Quickclot back in for USSOCOM forces

[COBRA-6]

Posted at lightfighter.net...

UNCLASSIFIED//
REFERENCES:
A. CDR USSOCOM LTR OF 9 MARCH 05
B. USSOCOM MSG 222016 MARCH 2005
C. PREHOSPITAL TRAUMA LIFE SUPPORT (PHTLS) MANUAL (SIXTH EDITION)
D. NOMI LTR 6440 SER 055/001 OF 21 NOV 2005
E. USSOCOM MSG 171252Z JAN 03
F. CDR USSOCOM LTR DTD 9 DEC 2005

UNCLAS

1. NARRATIVE. USSOCOMS NUMBER ONE MEDICAL PRIORITY IS
ELIMINATING PREVENTABLE LOSS OF LIFE ON THE BATTLEFIELD. TACTICAL
COMBAT CASUALTY CARE (TCCC) GUIDELINES WERE DEVELOPED BY
USSOCOM TO ENSURE THAT SOF UNITS SUFFERING CASUALTIES ON THE
BATTLEFIELD ARE ABLE TO RESPOND WITH ACTIONS THAT PROVIDE THE
BEST POSSIBLE MEDICAL CARE CONSISTENT WITH THE BATTLEFIELD
ENVIRONMENT AND GOOD SMALL UNIT TACTICS. RECENT OEF/OIF
REPORTS FROM BOTH SOF AND CONVENTIONAL ARMY UNITS HAVE SHOWN
TCCC TO BE HIGHLY SUCCESSFUL IN MANAGING CASUALTIES ON THE
BATTLEFIELD.

2. REF (A) DIRECTS THAT SOF ADVANCED TACTICAL PRACTITIONER TCCC
TRAINING AND EQUIPMENT BE CONSISTENT WITH THE LATEST TCCC
GUIDELINES FOUND IN THE PHTLS MANUAL. REF (B) DIRECTED THAT ALL
SOF UNITS DEPLOYING IN SUPPORT OF COMBAT OPERATIONS RECEIVE
UPDATED TCCC TRAINING WITHIN 6 MONTHS OF DEPLOYMENT. REF (C) IS
CURRENTLY IN PRESS AND WILL UPDATE THESE GUIDELINES. REF (D)
INDICATES THAT THE UPDATED TCCC GUIDELINES TO BE PUBLISHED IN
REF (C) HAVE BEEN FINALIZED BY THE COMMITTEE ON TCCC AND ARE NOW
READY TO BE TRANSITIONED.

3. USSOCOM COMPONENT COMMANDERS ARE DIRECTED TO
CONTINUE TO ENSURE THAT THEIR DEPLOYING UNITS RECEIVE
TRAINING TO INCLUDE ALL OF THE TCCC GUIDELINES IN REF (C)
WITHIN 6 MONTHS OF DEPLOYING ISO COMBAT OPERATIONS.
COMMANDERS ARE ALSO DIRECTED TO ENSURE THAT ALL UNIT
COMBATANTS HAVE THE UPDATED TCCC EQUIPMENT IN
PARAGRAPHS 5 AND 6 AND BE TRAINED IN ITS USE PRIOR TO
DEPLOYMENT.

4. IN ADDITION TO SERVICE STANDARD COMBAT TRAUMA
EQUIPMENT, EACH USSOCOM COMBATANT WILL BE PROVIDED
THE FOLLOWING COMBAT TRAUMA MANAGEMENT EQUIPMENT,
BE TRAINED IN ITS USE, AND CARRY THESE ITEMS IN THE FIELD:
COMBAT PILL PACK
GATIFLOXACIN 400 MG
MELOXICAM 15 MG
TYLENOL 650 MG BILAYER CAPLETS (2)
COMBAT APPLICATION (CAT) TOURNIQUET
HEMCON DRESSING
QUIK CLOT (POWDER)
NASOPHARYNGEAL AIRWAY

