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Different Methods to Control Bleeding

Bleeding, also called hemorrhaging, is the loss of blood. It can happen inside and/or

outside of the body. Hemorrhaging is a leading cause to traumatic death. You may bleed when

you get a cut or suffer any other wound. Bleeding can also happen when an organ is damaged

(MedlinePlus, 2017). Emergency medical technicians (EMT) use multiple methods on scene if a

patient is hemorrhaging. It’s important to know and understand these different methods in order

to be the best EMT I could possibly be. After high school I plan on going to Portland

Community College to get an EMT certification and save lives and learn more ways to control

bleeding in the field. I hope that these methods will become useful should I ever have to use one

of them. Being an emergency medical technician is really important to me because it will give

me a sense of fulfilment. I am compassionate and empathetic and I believe that I will be good

with patients that are in distress. I respond well in crisis situations and I’m calm, collected and

can think clearly under pressure. Some methods have been in common use for years and others

like Xstat, Quickclot and Celox have been field tested by the U.S. military for use in trauma

situations.

Xstat is a syringe filled with a lot of little tiny sponges that expands once released to stop

a gunshot wound from bleeding within twenty seconds. This was employed by the US army

since early 2015 (Sciencealert, 2015). This is a 60ml volume hemostatic device with ninety-two

fast absorbing sponges that controls severe or life-threatening bleeding. The U.S military did a

study that compared gause and Xstat in wound packing for hemorrhage control. They had used a

wound model to assess the mechanical side of things, the wound cavity was a see through gel

that had a 3mm inflow tube that opened up at the bottom. Manometers, which is a device to
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measure pressure, were at the side and the bottom of the cavity. Water that represented blood

then ran from a reservoir to fill the wound, it was then stopped and the pressures were measured.

Measurements included: pressure of the side and bottom of the wound, the weight of the dressing

before and after use, time of application, time of removal, bleeding rates, and loss of blood. Xstat

and gauze was then compared, the results from this were that the Xstat generally performed

better than common gauze (Kragh et al., 2015, p.974). Xstat is an easy tool to use and can stop

hemorrhaging within seconds and is readily available in any scenario i.e shooting incident. This

device would be very useful in immediate situations but I have many questions like, what if the

wound is smaller than the device, are there different sizes? What happens to the sponges after

they are in the wound, how do they get taken out?

Quikclot is another helpful method that EMT’s use to control bleeding. This method is a

thicker form of gauze that makes the blood clot quicker than standard gauze. This gauze is made

with a form of mineral called zeolite, which is capable of stopping rapid bleeding. Zeolite

contains positively charged ions, cations, t​hat serve as cofactors in the activation of clotting

​ uikclot​ ​sponges are applied with pressure that clots within minutes. They come in
proteins. Q

many different forms and sizes, to adapt to any kind of wound (Quikclot, 2014). Buddy Kozen

took two groups of twelve random pigs to study the results of how quikclot works compared to

how standard gauze works. Theses pigs ate a steady diet for five consecutive days and fasted the

night prior to the experiment. After undergoing this experiment he found that standard dressing

resulted in 54ml of total blood loss versus with Quikclot only 47ml of total blood was lost. The

occurrence of a re-bleed with gauze was 82% which is 72% less than the occurrence in Quikclot.

The survival of these pigs using this device is close to 90% where as the standard gauze survival
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percentage is only 50%. It was easily recognizable that Quikclots results were more efficient

than gauze (Kozen et al., 2008). Quikclot in my opinion does not seem like the most efficient

way to control bleeding because it is almost like just normal gauze but I do see why it would be

helpful for small injuries like a stab wound or a severed limb.

Celox was originally used in the battlefield to stop catastrophic bleeding in a timely

matter. This method involves sprinkling a powder that molds to the shape of any wound to get

steady pressure. When applied to blood, celox then becomes a gel glue mixture to make the

blood clot and stop the bleeding quickly (Celox, 2019). Brian Gegel did a study that used porcine

as well, he had used fifteen swine and compared Celox and a normal control group, gauze. All

pigs weighed between one hundred and fifty four to one hundred and ninety pounds, and ate a

standard diet and were not fed after 3:00pm the day before the experiment. The pigs were then

given an arterial wound and were allowed to hemmorage for a minute, the minimum amount of

response time of a medic or health care provider. After that minute celox was poured into the

wound followed by standard packing. Results showed that celox did not perform adequately and

one of the swine models did not reach hemostasis causing the big to bleed out and pass away.

(Burgert et al., 2012). Celox will only form a clot in a wound site where celox is applied. This

method has been proven to be a safe and efficient and stops bleeding quickly. I personally think

this is resourceful method for certain wounds, although I don't believe this will work on any

wound. This seems to be more for slices or gashes, will it work for other things like gunshot

wounds or stabbings? Is it healthy or safe for celox to be that deep into your skin?

