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Old April 20, 2005, 12:30 PM   #1
Balog
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That CAN'T be right

I've noticed a number of advertisements in SWAT for QuikClot, a product designed to stop bleeding in severe trauma patients. They claim it is the same product as issued to the armed forces, including the Marine Corps. From http://www.quikclot.com/productinfo/default.htm.
Quote:
The BattlePack is based in part on the current United States Marine Corps trauma kit.
That page further goes on to state that
Quote:
QuikClot brand hemostatic agent speeds coagulation of blood, even in large wounds, through a very simple process: It physically adsorbs the liquid from blood, thereby concentrating the clotting factors and encouraging rapid clotting to stop the bleeding.

QuikClot brand hemostatic agent is different from similar products in that it is chemically inert, and therefore is safe to leave in or on the wound until the patient receives medical treatment. Furthermore, since it contains nothing biological or botanical, there is little or no danger of an allergic reaction.
The Marine Corps' IFAK (Individual First Aid Kit) does indeed contain QuikClot. However, the period of instruction I received about using it could not have painted a different picture of the product. We were told it was to be used only as a last resort, after a pressure dressing with direct pressure and a tourniquet had failed to stop the bleeding.

Why should it be put off until the last possible second? It causes severe second and third degree burns! Our instructions were to pour it into the wound and then hold pressure on it until the dressing became too hot to touch, at which point the wound should be irrigated with water and a fresh dressing applied. Dire warnings were issued about allowing it to come in contact with eyes, respiratory system, or bloody hands.

There are two possibilities here.
One is that the product being sold is not the same one being issued to our troops. This would constitute mere false advertising.
The second is that the product is the same, and the QuikClot people are being deceitful about the side effects. This would constitute reckless endangerment of the customer.

Either way, the ads do not seem to meet the standards of a reputable magazine such as SWAT.
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Old April 20, 2005, 12:59 PM   #2
Rich Lucibella
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March 2004: SWAT Briefing Room, by Denny Hansen:
Quote:
QUIKCLOT UPDATE
In the December issue we ran a story on a product called QuikClot™. The product is a hemostatic agent that causes blood to clot upon contact. It has come to our attention that the product did not work “as advertised” on several severe wounds in Iraq.

Simply pouring QuikClot onto a severe wound, such as a spurting artery, may only be effective if applied in a buddy system, with one person applying QuikClot and another applying direct pressure. Also, when QuikClot is poured into a hemorrhaging wound a reaction begins heating the blood to temperatures from 194-212 degrees Fahrenheit.

It is these high temperatures which help make the blood clot—it also heats local skin, muscle and nerve tissue to boiling temperatures.It is our understanding that until the product undergoes further testing, its use has been prohibited by USSOCOM and USSOCOM personnel. We advise any S.W.A.T. readers to look into the use of QuikClot before applying it.
May 2004: Letters to the Editor:
Quote:
QUIKCLOT CORRECTION
Dear Mr. Hansen,
We at Z-Medica would like to respond to “Briefing Room” in the March 2004 issue, discussing our hemostatic product, QuikClot®. The editorial, as written, appears to reflect dated and incorrect information that has subsequently been refuted by field experience and peer-reviewed scientific testing. QuikClot, when used as directed for the control of moderate to severe hemorrhage, has been shown to be extremely effective and safe in both military and civilian settings. QuikClot has been credited with making the difference between life and death in numerous reports from Iraq, even after all other means had failed.

We would like to invite the attention of your readers to the following clarifications:
1) The reference SOCOM directive was issued over one year ago, quickly followed by a directive from the Secretary of the Army declaring QuikClot safe and effective and authorizing use by US Army personnel.
2) The SOCOM directive incorrectly stated that the temperature increase caused by QuikClot was up to 100 degrees C, causing clotting. QuikClot begins clotting not by heat production, but by removing water from blood and creating a concentration of clotting factors in the wound. No temperature greater than 150 degrees F., and that only with inappropriate/off-label use, has ever been recorded with QuikClot.
3) In over 200 confirmed uses, there has never been an incident of burns when the package directions were followed.
4) The United States Marine Corps has made QuikClot a standard issue item. The Army and other services have purchased large quantities.
5) The complaints of QuikClot not working properly (fewer than five cases, most by the same user) have been attributed to inadequate training in its appropriate use.
6) The Office of Naval Research, and Uniformed Services University have done in-vitro and in-vivo studies. These found QuikClot safely and effectively stopped combined arterial/venous bleeding.
7) At a presentation given at the 2003 Special Operations Medical Conference, the director of OEMS, also the chief FBI medical advisor, recommended QuikClot as the best current solution in the field environment.

Respectfully,
Jessica Perkins
Manager, Product Development
Z-Medica

Jessica,
Thank you for keeping us informed and bringing us up to date on QuikClot. Your efforts are appreciated, and I now carry QuikClot both in my vehicle and with my training gear.
Denny Hansen
Sounds to me like you need to recheck to see if your guys have the latest info.
Rich
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Old April 20, 2005, 01:04 PM   #3
mtnbkr
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Has anyone here witnessed Quikclot being used? Has anyone tried to test it themselves by pouring it into water or animal blood?