5. IN ADDITION TO SERVICE STANDARD COMBAT TRAUMA
EQUIPMENT, EACH USSOCOM COMBAT MEDIC WILL BE
PROVIDED THE FOLLOWING COMBAT TRAUMA MANAGEMENT
EQUIPMENT, BE TRAINED IN ITS USE, AND CARRY THESE ITEMS
IN THE FIELD:
HEXTEND
VELCRO IV STRAPS
INJECTABLE PHENERGAN
PYNG FAST STERNAL INTRAOSSEOUS DEVICE
ERTAPENEM
BLIZZARD RESCUE BLANKET
TECHTRADE READY HEAT BLANKET
THERMOLITE HYPOTHERMIA PREVENTION SYSTEM CAP
TRANSMUCOSAL FENTANYL LOZENGES 400 UG
PULSE OXIMETERS

6. SOME SOF UNITS HAVE ALREADY IMPLEMENTED THE NEW
TCCC STANDARD AND SHOULD FORGE AHEAD. SOF UNITS
WITHOUT INTERNAL PROGRAMS TO ENSURE THAT UPDATED
TCCC TRAINING AND EQUIPMENT IS PROVIDED IAW REF (B) CAN
RECEIVE BOTH THROUGH THE USSOCOM TCCC TRANSITION
INITIATIVE. AN MTT FROM THE US ARMY INSTITUTE OF SURGICAL
RESEARCH (USAISR) WILL CONDUCT THE TRAINING (1 DAY FOR
UNIT MEDICS ONLY, 2 ADDITIONAL DAYS FOR ALL UNIT
MEMBERS) AND PROVIDE REQUIRED EQUIPMENT. UNIT
REQUEST FOR PARTICIPATION SHOULD BE DONE THROUGH
USSOCOM POC AT LEAST 3 MONTHS PRIOR TO DESIRED
TRAINING. SPECIFIC TRAINING DATES WILL BE ESTABLISHED
SUBSEQUENTLY WITH USAISR PERSONNEL.



7. UNITS PARTICIPATING IN THE TCCC TRANSITION INITIATIVE
WILL PROVIDE FEEDBACK TO USAISR ABOUT BOTH TCCC
TECHNIQUES AND EQUIPMENT AS SOON AS FEASIBLE. USER
FEEDBACK FROM SOF WIAS AND FIRST RESPONDERS IS AN
INTEGRAL PART OF THE TCCC COMBAT EVALUATION PROCESS
AND IS CRITICAL TO GUIDING FUTURE DIRECTIONS REGARDING
NEW TCCC EQUIPMENT. UNITS OBTAINING TCCC TRAINING
THROUGH OTHER VENUES THAN THE TCCC TI ARE ALSO
ENCOURAGED TO PROVIDE FEEDBACK TO USAISR OR
USSOCOM ABOUT TCCC EQUIPMENT AND TECHNIQUES.

8. THE PREVIOUS USSOCOM MSG PROHIBITING THE USE OF
QUIKCLOT (REF E) IS CANCELLED. SINCE NEITHER HEMCON OR
QUIKCLOT HAS BEEN FOUND TO BE CLEARLY SUPERIOR IN
CONTROLLING EXTERNAL HEMORRHAGE, ALL USSOCOM
COMBATANTS WILL CARRY BOTH HEMCON AND QUIKCLOT. IAW
WITH THE UPDATED TCCC GUIDELINES IN REF (C+D),
HEMCOM WILL BE USED FIRST TO CONTROL LIFE-THREATENING
EXTERNAL HEMORRHAGE. QUIKCLOT WILL BE USED AS THE
BACKUP IN THE EVENT THAT HEMCON FAILS TO ADEQUATELY
CONTROL HEMORRHAGE

9. UNITS THAT DESIRE TO HAVE PREDEPLOYMENT TCCC
TRAINING PROVIDED BY COMMERCIAL COMPANIES WILL NEED
TO REQUEST VERIFICATION FROM USSOCOM THAT THE
PROPOSED COURSE MEETS THE REQUIREMENTS OUTLINED IN
REF (F). CONTACT USSOCOM COMMAND SURGEON'S OFFICE TO
COORDINATE THE APPROVAL PROCESS. ATTENDANCE AT
COMBAT TRAUMA COURSES NOT APPROVED BY USSOCOM
DOES NOT CONSTITUTE COMPLIANCE WITH THIS DIRECTIVE AND
IS NOT AUTHORIZED.

