title: Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases.
abstract: BACKGROUND
  Uncontrolled haemorrhage is the leading cause of potentially preventable death in both civilian and military trauma patients. Animal studies and several case series have shown that hemostatic dressings reduce haemorrhage and might improve survival. One of these products is HemCon ChitoGauze(®). The objective of this study was to determine the effectiveness and safety of ChitoGauze in achieving hemostasis in massive traumatic bleeding in civilian emergency medical services.
  
  
  METHODS
  From June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with ChitoGauze. The dressing was used according to protocol; if conventional treatment (gauze dressing with manual pressure) failed to control external traumatic bleeding or if conventional treatment was unlikely to achieve hemostasis. The ambulance personnel filled in an evaluation form after each use.
  
  
  RESULTS
  A total of 66 patients were treated with ChitoGauze during the study period. Twenty-one patients were taking anticoagulants or suffered from a clotting disorder. The injuries were located in the extremities (n=29), the head and face (n=29), or the neck, thorax and groin (n=8). In 46/66 patients, the use of ChitoGauze resulted in cessation of haemorrhage. In 13/66 patients, Chitogauze application reduced haemorrhage. ChitoGauze failed to control haemorrhage in 7/66 patients, whereby user error was a contributing factor in 3 of these failures. No side effects have been observed during treatment or transport of the patients and no adverse effects have been reported in discharge letters.
  
  
  CONCLUSIONS
  This is the largest prospective study in civilian healthcare and the second largest case series with prehospital use of hemostatic dressings. It demonstrated that ChitoGauze is an effective and safe adjunct in the prehospital treatment of massive external traumatic haemorrhage.
authors.affiliation: Department of Surgery-Trauma surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: R.teGrotenhuis@hotmail.com.
authors.forename: Ruben
authors.initials: R
authors.lastname: Te Grotenhuis
authors.affiliation: Ambulance Emergency Services Gelderland-South, Nijmegen, The Netherlands. Electronic address: Pierre.van.Grunsven@vrgz.nl.
authors.forename: Pierre M
authors.initials: PM
authors.lastname: van Grunsven
authors.affiliation: Ambulance Emergency Services Gelderland-Middle, Arnhem, The Netherlands. Electronic address: Wim.Heutz@vggm.nl.
authors.forename: Wim M J M
authors.initials: WM
authors.lastname: Heutz
authors.affiliation: Department of Surgery-Trauma surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Edward.Tan@radboudumc.nl.
authors.forename: Edward C T H
authors.initials: EC
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D001458:Bandages; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
chemical_list: D006490:Hemostatics
keywords: Ambulance; Bandage; Bleeding; Dressing; Emergency medical service; Gauze; Haemorrhage; Hemostatic; Prehospital; Trauma