Why Not Use Quik-Clot

Just a quick question we were throwing around at dinner tonight. I know Quik-Clot is used heavily in the military, and seems to work very well. That being said, why haven't the vast majority of EMS systems adopted it's use?

Thanks.

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Originally Posted by ATFDFF

Just a quick question we were throwing around at dinner tonight. I know Quik-Clot is used heavily in the military, and seems to work very well. That being said, why haven't the vast majority of EMS systems adopted it's use?

Thanks.

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I"m curious as well...

Wonder if it's a cost thing? Nah, not in our health system. :D

Its not too expensive, I've spent a lot more money on things that don't work. We keep it on a few of our bags as a last ditch, but I don't see it used much elsewhere in the area. A lot of medics are kinda supprised we even have it. I'm in the process of looking in to see if its even in protocal, but very good question.

I work for DOD and we can't use it. One of the stumbling blocks we've run into in Michigan was the reluctance of the manufacturers to actually say what's in their product. Products like Quik-Clot and the Rapid-Cool? burn gel are fantastic products. However, if your patient develops a reaction, the Docs need to know what they're potentially treating.

My brother is a retired Army Doc working in a civilain hospital now. I'll shoot him an e-mail and see what he thinks. Expect a reply in about 2 weeks. :)

Does it have a short shelf life?

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Originally Posted by rm1524

Does it have a short shelf life?

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No, actually. According to the website, an unopened pack has a shelf life of 3 years.

We just got quik-clot in our protocols here early this year. The same MD that said he would never let us have it, finally gave it to us. I'm not sure about his reasoning this time. To my knowledge noone under our med control has used it yet. Next time I run into the MD I'll ask him and let you guys know.

Not sure on why a particular MD's reasoning may be to not adopt QuikClot, but here are some drawbacks:
- Must be applied directly to the source of the bleeding (i.e. the torn vessel interior from a bullet or blade wound).
- Used in large amounts to control heavy bleeding, there is the potential for significant heat production, thus causing thermal burns. Although, if they're bleeding that badly, would a burn make their chances for survival worse?
- Since the original powder form was so fine, it blew around with the slightest breeze, often into eyes causing severe ocular burns. The newer version is applied in sponge form to stop that problem.

I read somewhere that the active ingredient of QuikClot is some sort of a derivative of volcanic/lava rock.

Perhaps the reason military medics can use it is since it IS a last ditch effort on the battlefield. Hopefully, in civilian EMS we have more resources readily available.

FYI, it's based on kaolinite (a kind of clay); the active ingredient in Kaopectate.

http://www.z-medica.com/getattachmen...of-Action.aspx

I think part of the problem why it is not used more is the slow creep of our governing agencies.

The DOT curiculum lays the ground work for what is "suggested" in your protocols. And what year was the curiculum last updated?

Then the state agencies set the next bar, writing "standard" protocols that are often used as the benchmark for the standard of care.

Then comes the medical director. Many services have outstanding medical directors that are at the top of their game. Many others have a medical director that just happened to be the only doctor in the county that didn't say no, doesn't know anything about EMS, and just signs of on those standard outdated state-protocols.

But even if you have a top-notch medical director, he/she has to face the prospects of lawsuits. Quik-Clot is a great product, but is it "standard of care" in the EMS field yet. It might save many lives, but that one person that files suit for some reason and wins a $$$ award because it was not standard-of-care could shut down an EMS service that barely stays in the black.

Of course this is my opinion only.

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Originally Posted by MarcusKspn

I think part of the problem why it is not used more is the slow creep of our governing agencies.

The DOT curiculum lays the ground work for what is "suggested" in your protocols. And what year was the curiculum last updated?

Then the state agencies set the next bar, writing "standard" protocols that are often used as the benchmark for the standard of care.

Then comes the medical director. Many services have outstanding medical directors that are at the top of their game. Many others have a medical director that just happened to be the only doctor in the county that didn't say no, doesn't know anything about EMS, and just signs of on those standard outdated state-protocols.

But even if you have a top-notch medical director, he/she has to face the prospects of lawsuits. Quik-Clot is a great product, but is it "standard of care" in the EMS field yet. It might save many lives, but that one person that files suit for some reason and wins a $$$ award because it was not standard-of-care could shut down an EMS service that barely stays in the black.

Of course this is my opinion only.

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+1

And, I hear many rumors about the stuff. Some say it will badly burn your pt, others say the powder form can cause an embolism. A lot of people base their opnions off rumors.

I asked about quikclot when I first started and my Med. Director told me the stuff works great at stopping bleeding, but the reason we don't use it is that it's darn near impossible to remove the quikclot without pulling the clot underneath it with it. Which restarts the bleeding and places the patient back into a critical situation. Only this time the patient is in an ED, or if they are lucky an OR/Trauma lab. He told me that they have eliminated the thermal burns with the current generation.

In our current protocol lists basics only have the use of the quick clot sponges. We arent allowed to use the dump in powder. Although the quick clot does work fairly well. I havent seen it used on a person, but i have seen it used on a horse.

Just a question... Would dumping the powder on a torn blood vessel possibly send small clots around the cardio vascular system? I don't imagine that all the powder clots there at the site and some could travel up the vain. I don't know, just brainstorming.

That's one of the reasons why loose powder form fell out of favor and they make the treated gauze.