10. USSOCOM POC FOR UNITS REQUESTING SUPPORT VIA THE
TCCC TRANSITION INITIATIVE *POC edited for PERSEC)*

 

[Scoobie Newbie]

What's it all mean Basil?  If Hexcon is as good as Quickclot then what would it matter which is used first.  Can they be mixed in reverse order from what's posted above?

 

[COBRA-6]

Quickclot is a powder/sandlike substance, the HemCon is more of a treated sponge... different applications, more tools in the box...

 

[Scoobie Newbie]

Seen.

 

[COBRA-6]

HemCon is also about $150 per dressing 

QuickClot now makes something similar to it called the Advanced Clotting Sponge which is basically coarser-grained QuickClot agent in a mesh bag that can be packed into a wound and won't be washed away by severe bleeding, (check out the cut femoral artery vid). The user can also cut open the bag and use it like regular QuickClot... much cheaper as well, about $35.

Lots of innovation happening out there, this looks promising:

16 March 2006
From New Scientist Print Edition
Jessica Marshall

When nothing else will work...
A DRUG widely used to treat people with haemophilia may soon be available on the front line to treat soldiers bleeding internally, if military trauma researchers have their way. The substance, called recombinant activated factor VII, is a component of the body's blood clotting cascade. It is already used by some emergency room doctors to halt internal bleeding in people injured in accidents such as car crashes.

One of the early uses for the drug came in 1999, when a soldier shot at point-blank range was brought into the Sheba Medical Center in Tel Hashomer, Israel, bleeding profusely. "The surgeons went to the family and said there was nothing they could do," says Uri Martinowitz, a haematologist and director of Israel's National Hemophilia Center, which is based at the centre. Martinowitz was at the time planning a preliminary trial of the substance on pigs. "That night I decided not to wait for the pig study, as there was nothing to lose for the patient." He injected the man with factor VII, and 10 minutes later the bleeding stopped.

Since then, factor VII has been used "off-label" by specialists to treat US and UK soldiers whose bleeding could not be controlled by other means. Though a number of case reports have indicated that it can be used successfully, it has not yet been approved for this purpose. That may change if a forthcoming clinical trial is successful, and Robert Vandre, director of the US army's Combat Casualty Care Research Program in Fort Detrick, Maryland, says the treatment could then be used widely on the front line by army medics.

While the army awaits the outcome of the trial, it is developing procedures for administering the drug in the field that will maximise its effectiveness. "It's got incredible potential," says Vandre.

 

[Donut]

Factor VIIa has been in discussion for a while, check out

http://www.trauma.org/resus/FactorVIIa.html

for a scholarly article on the stuff, as well as some good references and a link or two, too.

Martinowitz et al published an article in 1999 in the Lancet on the case.

DF

 

[COBRA-6]

ParaMedTech thanks, I'll take a look. The upcoming US Army trial mentioned in the article caught my attention.

 

[silentbutdeadly]

Just a note we are using Quickclot over here in Afghanistan. One per man and the stuff works pretty good. Cheers

 

[Big Red]

Just an update on Quickclot from the Iraq theatre. The US army is now stocking the Quickclot ACS in addition to the older Quickclot they've always had. I just picked up a case of the ACS from the CSH and will be replacing all our original quickclots in IFAKs and med bags.

The Hemcon is still also being issued but certainly not to every soldier as the original plan. I imagine this is due to cost.