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Old April 20, 2005, 01:06 PM   #4
Balog
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Sorry I missed those reports. I have only recently discovered the joy of SWAT and so I can only reference recent articles.

I will indeed check with the corpsman who gave us the period of instruction, as well as those in my unit who've BTDT to see if they've ever used the stuff. The doc who was giving the talk couched the explanation in the first person and claimed personal experience with the product in combat.

Obviously someone in this equation is either lying or wrong. I can only hope it isn't the person tasked with patching my sorry arse up.
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Old April 20, 2005, 03:39 PM   #5
Pat Rogers
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Balog,
Unsure who you are with, but often times those tasked with teaching may not have up to date information available to them.
A good example was that i recently heard an NCO give a class where he repeated the myth that a .50 cannot be used against personnel.

If you have the ability to talk to a Special Amphibious Reconnaissance Corpsman (SARC) you can get the straight scoop.
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Old April 20, 2005, 09:28 PM   #6
Don Gwinn
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I don't say this much, but what a great thread!
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Old April 21, 2005, 07:28 AM   #7
HankL
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Pat, If this is the same Balog who posts at THR he is a PFC in the USMC with no full time access to a computer.
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Old April 21, 2005, 07:47 AM   #8
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Can you imagine pouring the Quick Clot powder into a large wound and it heating up to 212 degrees, boiling and steaming? I don't think that would ever make it out of the factory. Maybe folks were confused with the MRE heat pack used to warm up MREs. Those do get awfully hot.

Either way, the Quick Clot is most definitely a last resort and it isn't meant as a stand alone miracle. If the choices were between bleeding to death and having a burn, the answer is obvious.
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Old April 21, 2005, 08:45 AM   #9
DAVID NANCARROW
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My eldest son is a 91W in Iraq with the 3rd I.D., and the two instances where it was required, he says the quick clot treated bandages work very well. It is pretty much a last resort, but according to him it does what its supposed to do.
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Old April 21, 2005, 09:06 AM   #10
Pat Rogers
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Thanks Hank!
It is not unusual for the troops to receive bum scoop. Hopefully it will get squared away.
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Old April 21, 2005, 10:44 AM   #11
alpineman
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Thanks for the info. I'm not military or LEO, but I have read about this product in magazines & I keep it in my home 1st Aid kit. Considering how often I shoot & use a chainsaw I thought it would be a good last-ditch tool.

BTW -- I only shoot & use the chainsaw at the same time when I'm having a really, really bad day.
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Old April 21, 2005, 02:19 PM   #12
Balog
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HankL: I am indeed the Balog who posts on THR.

I'm with 3/7, Weapons Co, CAAT White in 29 Palms. The only reason I've been online so much lately is I'm presently detached from my unit to attend an EMT class.

I suppose I should have been a bit more skeptical about the knowledge level of the instructor. I've received a wide variety of information that is either misleading, of dubious value, or just downright incorrect from people who were supposed to be teaching me. Don't get me wrong, the training I've received has been excellent. But just because someone is an E-4 or 5 doesn't make them an expert in all things ballistic or medical.
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Old April 28, 2005, 10:26 AM   #13
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Trust me, that's not limited to military life, either.
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Old May 23, 2005, 11:46 AM   #14
IZinterrogator
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Finally found my QuikClot at the bottom of one of my duffel bags yesterday, so I decided to try the stuff out in water ten minutes ago. I poured a 1.75 ounce pouch into a 12 fl oz coffee cup full of water. After five minutes, it looks like about half an inch worth of water has disappeared. There was some bubbling and smoking when the QC hit the water, but it did not heat up. So far, there has been an occasional bubble coming up from the bottom, but the post-pour reaction has been pretty tame. I tried stirring to see if anything new would happen, but nothing did. I'll post an update when I get home from work tonight.
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Old May 23, 2005, 04:30 PM   #15
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Okay, five hours later. The water is about 3/4 of an inch low. The water is cold and stirring causes some fizzing, but no heat is released when stirring. Pouring the water out of the cup revealed that the QC looked the same as when it was poured in. Exposure to air caused no reaction. All in all, a rather boring experiment.
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Old May 23, 2005, 06:23 PM   #16
Denny Hansen
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Quote:
All in all, a rather boring experiment.
But an experiment nonetheless, and a helluva lot more informative than mere speculation. Thanks.

Denny
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Old May 27, 2005, 08:34 PM   #17
tyme
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I would _really_ like to know precisely what's in quikclot, and I would _really_ like to see first-hand accounts of its use... not "someone in Iraq used it and said it works great." As much as I appreciate the Dec 2003 article in SWAT Magazine, I'd like to see an interactive discussion here or on THR or somewhere with someone who has some medical knowledge and who has used quikclot in the field, ideally several times. The Dec '03 article was too close to an advertisement for my tastes. I don't care about studies or what the marines put in their medic kits. I want to know how it works, and "concentrating blood clotting factors" isn't very descriptive -- how does it do that?