The method most commonly used, at home and in the field, to hold and apply pressure

when someone is bleeding. If someone has suffered an injury where they are bleeding pretty
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profusely, you would want to make sure that your hands are as clean as possible, get some gauze

and apply firm pressure to hopefully stop the bleeding quickly. If bleeding continues and absorbs

through the gauze, you would not replace the gauze as that would cause more blood loss. You

would then continue to add gauze. If the cut or wound is on a limb, to stop bleeding faster, you

would raise the limb above the heart if possible and apply gauze and hold pressure. Although

using gauze can have a negative effect on the healing process of the wound. When using gauze,

it is more likely to get an infection due to the amount of bacteria that builds up when more gauze

is applied. Signs of an infection could be: swelling around the wound, hot or warm close to

wound, increased pain, puss or draining coming from cut or wound. Or possibly even a fever.

Gauze is made out of cotton and is made to absorb blood for a temporary hold. It is not meant to

stop bleeding from big wounds like a gunshot or impalement. It is decidedly not the safest

method to use because according to the research I have done, using the standard hold and apply

pressure, you lose more blood than if you were to use Celox, Xstat or Quikclot.

TXA ( Tranexamic acid) also known as Cyklokapron is another method to control

prehospital hemorrhaging. T
​ XA is an antifibrinolytic that prevents fibrinolysis. Fibrinolysis can

overwhelm clot formation following trauma and can lead to more extensive hemorrhaging. The

greatest benefit of admistring TXA is likely to occur when given between one and three hours

post trauma. CRASH-2 data suggests use of TXA reduced the risk of death due to bleeding by

21%. This trial was completely randomized, double-blinded, placebo-controlled study and

included more that 20,000 patients. All patients were adults with significant or risk of bleeding

within eight hours of injury. Mortality rates were reduced by the use of TXA in the field but, as

this study showed, only if administered shortly after the trauma occurred. The CRASH-2 study
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showed in these instances, death in the TXA group was 5.3% vs. the placebo group where death

occured at a rate of 7.7% when TXA was given within one to three hours of injury. When

treatment was within one hour or less, mortality dropped to 4.8% in the TXA group and 6.1% in

the placebo group. The U.S. Military also conducted tests, most recently in Afghanistan, using

TXA to treat combat traumas within the same 3 hour or less timeline as being effective treatment

(Defense Health Board, 2011). Of note, and as cited in the CRASH-2 study, is the cost

effectiveness of TXA. The cost savings was estimated to be $17,172 administering TXA to a

1,000 patients (compared to non-use) and only an incremental cost of $64 per life year gained.

Where medical costs continue to rise, these and traditional non-medicine techniques show

promise for more wide-spread and cost-effective treatment (Roberts. I et. al., 2013)

The common bandaid, vasoline, lip balm and even deodorant containing aluminum

chloride have been used to treat small nicks and minor bleeds. Applying ice to minor bleeds in

the mouth or nose has also been effective. Tourniquets have been used to compress a limb by

restricting blood flow to an arterial bleed by tightening a cord, cloth or belt above the wound.

Regardless of method, what these all have in common is the stemming of blood flow as open

wounds can lead to infection, and in trauma situations to massive hemorrhaging where the

patient can bleed out and die. Comparing all of these methods I have researched, there doesn’t

appear to be one that is considered best. Instead, it’s about assessing the type of wound and using

my professional training as an EMT to determine the best medical treatment for that particular

patient and type of wounds suffered.

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References

Addition of Tranexamic Acid to the Tactical Combat Casualty Care Guidelines ( 2011,

September 23) in health.mil

https://health.mil/Reference-Center/Reports/2011/09/23/Addition-of-Tranexamic-Acid-to

-the-Tactical-Combat-Casualty-Care-Guidelines

Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot. A

​ cademic

Emergency Medicine​, ​15​(1), 74-81.

doi:https://doi.org/10.1111/j.1553-2712.2007.00009.x

Bleeding. (2015, January 25). In M

​ edlinePlus​. Retrieved from

https://medlineplus.gov/bleeding.html#cat_78

Emergency Medical Services (n.d.). In ​Celox Medical​. Retrieved from

http://www.celoxmedical.com/product-sector/north-america/emergency-medical-services

Kozen, B. G., Kircher, S. J., Henao, J., Godinez, F. S., & Johnson, A. S. (2008, January 16). An

Kragh Jr., J. F., Aden, J. K., Steinbaugh, J., & Dubick, M. A. (2015, July). Gauze vs XSTAT in

wound packing for hemorrhage control. ​The American Journal of Emergency Medicine​,

33​(7), 974-976. doi:https://doi.org/10.1016/j.ajem.2015.03.048

Roberts I, Shakur H, Coats T, Hunt B, Balogun E. The CRASH-2 trial: a randomised controlled

trial and economic evaluation of the effects of tranexamic acid on death, vascular

occlusive events and transfusion requirement in bleeding trauma patients. ​Health Technol

Assess 2013​;17(10)

https://doi.org/10.3310/hta17100
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Saracino, P. (n.d.). Battlefield Medicine. In E

​ ncyclopedia Britannica​. Retrieved from

https://www.britannica.com/science/battlefield-medicine#ref988238

This sponge-filled syringe can plug a gunshot wound in 20 seconds (2015, December 10). In

ScienceAlert​. Retrieved from

https://www.sciencealert.com/this-sponge-filled-syringe-can-plug-a-gunshot-wound-in-

0-seconds