Military re-thinking emergency medical techniques?

There is a lot of bullshit in emergency medicine and it is sometimes hard to separate the good medicine from the bad medicine. I can give you several very well known examples of this. The "Golden Hour" is one and another is relative blood pressure values based upon palpation in the limbs and yet another is that Medical helicopters changes outcomes. There have been reports for at least a year that I know about that talks about considerable problems with the Hemcon type substances. In particular causing deaths and injuries from blood clots.

Being an ex-Sargent in charge of a scout platoon in an infantry battalion I want these guys to get the best treatment that they can possibly get and it sounds like some corners are being cut in the pursuit of that ends. If it is found to be sloppy protocols that is one thing. If it is found to be in the pursuit of profits I hope some of these people are jailed or hopefully executed.

KR
EMSI (candidate)
EMT-B
NREMT-B
Wilderness EMT
 
kr1, I hear you. I've heard so many contradictory things in my training, half of which seems to be "I know this because I'm an EMT-A or Paramedic" leaves poor me on the bottom of the food chain looking like an idiot because I won't tell someone to take a painkiller.
I do understand that it is very hard to study a lot of it, and so it is largely best guesses, but maybe someone could come up with a way to collate data without crews being tempted to make sure they "did the right thing" on paper.
 
kr1 said:
There is a lot of bullshit in emergency medicine and it is sometimes hard to separate the good medicine from the bad medicine. I can give you several very well known examples of this. The "Golden Hour" is one and another is relative blood pressure values based upon palpation in the limbs and yet another is that Medical helicopters changes outcomes. There have been reports for at least a year that I know about that talks about considerable problems with the Hemcon type substances. In particular causing deaths and injuries from blood clots.

Being an ex-Sargent in charge of a scout platoon in an infantry battalion I want these guys to get the best treatment that they can possibly get and it sounds like some corners are being cut in the pursuit of that ends. If it is found to be sloppy protocols that is one thing. If it is found to be in the pursuit of profits I hope some of these people are jailed or hopefully executed.

KR
EMSI (candidate)
EMT-B
NREMT-B
Wilderness EMT
Click to expand...

I don't think it was Hemcon, but rather Woundstat. Woundstat was recently pulled from all SOCOM supplies because of its overzealous clotting capacity causing complete blood flow stoppage to entire extremities and had also produced clots that traveled in the bloodstream.....which is bad.

But in general, the article is poorly researched. The US military did in fact introduce hemostatic agents quickly. The real problem was two-fold...1. Lack of PROPER training for the end user, and 2. The original powder form was not really conducive to extreme field use, and did I mention lack of training!?

The $89 bandage they are talking about....Hemcon is not a replacement for gauze therefore either the writer has no idea what he/she is talking about, or once again we get back to the training issue....Hemcon is to be used, in a major bleed situation, either arterial or heavy venous in which a tourniquet or other direct pressure methods, or other hemostatic agents are not appropriate...i.e. like the neck.....once again..from the field trauma perspective (I'm only speaking from that angle, not the CASH level medicine talked about) the article is way off.

So, on a side note, I've seen several non-combat trauma FAK's around the web which people put in hemostatic agents as their only stop gap. Bad idea....if you are not trained, you will try to apply this stuff and watch someone bleed out right in front of you.

H
 
hutch762mg said:
I don't think it was Hemcon, but rather Woundstat. Woundstat was recently pulled from all SOCOM supplies because of its overzealous clotting capacity causing complete blood flow stoppage to entire extremities and had also produced clots that traveled in the bloodstream.....which is bad.

But in general, the article is poorly researched. The US military did in fact introduce hemostatic agents quickly. The real problem was two-fold...1. Lack of PROPER training for the end user, and 2. The original powder form was not really conducive to extreme field use, and did I mention lack of training!?

The $89 bandage they are talking about....Hemcon is not a replacement for gauze therefore either the writer has no idea what he/she is talking about, or once again we get back to the training issue....Hemcon is to be used, in a major bleed situation, either arterial or heavy venous in which a tourniquet or other direct pressure methods, or other hemostatic agents are not appropriate...i.e. like the neck.....once again..from the field trauma perspective (I'm only speaking from that angle, not the CASH level medicine talked about) the article is way off.

So, on a side note, I've seen several non-combat trauma FAK's around the web which people put in hemostatic agents as their only stop gap. Bad idea....if you are not trained, you will try to apply this stuff and watch someone bleed out right in front of you.

