvantages and advatages.  And both need to be used in a specific way.  They are both good products and good tools in the toolbox, if you educate yourself on how they work and why they work.

I will also offer this.  We may see somthing better than both of them in the very near future  .  But what do I know, I have an empty profile!


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## DFW2T (18 Mar 2006)

Alot of good info in there......thanks.   

Cheers
DFW2T


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## Armymedic (18 Mar 2006)

JANES said:
			
		

> But what do I know, I have an empty profile!



Geez....bitter?  

I haven't heard of much "in the field" military use of Hemcon, except from the corpsmen I was talking to.

I find the thought of someone pouring Quick clot into a thoratic wound a bit scary as well.


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## medicineman (18 Mar 2006)

Armymedic said:
			
		

> I find the thought of someone pouring Quick clot into a thoratic wound a bit scary as well.



No different than pouring into that wide open pig`s groin in the video.   ;D


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## Big Red (18 Mar 2006)

I used a Hemcon on a laceration requiring stitches that a pressure dressing wasn't stopping. The Hemcon stuck to the blood and stopped the bleeding.  I believe they are worth about $150 for a 4"x4" dressing, but I didn't pay for mine.


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## Big Red (18 Mar 2006)

Just to add, I havent heard of anyone carrying the Hemcons issued besides SF types. I believe the cost is prohibitive for them to be handed out in individual first aid kits for the entire army if Quickclot does the job for alot less money.  They also don't have a very long expiry date.


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## JANES (18 Mar 2006)

The Hemcon dressings shelf life was supposed to be incresed from 18 to 36 months.  I'm not sure whether this has happened yet or not.  They cost $100 USD's per dressings.  Temp storage is rated up to 50 C.  Hard to distiguish sides through NVG's.  Ineffective if they get wet.  Not to be used intra-abdominally, though intitial tests on pigs had them stuffed into lacerated livers saving pigs with an injury that was previously untreatable.  There is the shellfish allergy issue too, though none have occured to date.  After placement the dressing stays on for 48 hours.  Be cautious of aggressive fluid resus post application, as it may "pop the clot" even with the dressing on.  And everyone (US Army) is supposed to eventually get one in their IFAK (improved first aid kit).  Here's my reference for that one: http://www.usmedicine.com/column.cfm?columnID=217&issueID=83  Para 14ish, that should keep some of you happy!

Each Marine gets a Quick Clot, and so does every deployed CDN soldier.


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## kj_gully (18 Mar 2006)

Hijust a couple more points on Hemcon. Anecdotally, hemcon outperforms quikclot in the field, the worst bleeders seem to 'wash away'the quikclot. It (hemcons) dressing does not heave a CE approval, that is coming, this autumn, and will help with the approval process in Canada (not currently  approved for use WITHIN Canada). one of the main draw backs of hemcon is its relatively inflexible, sort of like high density foam. They are trialling a kerlex type guaze impregnated product which shows promise. Now all the proceeding is from my discussion with the company reps, so is obviously biassed. But I will put this out to any movers and shakers, ie multi bar on shoulder +, they offered to allow access to their live tissue lab in Portland Oregon to use whatever products we wanted, as long as we tried their products as well.


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## JANES (18 Mar 2006)

Quick Clot won't wash away if used properly, and I think thats the problem with the anecdotes, especially the field report from 03, was that tourniquets or indirect pressure were not applied first and the blood in the wound not soaked up.  Those are the bigest problems with the Quick Clot, not what it does, but how it is used.  If used properly - stop the bleeding above the wound with a tourniquet or indirect pressure, then soak up the blood, then apply the Quick Clot, then apply a dressing and pressure - there should be no problems, and theoretically better than the Hemcon because it can be used on large multlilated wounds which are the norm.  Then you can release the tk or the pressure point and it should hold.  Of course it will wash away and not work if the wound is pouring blood.  And if you pour it in a big pool of blood, then it will heat up.  The bad press Quick Clot got was from lack of instruction and lack of understanding of how it works.  The little 4x4 Hemcon don't stand a chance against large shrapnel wounds and blast injuries.  I'm not saying that the Hemcon is no good though.  Trust me though, there's a new one in the works that might just beat them both!