Our police department evaluated the use of this as a measure for officer self or buddy rescue. Our regional OMDs have not approved it, for the various reasons listed. We do train using the CAT tourniquet and wound packing, which we have researched out from anecdotal evidence and papers on combat care now being used in Diarreheastan.

Ive seen both the powder and sponge used before in experimentation on a Pig thanks to youtube. The Doctor using it cut the Femoral artery of the pig and used the quick clot powder to stop the bleeding. After sitting for a moment the doc used normal saline solution to flush the wound and there was no bleeding afterwards. Ive also heard that soldiers during the Civil war were using ordinary black pepper to stop bleeding. I dont know if there is any truth to that.

I am intrested to see if Quick Clot or similar products are going to be part of EMS Protocol in the future.

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Originally Posted by IronValor

I've also heard that soldiers during the Civil war were using ordinary black pepper to stop bleeding. I dont know if there is any truth to that.

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A quick search of the 'Net seems to bear that out. I suspect part of what happens there has to do with something helping the clotting process start - witness some of the home remedies listed here.

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I am intrested to see if Quick Clot or similar products are going to be part of EMS Protocol in the future.

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Hate to say it, but I see the potential for abuse. Instead of using traditional methods for bleeding control, which may be perfectly acceptable and adequate for a given situation, just dump on some Quick Clot and be done with it...

being military myself the quik clot powder is no longer used due to secondary burns from the powder. i know some swat teams are using the quik clot bandages. they work well and i know a few fire depts that carry them for emergency situations

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Originally Posted by zzyyzx

Not sure on why a particular MD's reasoning may be to not adopt QuikClot, but here are some drawbacks:
- Must be applied directly to the source of the bleeding (i.e. the torn vessel interior from a bullet or blade wound).
This is not nessesarily true. The QuickClot could be used without having to actually apply it to the source of the bleed due to its powernature, but it was more effective if you could....obviously
- Used in large amounts to control heavy bleeding, there is the potential for significant heat production, thus causing thermal burns.There is an exothermic reaction from the clotting agent, however there was more of a danger to the first responder either burning themselves, or the agent coming in contact with the eyes of the first responder, as is mentioned further below. Although, if they're bleeding that badly, would a burn make their chances for survival worseThe studies that I have seen coming from the army center for lessons learned does not mention that it could be significant to do any further harm.?
- Since the original powder form was so fine, it blew around with the slightest breeze, often into eyes causing severe ocular burns. The newer version is applied in sponge form to stop that problemI might be mistaken here and forgive me if I am, but the sponge material that you may be reffering to here is actually HEMCON. This is a pad that you have to cut to fit to the size of the bleeder and then hold direct pressure for 5 minutes before you can let off of it. The main draw back to a HEMCON bandage is the time that it takes to apply, as well as the fact that it is manufactured using some material derived from shell fish, which the patient could be allergic to. .

I read somewhere that the active ingredient of QuikClot is some sort of a derivative of volcanic/lava rock.

Perhaps the reason military medics can use it is since it IS a last ditch effort on the battlefield. Hopefully, in civilian EMS we have more resources readily available.

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You have to always keep in mind that military medicine is far from that which is perfectly acceptable in a civillian setting. We dont treat by the ABC's our first concern is stopping life threatening hemmorage, which is the number one preventable killer on the battlefield.

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Originally Posted by KanFireman

I asked about quikclot when I first started and my Med. Director told me the stuff works great at stopping bleeding, but the reason we don't use it is that it's darn near impossible to remove the quikclot without pulling the clot underneath it with it. Which restarts the bleeding and places the patient back into a critical situation. Only this time the patient is in an ED, or if they are lucky an OR/Trauma lab. He told me that they have eliminated the thermal burns with the current generation.This is true which is why if it is used, it should only be removed surgically by a physician in an O.R..

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Originally Posted by zackman1801

In our current protocol lists basics only have the use of the quick clot sponges. We arent allowed to use the dump in powder. Although the quick clot does work fairly well. I havent seen it used on a person, but i have seen it used on a horse.I have used it on several people at the point of injury (POI) with very good results. I was even able to use it to save the life of a military working dog in Iraq sometime in 2009.

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Originally Posted by KanFireman

That's one of the reasons why loose powder form fell out of favor and they make the treated gauze.You can find this QuickClot gauze under the marketing name of QuickClot Combat Gauze. It is impregnated with the clotting agent is is used to pack wound much the same way you would using a roll of Kerlex. Once in the wound the guaze disolves and will close off the wound, but there are drawback in time consideration. There is no exothermic reaction using the product though.

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Originally Posted by sapper937

being military myself the quik clot powder is no longer used due to secondary burns from the powder. i know some swat teams are using the quik clot bandages. they work well and i know a few fire depts that carry them for emergency situationsThats absolutly correct. After the remaining stock is gone the US Military will no longer use the powder.

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Of course everything goes back to what you are allowed by you PA or MD to use in your own scope of practice. I would never suggest that I know more than they would; however I have seen things that work and have a few miles under my belt regarding tactical medicine.

I hope that any insight I have on the matter is helpful and I didn't sound like a know it all. I'm just in a unique position of being a medical instructor for the Army Medical Center and School, so its my job to stay up on a lot of this stuff so I send well taught medical professionals to the theaters of operation to take care of our brothers and sisters who are in harms way.

If anyone has any questions, I'm in one of the best places to find out the information you need. Feel free to ask or shoot me a PM.

Stay Safe everyone!