H
Click to expand...


Yep, you are correct. I wrote that with a little fire in my eyes after reading the article and I didn’t distinguish between the two correctly. I did research on Quikclot for possible use in our fire department on our ambulance. After more research into it I was totally against trying to use it. Debridement, clot issues etc. convinced me that there was no way that we needed or wanted to use it on our ambulance. Of course I would need to have started with our medical control to use it in any event and I wanted reasons that it would have been useful before going to him. After the research I saw no reason to try.

Things change in emergency medicine, sometimes fast and sometimes slowly. The latest turn around is that we are all probably going to be using tourniquets again. The National registry has decided that there is no evidence that raising the limb above the level of the heart does anything useful and from applying direct pressure with several bandages and then artery pressure points (if warranted) we are apparently going to be going straight to a tourniquet. I should point out that this is not the current protocol and should not be used except when direct pressure and all other methods fail. And I should also point out that while I have been told that it is something that is going to change, I have actually not seen that change on their website yet. So I would still only use whatever the approved protocol is for your area. Telling your med control that you read it on Bladeforums is not likely to impress them and make the difference. :eek:

And I agree with you hutch 100% on the training. The problem with poor training is that there is almost always a tendency to “do something” and when you give someone a hammer, everything starts to look like a nail unless you train them properly. Meaning that you give someone an agent like this, especially when the marketing tells you things like its “all natural” there is a tendency without proper to training to use it all the time even for instances were its not appropriate because “it can’t hurt”. The way it hurts is that while someone is doing that they are not taking the appropriate course of action that might actually save the persons life.

Now, I have been out for over 25 years but when I was in the medics I knew were very, very good. Several had won their Expert medics badge. That was as tough to get as the Expert infantry badge. I have no reason to believe that the current generation of medics is any less competent if the training curriculum taught them appropriately. Most of these are smart, brave guys. I remember as a kid the first man killed in Vietnam from my hometown wasn’t an infantryman, it was a medic.

I also agree with you that I cannot see any reason to include one of these agents in a FAK. I don’t have one in mine and my personal opinion is that if I can’t stop the bleeding with my current knowledge on pressure, etc then it is likely that nothing else would have made a difference.

KR
 
Last edited:
This is not a huge surprise to me...everyone I know who is actively out there stabilizing people for the doctors to reassemble, either in-theatre or in civilian life, relies more on the old standbys than the clotting agents.

I do know a number of people who believe in them and use them regularly but they tend to be quite particular in how they apply them and under what conditions. They seem to be a 1% of the time kind of a tool. Of course I own the stuff, because I can, but frankly I would be reluctant to use it unless I thought I was a goner without it anyway. Generally speaking my impression is that unless circumstances prevent you from doing so, your best option is direct pressure from a gloved hand.
 
Only peripherally related to this but I was hearing on the radio about this medical center that computerized their records and started tracking which treatments and practices actually worked for their patients.

They were doing a lot of stuff like in the article, ie doing it because somebody else had said it was the way to go rather than relying on objective data.

Once they started going on data they made some changes, a lot of them just common sense stuff that radically reduced mistakes and the cost of care.
 
The military was just trying to do the best for its guys and I believe that. Mistakes were made in rushing new protocols granted but I think the alternative in waiting for the glacier speed of peer reviews and BS FDA approval is not in the battlefield warriors best interest.

It is life over limb litterally all day all the time in theater.

Skam

EMT-A
WREMT
SAR TECH I
 
Hi,

Interesting article but not very surprising. At its very basic level medical science is about having a new idea and then killing or saving enough patients with it until everyone figures out if it works or not.

And the military has historically been a good place for medicine try new things. Particularly in traumatic injury. Sometimes things work and sometimes they don't. This is why review is an on going and never ending process.

For those of us involved in civilian EMS, yes, there are things we do simply because that's the way we've always done it. Protocols are often slow to change because of legal ramifications. But they are reviewed, maybe not as often or as transparently as us EMT's would like. But it does happen. Remember, EMS is a relatively new idea and discipline. And in the end, right or wrong, protocols are all we have to guide us and cover our backsides.

I do get a little worried about some of the things people seem to think they need in a first-aid kit. Things like clotting agents, epi-pens, airways, anti-biotics, and even suturing are best left to people with training and practice in their usage. And reading a book or pamphlet isn't training.

dalee
 
You must log in or register to reply here.
Back
Top