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## kj_gully (18 Mar 2006)

Well I'm glad your self imposed exile was short lived. I know quikclot's probs are mostly due to improper use, I'm just passing on what I got. It is pertinent however, because it will often be used improperly. what do you think about the quikclot in the mesh bag? As for heating, I know that the studies have said it burns I believe 4mm of tissue surrounding, worst case, and independant med pers have wondered if that may be theraputic cautery. I was impressed by hemcon's pitch, and their passion. It's early days in development, and i share your faith that better products are on the horizon. I think they both serve a purpose, and both should be made available. It would definitely take some ingenuity to make hemcon work on the nasty wounds you mention, but you can fold em cut em and stack em like shingles, and the product literature is pretty inventive. They basically glue together, and will form a large sheet, but it would be a costly dressing.


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## JANES (19 Mar 2006)

My opinion of the mesh bag is mixed.  On one hand it will burn less because less of it will be exposed to the wound at a slower rate.  It also solves the problem of cleaning it out of the wound.  On the other hand it limits the application to the size of the mesh bag.  I wonder if it will work like a sponge that you can dab on the wound, or more likely if the clot will adhere to the mesh bag, then you can't turn it over and use the rest of the quickclot in the bag on the other half of the wound.  It will be interesting to see real use data come back from these.


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## JANES (24 Mar 2006)

A little more info on the QC sponges.  They are currently only being trialed by a select few (US  & CDN) in theatre.  Initial reports are good.  They talk about less heat, and that you dab the dressing, so apparently it doesn't adhere to te wound.  Not sure how you can apply pressure if you're dabbing.  So far looks good, but thats just the word on the street.  No hard facts.  Still isn't Health Canada approved (the sponge).


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## JANES (11 Apr 2006)

Feels like I'm talking to myself here.  The teabags still get really hot.  The granules are a bit larger.  You can still cut the bag open and pour the kitty litter in too.  Feedback so far is marginal.


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## big bad john (6 Jun 2006)

I saw an article in this months Soldier Magazine the offical magazine of the British Army and thought that it was on subject and would be pertinent.

http://www.soldiermagazine.co.uk/mag/kitstop.htm

MEDICAL scientists have turned to Mother Nature in their efforts to stop life-threatening bleeding from front-line injuries. 

QuikClot and Hemcon are simple to use and ideal when a field dressing fails to stop haemorrhaging, the wound has a curved or irregular shape or it is so high up a limb it’s too difficult to apply a tourniquet. 

The Hemcon dressing is impregnated with chitosan, a substance with powerful sticking properties taken from crushed shrimp shells. 

Once applied to severely bleeding arteries or penetrating wounds, Hemcon forms a strong but flexible antibacterial barrier that seals the injury for up to two hours and reduces the risk of infection.

The dressing is safe to use on soldiers who are allergic to shrimps and is easily removed with water. QuikClot is a powder made from volcanic rock that can be poured into any shape of wound. It works by speeding up the body’s natural blood-clotting process, which can be too slow to stop a large volume of blood escaping from an injury. The powder also rapidly sucks up the water in blood, leaving behind clotting components such as platelets to form a plug that stops further blood loss. 

When QuikClot comes into contact with blood it generates a lot of heat so medical teams should carefully consider whether it is safe to use on certain injuries.

Both products are now being used by medics to treat combat injuries sustained in theatre.


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## JANES (10 Jun 2006)

HemCon has come out with a thinner more plyable dressing with the same effectiveness.  They have also pretty much completely solved the quality control issue they had a few years back that some people still talk about.  They are also making smaller sizes at a much more affordable price.

