Haemostatic Dressing First Aid Kit
Research shows that 40% of civilian deaths from traumatic injury occur due to exsanguination, or excessive blood loss, with between a third and half of these victims dying before they reach hospital.1Catastrophic bleeding is the second highest cause of death outside of the armed forces and is the leading cause of death in military situations.2
Traumatic injuries include stabbings and gunshot wounds, and injuries sustained in explosions, as well as vehicular accidents and major incidents with machinery or equipment in the workplace. The level of pre-hospital fatalities emphasises the need for expert first aid training to deal with such traumas, enabling first responders to prevent blood loss promptly and reduce the risk of death.
Catastrophic blood loss from a traumatic injury can be stemmed in three ways: by applying pressure to the wound, by forming a tourniquet to stop blood flow to the wound, and by the use of a haemostatic dressing.
What is a haemostatic dressing?
Haemostatic dressings are not suitable for all heavy bleeding injuries, but when used appropriately and applied correctly, they can save lives. They use chemical processes to stop bleeding rapidly in traumatic injuries and usually work within two to three minutes, with some specialist rapid-action products acting even faster.
The dressings work by either creating a physical barrier to stem blood flow, or by encouraging clotting at the wound site, or often a combination of both.
Types of haemostatic dressing
Haemostatic dressings usually consist of bandages or gauze that are impregnated with chemicals to help seal the wound. Haemostatics may also come as a pad, which is pressed on to the wound site, or a ‘tea bag’ style sachet of the chemical which can be pressed deep into an open wound.
Haemostatic powders are also available, including some with special applicators that can penetrate deep into a stab wound or gunshot wound. However, these are much more difficult to use in the field and so are not recommended for standard first aid kits.
There are three types of haemostatic dressing, each of which works in a different way:
- Mucoadhesive agents – these work by sticking to the damaged tissues, creating a physical barrier to blood flow.
- Factor concentrators – these work by absorbing water from the wound, which causes the blood to become thicker, increasing the concentration of natural clotting agents.
- Procoagulents– these are mineral based compounds that stimulate and accelerate the natural clotting processes.
Are haemostatic dressings required in a first aid kit?
Haemostatic dressings are an expensive addition to your first aid kit, and so should only be specified if there is a genuine need. However, if such a need does exist, they should never be ruled out on the basis of cost, as they could mean the difference between life and death.
The HSE June 2016 First Aid eBulletin included a recommendation for the provision of haemostatic dressings in workplace first aid kits if a First Aid Needs Assessment indicated that there was a risk of traumatic injury resulting in catastrophic bleeding. This covers industries such as heavy manufacturing, agriculture, forestry and construction, along with any other workplace where open or penetrating wounds may occur. The HSE advice drew on the conclusions of the 2015 European Resuscitation Council review of first aid protocols.
When should you use a haemostatic dressing?
Haemostatic dressings are never a first option when treating a heavily bleeding wound. You should always try to stop the bleeding by applying pressure at the wound site first, using a clean dressing or specialist pressure dressing. Only if this fails to control the bleeding should a haemostatic dressing be considered.
Haemostatic dressings should not be used for head or chest wounds, as the blood flow around the brain and the heart should not be compromised in any way. They are ideal for heavily bleeding wounds of the abdomen and torso, or of the junctions, such as the groin and shoulders where pressure dressings may not be so easy to apply.
For bleeding wounds on the arms or legs, you can use either a tourniquet or a haemostatic dressing, or a combination of both. Your choice of which to use may depend on the number of casualties you have to deal with, as a tourniquet will be effective immediately, while a haemostatic dressing will need to be held in place for several minutes before it begins to work. Both types of dressing have advantages and disadvantages, and your first aid training will help you to make the right call in each unique situation.
How to use a haemostatic dressing
As stated above, a haemostatic dressing should only be used when pressure has failed to stop the bleeding. There is a wide range of different types and brands of haemostatic dressings, so you should always read and follow the manufacturer’s instructions, even if you have experience with this equipment and are confident in its use.
- For shallow wounds – apply a haemostatic pad or pad of haemostatic gauze to the wound and hold it firmly in place. The manufacturer’s instructions will tell you how long the dressing should take to work, and you must hold it in place for the full duration before checking to see if blood flow has stopped. If the wound is still bleeding, reapply pressure for the same period again.
- For deeper wounds – if the wound is deeper, you will need to pack it with haemostatic gauze, or press the haemostatic pad as far as possibleinto the wound. Once again, this will need to be held in place for as long as specified.
It is important to remember that haemostatic agents will only work if they are in direct contact with the source of the bleeding, so care should be taken to place them appropriately. Simply covering a deep wound with a haemostatic dressing will not stop the bleeding.
Haemostatic agents should never be allowed to come into contact with the eyes, the airway or any exposed brain tissue, as this can cause serious complications.
Are haemostatic dressings safe?
It is a common misconception that haemostatic dressings cause burns by creating an exothermic reaction. This may have been true with early products, such as the first generation Quickclot range3, however these products have been refined and there is no longer any risk from use.
It is worth noting, however, that haemostatic dressings are not suitable for use in remote locations, as they must be removed within 24hours of application to prevent further damage. This is not an issue for most workplaces, but it should be considered for locations such as oil rigs, ocean going fishing vessels and remote research posts.
Post dressing care
A haemostatic dressing should only ever be removed by a trained doctor or paramedic, and it should remain in place until the victim reaches hospital. If you try to remove or replace the dressing in the field, you risk reopening the wound and restarting the bleeding.
Once you have stopped the bleeding using a haemostatic dressing, you should dress the wound and tuck the packaging securely under the dressing, so that the A&E team will know exactly what kind of product has been used. Different haemostatic dressings need to be removed and cleaned in different ways, so it is important that they know what they are dealing with. The packaging may also be passed to paramedics, but this risks it being lost in transit or not being passed along.
Haemostatic dressing training
There is no doubt that haemostatic dressings can save lives in a range of traumatic situations involving catastrophic bleeding, but they will only be effective if they are used appropriately and applied correctly. It is essential, therefore, that professional first aid training, including tourniquets and haemostatic dressings,is provided for all nominated first aiders where these items are recommended and supplied as part of the first aid kit.
1Kauvar DS, Lefering R, Wade CE.
Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations.Journal of Trauma. 2006
2Sauaia A, Moore FA, Moore EE, et al.
Epidemiology of trauma deaths – a reassessment. Journal of Trauma 1995
3Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, Chambers L, Demetriades D, Velmahos G, Alam H. QuikClot use in trauma for hemorrhage control: case series of 103 documented uses. Journal of Trauma