Along with that, I'd like to see first-hand comments from a doctor in a hospital who has admitted and treated someone who had been treated with quikclot in the field. I'd like to know what kinds of problems it causes, presuming the blood loss and shock are treated successfully.

Based on z-medica's description, it sounds like sodium polyacrylate could be the main ingredient, but from IZ's description it sounds like something else. Sodium Polyacrylate is used in diapers; it absorbs hundreds of times its weight in water, very quickly, turning into something resembling geletin. I don't think the stuff would be healthy circulating in the bloodstream, and I would think it would cause clots in bad places, but for simply stopping massive hemorrhaging and leaving it to the doctors to deal with other clots later, it might work.

John Farnam has been rather negative on quikclot in his quips pages, but then again he's never claimed to have seen it used. I don't recall any of his former-student-doctors who have written to him about it claiming to have seen it used, either.
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Old May 27, 2005, 09:48 PM   #18
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Quote:
Sodium Polyacrylate is used in diapers; it absorbs hundreds of times its weight in water, very quickly, turning into something resembling geletin.
This definitely wasn't that. It came out of the package like coarse sand and still had a coarse sand texture after five hours of soaking. The package says it contains trace amounts of quartz.
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Old May 27, 2005, 10:24 PM   #19
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Zeolites.
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Old May 28, 2005, 01:32 AM   #20
tyme
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Dumb me for not looking it up in wikipedia. That explains more or less why it works.
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Old May 28, 2005, 05:19 PM   #21
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Price of Quick Clot

Anybody have any idea how much this stuff costs? I was looking at the website, and it didn't say anything at all. I am a certified First Responder, hoping to become a Sheriff's Deputy soon (gotta go through testing and what not this summer). It sounds like a really good idea, but I don't think I would use it without the buddy system or a supplemental tourniquet (sory, I can never spell that). It would be just one of those things that might be good to have with my first aid kit if I should happen to roll up on a really messed up accident, or witness one happen, and have to save a life. If anyone knows the price, let me know. Thanks a lot!
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Old May 28, 2005, 07:04 PM   #22
IZinterrogator
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Try Brigade Quartermasters. That's where I got mine. I would get one of the battle packs since you are a first responder, but buy extra bandages because those Israeli ones are confusing to use at first.
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Old June 18, 2005, 06:55 PM   #23
IZinterrogator
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I'm thinking it might be time for another Quikclot experiment

I'm thinking about going to the store to buy a steak, squeezing the blood out of it, and then dumping Quikclot on that. I don't see any reason why the blood wouldn't clot, as there should still be platelets in the cow blood, but then again, I'm not a molecular biologist. Thoughts, anyone?
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Old June 18, 2005, 07:14 PM   #24
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Quick Clot does not work by using the normal clotting structures in the blood, but by pulling moisture out of the blood, basically causing a drying of the blood. That may help the platellets to work, or maybe not, but it will dessicate the blood.

A lot of the women out there will be familiar with the same product used in beauty salons for manicures. It is used in fine quantities to stop cuticle bleeding and works very well.
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Old June 23, 2005, 05:15 PM   #25
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Steak juice vs. blood etc

What a fantastic thread. I just sent a BQM Battle Pack with my boyfriend to Iraq, so I was reading up on it to properly inform him and encourage him to carry it....

IZ --

Regarding steak juice and QuickClot -- you'd need fresh, whole blood to adequately do your test. The juice you'd get out of the average store-bought steak wouldn't be adequate. For one, it won't be straight blood; it will be dilute fleshy juice, with possible preservatives in it. Also, it won't be fresh enough. As a med student (I'm old though, in the Navy, not some kid like the rest of my class), I should know the exact lifetimes of the various clotting factors, but I don't have them memorized. I can tell you that neither the clotting factors nor the platelets would be able to work when so diluted as they would be in steak juice, even if they were fresh. Just compare the look of your own blood to yummy steak juice; it ought to be a lot thicker. The platelets, actually, would probably be dysfunctional if not compeltely destroyed already by their environment, for reasons poorly explained below....


I'll avoid the full lecture on clotting cascades, but in summary, both platelets and the aforementioned clotting factors are involved, in a fabulously and annoyingly complex set of cross-talking pathways. Platelets are actually small fragments of cells with intact membranes and all that (imagine them "budding off" of a larger cell and sealing themselves up), and they need to be in a life-sustaining solution (with proper concentrations and pH etc, like your blood) to remain intact and work, as they've got all these surface proteins and receptors that participate in the reactions that lead to them aggregating to form a clot.

Basically, the coagulation cascade gets activated when any of the three elements of "Virchow's triad" are encountered -- injury to the lining of a blood vessel, a change in flow (turbulence, stasis, etc), or a hypercoaguable state inherent to the blood itself. That first thing would include exposure to anything that's NOT the lining of a blood vessel -- air, styrofoam steak package, etc. So if the steak juice were going to clot, it should've done so already. Mmmm, steak. Just eat it and use the juice for gravy.
Now, of course, just because the cascade gets activated doesn't mean that an adequate clot would form, to be clear. In a large wound, the process is clearly fighting against pressure, flow, and volume, so I guess that's where QuickClot comes in.

(*@&it, now I want a steak.
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