And to get back to the initial post.  I would say that HemCon is a safer less invasive product.  I have heard that surgeons are having to do some serious debridment of wounds that QC was poured into, to the point of actually cutting away burnt tissue.  This is still probably a training issue.  They are both good products and both have their place, but HemCon is no doubt safer.  Quick Clot is a last resort.


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## kj_gully (21 Jun 2006)

Just read in the journal of special operations medicine, reprinted from journal of trauma:injury, infection & care, october 2005- 
in trial of fatal exsanguinating femoral wounds in swine, Quikclot, Chitosan (hemcon) and fibrin dressing   ( heard of but not seen by me) were tested under identical conditions. standard control was army (US) Field Bandage. after 45 seconds of bleed, each hemostatic agent was applied twice, for 3 min/time,through blood pool. Results: AFB: 0 hemostasis, Quikclot: 0 hemostasis, marked wound temp increase (71 degrees C) Chitosan: Briefly stopped bleeding in 1 animal. 0 surviviors. fibrin Dressing: 10 of 15 animals acheived hemostasis. their conclusions: quikclot in this trial didn't perform function, and heated tissue to a point where it showed 'gross and histological change of unknown clinical significance" Chitosan extended bleed out times, by a non significant degree. Fibrin prevented exsanguination 2/3 time, and significantly extended bleed out times for the rest.


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## JANES (21 Jun 2006)

Can you clarify the part of your post that says the HemCon heated the tissue?  HemCon doesnt get hot.  The Fibrin dressing used to cost $1000 per dressing.  I say used because they have all been recalled because they contain human fibrin and the liability was too much and they couldnt field the dressing.  

The test is also not realistic.  Each product has to be used specifically, not generally.  Each need training to use, and specific training for each dressing.  If used properly, I'm sure the mortality rates would be affected.  I would also throw out the fact that HemCon may not have sorted out their quality control issue to which now they say they have. 

We're going to see a lot of new testing going on with the Quick Clot ACS, the HemCon ChitoFlex and the Celox all out.


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## kj_gully (21 Jun 2006)

ya ya, thanx for the pick up, will edit.


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## kj_gully (21 Jun 2006)

don't disagree with anything you've rebutted, just putting it out there. To me this test was a test of the lowest common denominator, ie untrained person applying product. obviously if TK's were used, blood mopped up products could work better. I've seen a promo video from Hemcon on a swine femoral bleed pretty impressive. I would be glad to have any of them in my bag of tricks. price being no object, which of course it is, these fibrin dressings seem to be hands down a better product for this particular scenario.


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## JANES (22 Jun 2006)

The lowest common denominator should not be a factor with these devices.  Training is the key to their use.  If you are carrying it and not trianed to use it properly, you may as well of saved your money and stuck with the old field dressing.  It s the same with any peice of equipment you carry, you need to be trained how to use it.  

I'm not arguing with you, I'm just saying that lowest common denominator tests shouldnt happen, becasue they dont find any quantifiable conclusions.

I could test weapons by taking a 4 different rifles and shooting them at a target, but if I am not aiming and using proper marksmanship principles, and I say that the rifles that didnt hit the target very well are no good, its not a realiable test.

The fibrin dressings may be the magic bullet.  Thats becasue they are full of human fibrin.  The bottom line still remains - they are not and will most likely never be available.  Liability way too high with human products in them, and even IF they were available, at $1000 a peice, who is going to buy it?

Its the same with the Factor VIIa that people are all excited about.  At $10,000 a pop and a storage temp requirment of 10 degrees, it wont be fielded any time soon.


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## tomahawk6 (24 Jun 2006)

Some recent HEMCON articles.

http://www.strategypage.com/htmw/htmoral/articles/20060624.aspx

Powerpoint:
http://www.cs.amedd.army.mil/clsp/slides/CHITOSAN%20HEMOSTATIC%20DRESSING.ppt

http://www.sciencentral.com/articles/view.php3?type=article&article_id=218392341

Also a great pdf article.
www.nomi.med.navy.mil/SWMI/ATF Resource/1.17TCCC.pdf


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## Sawbones (25 Jun 2006)

JANES said:
			
		

> Its the same with the Factor VIIa that people are all excited about.  At $10,000 a pop and a storage temp requirement of 10 degrees, it wont be fielded any time soon.



