Page 35 - Journal of Special Operations Medicine - Spring 2016

Management of External Hemorrhage in

Tactical Combat Casualty Care:
The Adjunctive Use of XStat Compressed Hemostatic Sponges
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TCCC Guidelines: Change 15-03

Kyle Sims; F. Bowling; Harold Montgomery;
Paul Dituro; Bijan S. Kheirabadi, PhD; Frank Butler, MD

ABSTRACT
Exsanguination from wounds in the so-called junctional Application tourniquet (Composite Resources Inc.;
regions of the body (i.e., the neck, the axilla, and the http://combattourniquet.com) or SOF Tactical Tourni-
groin) was responsible for 19% of the combat fatalities quet (Tactical Medical Solutions; https://www.tacmed
Combat Ready. Combat Reliable. who died from potentially survivable wounds sustained solutions.com) as the intervention of choice for initial
in Afghanistan or Iraq during 2001 to 2011. The de-
control of life-threatening extremity hemorrhage if the
velopment of improved techniques and technology to bleeding site is amenable to limb tourniquet use.
manage junctional hemorrhage has been identified in
the past as a high-priority item by the Committee on 3. For life-threatening external hemorrhage from
Tactical Combat Casualty Care (CoTCCC) and the wounds that are not amenable to tourniquet use, the
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Army Surgeon General’s Dismounted Complex Blast hemostatic dressing Combat Gauze (Z-Medica; www
Injury (DCBI) Task Force. Additionally, prehospital .z-medica.com/healthcare), applied with 3 minutes of
care providers have had limited options with which to direct pressure, is recommended as the first option of
manage hemorrhage resulting from deep, narrow-track, choice for the initial control of bleeding, Celox Gauze
penetrating trauma. XStat is a new product recently (Medtrade Products Ltd.; http://www.celoxmedical
™
WHEN SECONDS COUNT, it’s vital for approved by the US Food and Drug Administration as a .com) and ChitoGauze (HemCon Medical Technolo-
products to perform under the toughest field hemostatic adjunct to aid in the control of bleeding from gies Inc.; http://www.hemcon.com) are recommended as
junctional wounds in the groin or axilla. XStat has now alternates. 2–4
conditions and be ready when you are. Arrow ® Arrow ® been recommended by the CoTCCC as another tool for
®
Teleflex is committed to connecting battlefield EZ-IO ® EZ-IO T.A.L.O.N. ™ the combat medical provider to use in the management 4. If the junctional bleeding is from a site that is amenable
System for Military Use Needle Set of junctional hemorrhage. The evidence that supports to the use of a junctional tourniquet, the Combat Ready
responders with easy-to-use, reliable military- adding XStat to the TCCC Guidelines for the treatment Clamp (CombatMedical; http://combatmedicalsystems
use airway management and vascular access of external hemorrhage is summarized in this paper. .com), the Junctional Emergency Treatment Tool (North
American Rescue; http://www.narescue.com), and the
solutions that can help save lives. Keywords: hemorrhage, junctional; hemorrhage, external; SAM Junctional Tourniquet (SAM Medical Products;
hemostatic; tourniquets; TCCC Guidelines; XStat ™ http://www.sammedical.com) are the CoTCCC-recom-
mended devices of choice. Combat Gauze or one of the
other recommended hemostatic dressings should be ap-
Teleflex.com/military Proximate Cause for This Proposed Change plied with 3 minutes of direct pressure to gain control
of the bleeding while a junctional tourniquet is being
Rusch ® 1. Exsanguination from junctional hemorrhage (i.e., the readied for use. 3,5
TruLite Secure ™ LMA Supreme ™ neck, the axilla, and the groin) was responsible for 19%
®
Single-use Laryngoscope Airway of the combat fatalities who died from potentially sur- 5. The clearance of XStat by the US Food and Drug Ad-
vivable wounds sustained in the conflicts in Afghanistan ministration (FDA) offers a new option for the control
and Iraq between 2001 and 2011. 1 of external hemorrhage from junctional bleeding sites
Teleflex, the Teleflex logo, Arrow, EZ-IO, LMA, LMA Supreme, Rusch, T.A.L.O.N and TruLite Secure are trademarks or registered trademarks of Teleflex Incorporated or its affiliates,
in the U.S. and/or other countries. © 2016 Teleflex Incorporated. All rights reserved. MC-002114 that are not adequately addressed by the aforemen-
2. The Tactical Combat Casualty Care (TCCC) Guide- tioned measures. The FDA clearance letter of 3 April
lines dated 3 June 2015 recommend the Combat 2014 states that XStat should be used:

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