Are you curious about hemostatic agents? Are you wondering when you should use them and how they work? You're in the right place. In this article, you'll learn when, where, and how to use a hemostatic agent. 

Hemostatic agents come in many forms, including Quikclot impregnated gauze and Celox granules. Hemostatics work by speeding up the clotting process and slowing a serious hemorrhage. 

There seems to be some mystery about how hemostatics work and if they're safe. Don't worry. After reading the sections below, you'll be better equipped to administer hemostatics and more prepared for all aspects of bleeding control. 

What are Hemostatic Agents? 

Hemostatic refers to any agent used to speed up clotting to stop a bleed. Let's discuss specifics. 

Hemostatic fast facts: 

• Some hemostatic agents activate the bodies natural clotting cascade, speeding up clot formation and slowing hemorrhage. 
• Other hemostatic agents work without the body's clotting system, allowing clots to form.
• Antihemorrhagic is another name for medicinals that increase the body’s ability to form clots. 
• Some hemostatic agents are impregnated (combined with) rolled gauze. This allows you to combine the benefits of wound packing with the technology of hemostatics. 
• Some hemostatics are in powder form, either sprinkled or injected into the wound. 
• Hemostatic agents are often developed and tested on the battlefield.

Alright, now that you have an overview of hemostatics, let's go into more specifics. 

How do Hemostatic Agents Work? 

In this section, we'll discuss the two main substances used in hemostatic agents. The substances within hemostatics react with the blood, causing a clot to form. However, both substances work in different ways. 

Here they are: 

• Kaolin. Kaolin is used in QuikClot. Kaolin is non-organic and activates the body's natural clotting system. Kaolin has been shown to work in patients who have coagulopathy (blood clotting disorders). 
• Chitosan. Celox utilizes chitosan. Chitosan does not use the body's clotting system. Instead, chitosan forms a gel-like plug, preventing further hemorrhage. This substance originates from shellfish; however, those with potential allergy concerns shouldn't worry. There have been no reported allergic reactions from Celox, even from people with confirmed shellfish allergies. However, even if there were an allergic reaction, serious bleeding control takes priority. 

Alright, now that we know a bit about the substances used for bleeding control, let's look at the brands and how they come packaged.

What are the Different Types of Hemostatics? 

Let's explore the different types of hemostatics carried in first aid kits. While some hemostatics are used for serious bleeding, others are useful for everyday cuts. 

Here are several brands of hemostatics on the market. These three are approved by the CoTCCC. 

• Celox 
• Chitogauze
• Quikclot 

Here are several ways the hemostatics come packaged:

• Gauze rolls
• Granules
• Wound applicator

The way you apply a hemostatic agent is more important than you might realize, so let's go into the pros and cons of each of them. 

Hemostatic Gauze Rolls  

Gauze rolls are among the most popular form of hemostatic agent. They are easily stored and useful for almost all types of injuries. 

Gauze roll benefits: Will the gauze roll, you don't need to worry about powder blowing away in the wind. Also, if you're just treating a small wound, you can cut a piece of the gauze and save the rest. 

Gauze roll negative: The gauze rolls can be the most expensive. Also, for non-serious, surface-level bleeding, you may be better served with a powder, as you don't need the packing benefits of rolled gauze. 

Hemostatic Granules 

Granules are often contained in a simple package, allowing you to pour them onto a surface-level wound or into a deep wound. Celox granules are easily packable in your trauma kit.

Granules pros: Granules can be less expensive. Also, if you want a hemostatic for less serious wounds, a powder or granule form might be your ticket. 

Granules cons: if you're working in austere environments, subject to wind, rain, or snow, you may want to stay away from granules on their own. Granules are harder to control in windy conditions. However, if you’re careful, you can mitigate this problem. 

Hemostatic Wound Applicator 

The wound applicator removes some of the uncertainty of the granules on its own. A wound applicator is, essentially, a syringe filled with granules. This gives you much more accuracy when placing the granules within a wound. 

Wound applicator pros: You can inject the hemostatics deep within the wound. You don't need to worry about wind or rain messing with your dressing. 

Wound applicator cons: The wound applicator is best suited for deep puncture wounds. So, you'll need some gauze rolls for large junctional wounds. Also, some wound applicators can be expensive. 