Seems to be some confusion re: Factor rVIIa being in the CF - it has been 'fielded' with the CF in Op Athena and Op Archer since 2004.  Anywhere we deploy blood products, we'll deploy Factor rVIIa.  Hasn't been needed much yet, thankfully.  The Lab techs keep it in the fridge for the OR team.

Sawbones.


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## Armymedic (25 Jun 2006)

Sawbones said:
			
		

> it has been 'fielded' with the CF in Op Athena and Op Archer since 2004.  Anywhere we deploy blood products, we'll deploy Factor rVIIa.  Hasn't been needed much yet, thankfully.  The Lab techs keep it in the fridge for the OR team.



Welcome to the site, Sawbones. (Orthopedic surgeon, perchance?)

Well that is good news.
But that helps the medics treating the troops whom are bleeding at the battle edge who still have a transport time of over 1 hour in what way?


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## JANES (25 Jun 2006)

Sawbones said:
			
		

> Seems to be some confusion re: Factor rVIIa being in the CF - it has been 'fielded' with the CF in Op Athena and Op Archer since 2004.  Anywhere we deploy blood products, we'll deploy Factor rVIIa.  Hasn't been needed much yet, thankfully.  The Lab techs keep it in the fridge for the OR team.
> 
> Sawbones.



I'll just clarify.  What I meant by fielded was in the medics pack to be infused in the "field".  I've never considered a MTF the field even if it is in Kabul or KAF etc.  What most doctors and a nurses considers the field is a little different than my perspective of the field I guess.  Just my perspective.  And my whole point - it's in the fridge!


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## Sawbones (25 Jun 2006)

Army Medic - can't help you too much with the profile - my trade is too small  

Factor rVIIa won't help the MedTech avoid having his patient become a KIA, but does help prevent his casualty becoming a DOW after entering the facility.  Thats a good thing.

Most KIAs occur far too quickly for Factor rVIIa to be useful - it only corrects disordered coagulation, which takes time to set up, usually after a bunch of IV fluid and blood products.

With current technology, even with the principles of TCCC, especially control of visible hemorrhage, the most useful tool for the MedTech in dealing with trunk wounds far from Mother is still the helicopter.  That hasn't changed in our lifetimes.  

Hence some of the the recent comments in the media by commanders about wanting our own helos.  Can't imagine what it would be like watching someone bleed out while they're trying to find a helo, but it still happens. Someone has told me that nationality is now part of the nine-line, that says something about it.

Bleeding within the wounded torso currently has no remedy with the exception of timely surgery. That's one of the reasons the KIA rate hasn't changed too much in the last 150 years (head wounds is another).  

We're still looking for the invention to change that, but so far our best friend in this area has been better body armour.

The MedTech has to ensure the casualty doesn't become a KIA from stuff he/she could fix - visible hemorrhage, pneumothorax, airway obstruction, hypothermia, over-resuscitation, wasting time or just missing the injury.  He/she also prevents DOWs by preventing complications due to delay, poor splints, poor dressings etc.

For those torso wounds, a key skill is knowing what is the fastest way to get the casualty back to a surgical unit at any given point in the mission.  Overall, its a much different situation than that with which the civilian EMS guys have to contend.

Sawbones


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## tomahawk6 (25 Jun 2006)

The survival rate in theater is at 90% which is really amazing. The reasons are better point of injury care and technology. The casualty rate in theater is 17500 wounded and 2500 KIA. As in Vietnam the role of the helicopter is instrumental in the survival rate of wounded soldiers.

http://www.defenselink.mil/news/Mar2005/20050307_105.html

http://www.americanprowler.org/dsp_article.asp?art_id=9573


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