 

[Armymedic]

There is a mini Pepsi/Coca-cola war going on between Quickclot and Hemcon, with Sam's Medical Celox tossed into the mix. Celox see: http://www.celoxmedical.com/

QC has come out with the ACS, and next year a QC permeated gauze (called combat gauze)

And PersysMedical is producing an ER dressing with QC 'teabags" sewn onto to the inside of the dressing. see:  http://www.ps-med.com/PDF/bandagePlus_brochure.pdf

Hemcon has/is coming out with a variety of sizes for their dressing and a new flexible ribbon of hemostatic dressing called ChitoFlex

see:  http://www.hemcon.com/Products/ChitoFlex/tabid/58/Default.aspx

Personally, I like Celox, although it needs to develop its product more into the "teabag" and other avenues of application so that the fine granular powder is easier to use. But I see Hemcon working its way into my bag, and QC products being in the shooters med kits. In the near future Celox will be pushing both out of the way once it gets a larger US market share.

 

[toughenough]

4. IN ADDITION TO SERVICE STANDARD COMBAT TRAUMA
EQUIPMENT, EACH USSOCOM COMBATANT WILL BE PROVIDED
THE FOLLOWING COMBAT TRAUMA MANAGEMENT EQUIPMENT,
BE TRAINED IN ITS USE, AND CARRY THESE ITEMS IN THE FIELD:
...
MELOXICAM 15 MG
...

Would anyone be able to shed some light on the reasoning/use for this? After a recent elbow fracture I was prescribed a similar item called novo meloxicam, and I didn't really find it worked very well at all, let alone in a combat situation. Is it really intended to help joints/arthritis, or is it intended for another purpose?

Thanks

 

[Armymedic]

Would anyone be able to shed some light on the reasoning/use for this? After a recent elbow fracture I was prescribed a similar item called novo meloxicam, and I didn't really find it worked very well at all, let alone in a combat situation. Is it really intended to help joints/arthritis, or is it intended for another purpose?

Yes sure. It is called a combat pill pack. Historically it has contained different drugs but the basics are:
a. an NSIAD or equivelent to reduce inflamation and swelling
b. an antibiotic, general broad spectrum to stop initial infection
c. Acetomenophen as analgesic.

The current US pill pack carry:

4. IN ADDITION TO SERVICE STANDARD COMBAT TRAUMA
EQUIPMENT, EACH USSOCOM COMBATANT WILL BE PROVIDED
THE FOLLOWING COMBAT TRAUMA MANAGEMENT EQUIPMENT,
BE TRAINED IN ITS USE, AND CARRY THESE ITEMS IN THE FIELD:
COMBAT PILL PACK
GATIFLOXACIN 400 MG  antibiotic
MELOXICAM 15 MG  Antinflamatory
TYLENOL 650 MG BILAYER CAPLETS (2)  analgesic

It allows soldiers who are sustained minor injuries (or are not injured enough to warrant Urgent or Priority CASEVAC) to fight for upto 24 hrs before needing to get to more/higher care.

 

[toughenough]

So basically it works well on a minor joint injury? I was just questioning because it did not affect swelling or ease the movement of my joint at all, at the same dosage, taken daily (but it was a fairly serious injury that had me out for 2 months time).

Thanks for the feedback.

 

[k_mac]

A question concerning clotting agents in general

Correct me if I'm wrong, but my understanding is that there is a risk of pulmonary embolism with post surgical patients for example. Does a similar risk exist for the use of some of the clotting agents described in this forum? Obviously the benefit to a combat casualty far outweighs the risk of a PE. Just curious.

 

[Armymedic]

Keeping the casualty alive to make it to surgery trumps any post surgical complications. But to answer you more directly: I have not heard of such a thing with the currently issued hemostatic agents. There is a new one (Woundstat, I believe) that has shown it can get into the blood stream and cause a embolism...but I am not fully briefed on that trail.

 

[medicineman]

There is more of a risk of PE in post surgical patients because they're immobile or an embolism from a long bone fracture - unlikely from the clotting agents.

MM