When Should I Use Hemostatics?  

Hemostatics can be used for almost any incidence of bleeding - from paper cuts to gunshots. With that said, their best use comes in with more serious bleeding, where their benefits outweigh potential risks. 

Most hemostatics are implemented for life-threatening bleeding. These are instances where regardless of the risks, the patient will die if you don't control the bleeding. 

However, here are some risks to keep in mind: 

• Blood clots. Some types of hemostatics activate the clotting cascade. For this reason, some hemostatics could cause clots to travel to other areas of the body. This isn't a concern with life-threatening bleeding; however, consider avoiding hemostatics for non-life-threatening bleeds. 
• Forgoing Tourniquets. Hemostatics do not take the place of the tourniquet. If someone believes hemostatics are the end-all, they might forego using a tourniquet - this is a mistake.  

In general, hemostatics are safe. Especially when treating serious life threats, the benefits outweigh the risks. Alright, now let's discuss how to use hemostatics in a real-world situation. 

How Should I Use Hemostatics?

Let's cover several steps to using hemostatic agents. While this guide will give you some starting ideas, be sure to seek out hands-on training. Becoming certified in first aid will help you grasp how everything works together. 

Steps to using hemostatics: 

1. Safety. If you can, put on gloves before any medical procedure. However, if you don't have time, applying PPE isn't always practical. With that said, you should always try to move yourself and the patient to a safe location. 
2. Apply pressure with your hand. As you're preparing the gauze, apply pressure with your hand. You can use your knee to apply pressure if you need both hands to prepare the gauze of the tourniquet. 
3. Wound packing. If you have a deep wound to the groin, neck, or armpit area, you should consider wound packing. To pack a wound, expose the area and then begin by placing pressure deep within the wound; then, almost like your fingers are a sewing machine, begin feeding gauze underneath your fingers and holding pressure. Be sure to hold pressure throughout. 
4. Hold pressure for 3 minutes (at least). You still need to hold pressure while using hemostatic gauze. A big bleeding control mistake is releasing pressure too soon. 
5. Apply a pressure dressing. After holding pressure, apply a good pressure dressing to prevent bleeding from reoccurring. 
6. Tourniquet. If the bleeding isn't in a junction, consider going straight to a tourniquet and forgoing the hemostatic agent. 

Using hemostatic gauze isn't much different than using regular gauze. The hardest part about using hemostatic gauze is knowing when to use it, when to avoid it, and when to use a tourniquet. The more you study bleeding control, the easier it will be to make these difficult decisions. 

Frequently Asked Questions about Hemostatic Agents  

Let's take a moment to answer several common questions about hemostatic agents. 

Do Hemostatics cause Burning? 

An exothermic reaction refers to a chemical reaction that produces heat. While some of the older versions of hemostatics caused an exothermic reaction, most on the market today do not produce noticeable heat. 

Can You use QuikClot on the Abdomen? 

The use of hemostatics in the abdomen is beyond the scope of typical first aid. While there is the possibility of using hemostatics for abdominal bleeding, it would be very difficult to do this effectively without large amounts of gauze. Here is a link to Quikclot for more information on controlling abdominal hemorrhage. 

Which is better QuikClot or Celox? 

Both Quikclot and Celox are proven hemostatic agents. Neither is necessarily better than the other. Quikclot Combat gauze is often used in the military. Celox is readily available in gauze, plunger, and granule form. 

Does Celox Hurt? 

Celox gauze shouldn't cause any increased pain. However, if you're using the wound applicator to apply Celox deep within a wound, this will likely cause increased discomfort. With that said, it's important to stop a bleed as fast as possible, regardless of possible pain. 

Final Words on Hemostatics 

Hemostatic agents are just another tool in the rescuer's trauma bag. Hemostatic agents are not magic. If you don't know how to administer good first aid and good bleeding control, then a hemostatic agent isn't going to turn you into a superhero. Also, if you don't have the extra cash for hemostatics, you can still perform good bleeding control with traditional methods. 

If you take the time to understand injuries, you'll be better equipped to treat them. In 2021, we have a national shortage of paramedics and EMTs, so it's more important than ever to get equipped and get trained. 

Note: this article is not meant to endorse or degrade any particular brand or type of hemostatic. Technology can changes daily. Be sure to follow local laws and guidelines.