title: Hemostasis in a noncompressible hemorrhage model: an end-user evaluation of hemostatic agents in a proximal arterial injury.
abstract: OBJECTIVE
  1. Evaluate hemostatic bandages by the end user using subjective and objective criteria. 2. Determine if user training and education level impact overall hemostatic outcomes. 3. Our hypothesis was that prior medical training would be directly linked to improved hemostatic outcomes in noncompressible hemorrhage indepen- dent of dressing used.
  
  
  METHODS
  Military personnel were given standardized instruction on hemostatic dressings as part of a tactical combat casualty care course (TC3). Soldiers were randomized to a hemostatic dressing. Proximal arterial (femoral and axillary) injuries were created in extremities of live tissue models (goat or pig). Participants attempted hemostasis through standardized dressing application. Evaluation of hemostasis was performed at 2- and 4-minute intervals by physicians blinded to participants' training level.
  
  
  METHODS
  Military personnel that are due to deploy are given "refresher" instruction by their units as well as participating in the TC3 to further hone their medical skills prior to deployment. The TC3 is simulation training designed to simulate combat environments and real-life trauma scenarios.
  
  
  METHODS
  Military personnel due to deploy, physicians (residents and board certified surgeons), animal care technicians, and veterinarian support.
  
  
  RESULTS
  Celox 42 (33%), ChitoGauze 11 (9%), Combat Gauze 45 (35%), and HemCon wafer 28 (22%) bandages were applied in 126 arterial injuries created in 45 animals in a standardized model of hemorrhage. Overall, no significant difference in hemostasis and volume of blood loss was seen between the 4 dressings at 2 or 4 minutes. Combat gauze was the most effective at controlling hemorrhage, achieving 83% hemostasis by 4 minutes. Combat gauze was also rated as the easiest dressing to use by the soldiers (p<0.05). When compared to nonmedical personnel, active duty soldiers with prior medical training improved hemostasis at 4 minutes by 20% (p = 0.05).
  
  
  CONCLUSIONS
  There is no significant difference in hemostasis between hemostatic bandages for proximal arterial hemorrhage. Hemostasis significantly improves between 2 and 4 minutes using direct pressure and hemostatic agents. Prior medical training leads to 20% greater efficacy when using hemostatic dressings.
authors: Department of Surgery, Madigan Healthcare System, Tacoma, Washington 98431, USA.
authors: Steven
authors: S
authors: Satterly
authors: Daniel
authors: D
authors: Nelson
authors: Nathan
authors: N
authors: Zwintscher
authors: Morohunranti
authors: M
authors: Oguntoye
authors: Wayne
authors: W
authors: Causey
authors: Bryan
authors: B
authors: Theis
authors: Raywin
authors: R
authors: Huang
authors: Mohamad
authors: M
authors: Haque
authors: Matthew
authors: M
authors: Martin
authors: Gerald
authors: G
authors: Bickett
authors: Robert M
authors: RM
authors: Rush
mesh_terms: D000818:Animals; D001158:Arteries / Q000293:injuries; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D008889:Military Personnel / Q000193:education; D023421:Models, Animal; D014481:United States; D006801:Humans
chemical_list: D006490:Hemostatics