Despite advances in medicine, hemorrhagic shock continues to be the leading cause of mortality in trauma situations. Hemostatic dressings manage extensive blood loss, reduce the need for blood transfusion, decrease instances of infection, and prevent hemorrhage-related deaths, among other vital functions.
Hemostatic dressings work to stop heavy and life-threatening bleeding by physically sealing the wound, increasing the concentration of clotting factors at the wound site, or stimulating and accelerating the body’s natural clotting pathway.
Whether you’re trained, semi-trained in applying hemostatic dressings, or don’t know anything about them, you have come to the right place. Please read to discover what hemostatic dressings are, how they work, and how you should apply them to manage bleeding. You will also learn factors to consider when buying and choosing a hemostatic bandage for a particular wound.
What Are Hemostatic Dressings?
Hemostatic dressings are topical dressings to manage catastrophic external bleeding locally. Emergency Medical Technicians (EMTs) use these dressings to stop bleeding from traumatic injuries and at surgical wound sites in military and civilian settings.
Hemostatic dressing is available in gauze, sponge, gel, powder, or granular forms. The hemostatic dressing is structurally different from plain gauze because the former contains an active agent to stop bleeding.
Some hemostatic dressings are effective for some wounds and not for others. Some formulations work for some injuries and not others.
Whether you’re a healthcare professional, someone who operates in combat environments, or an individual who might have to act as an emergency responder in their work environment, you should know how hemostatic dressings work.
The following section explains how the various hemostatic agents work.
The Working Mechanism of Hemostatic Dressings
Hemostatic dressings are used to stop heavy bleeding. The mechanism of action varies depending on the agents used in the dressing.
The following sections focus on the hemostatic agents currently used in medical and military settings and how they work to stop bleeding:
This class of hemostatic agents is designed as a three-dimensional honeycomb-like structure that absorbs small molecules like those that comprise the aqueous components of blood. This absorption process is a non-chemical reaction.
When the aqueous blood components are absorbed, a thick concentration of the larger molecules of the cellular, platelet, and protein components are left behind. This absorption increases the concentration of clotting factors at the wound site.
Earlier generations of hemostatic agents that used factor concentrators caused the temperature at the wound site to increase significantly and resulted in tissue burns.
However, subsequent products have found a way around this drawback. So nowadays, you don’t have to worry about burn injuries when using hemostatic dressing with such an agent.
Hemostatic dressing with mucoadhesive agents adheres tightly to tissues and stops the bleeding by physically sealing the wound site.
Mucoadhesive agents like chitosan, derived from the natural polysaccharide chitin found in shellfish, are widely used as hemostatic dressing agents.
Here’s how mucoadhesive agents work:
- The positively-charged hemostatic agent in the dressing attracts the negatively-charged red blood cells.
- The agent becomes sticky when it comes in contact with the red blood cells.
- The adhesive action creates a seal over the bleeding site.
- The seal acts like a clot to stem the bleeding.
The most significant advantage of hemostatic dressings with mucoadhesive agents is that they trigger the clotting action without needing the body’s physiological clotting pathway. This dressing is effective even if the wounded person is on anticoagulant therapy or has coagulation disorders.
Most chitosan formulations are biodegradable and don’t have to be removed before surgery.
Newer products use packable gauze with chitosan to achieve double benefits from chitosan’s ability to promote blood clotting and the ease of use of gauze material.
Hemostatic dressings with procoagulant factors are advanced products. They stimulate and accelerate the body’s natural clotting mechanism by delivering procoagulant agents to the wound site.
Many of these hemostatic dressings come in the form of a sachet the size of a teabag. The sachet can contain procoagulant agents like kaolin that activate the body’s intrinsic clotting mechanism.
The sachet has to be applied directly to the wound. Afterward, it’s easy to remove the dressing.
Besides kaolin, some dressings with procoagulant supplements contain human clotting factors and factors obtained from cow’s blood.
How To Apply Hemostatic Dressing
Whatever be the agent, hemostatic dressings have to be used in the following manner:
1. Identify Catastrophic External Bleeding
Using a hemostatic dressing is the last resort in a bleeding incident. You should only use it for life-threatening and catastrophic external bleeding.
You should use hemostatic dressing in the following circumstances:
- The bleeding is likely to become life-threatening if not stopped immediately.
- The wound is in a critical vascular region.
- Direct manual pressure cannot stop the bleeding.
- Standard and pressure dressing cannot stop the bleeding.
- The wound site is not conducive to applying a tourniquet, such as a junctional region like the neck, groin, or axilla.
According to the Journal of Emergency Medical Services, the hemostatic dressing should be applied as a supplement to measures like elevating the wounded person, applying direct manual pressure, and using pressure points and tourniquets.
You shouldn’t use hemostatic dressing in the following instances:
- The wound is at a location where blood flow must not be obstructed, such as the abdomen or chest, or in case of open skull fractures.
- The wounded person is at a place where there’s no medical facility to remove the dressing within 24 hours, such as on an ocean-going vessel, an oil rig, or a remote research outpost.
2. Expose the Wound
Open or tear clothing around the wound to expose the site. This exposure makes it easy to examine the extent of the wound and the amount of blood loss, apply the dressing, and monitor the area. Exposing the wound will also allow you to assess the extent and seriousness of the whole injury properly.
3. Remove Pooled Blood From the Wound Site
Use plain gauze to remove excess pooled blood from the wound site. Place the gauze over the blood and apply pressure. You may have to use more than one gauze to remove all the pooled blood.
DO NOT remove any clot that may have already formed at the site.
Removing pooled blood allows you access and examine the wound site and makes it easy to apply the hemostatic dressing.
4. Identify the Major Source of the Bleeding
Identify the major source of bleeding, which may be an artery or a vein. You have to use a hemostatic dressing to stop bleeding at this site.
Here’s how the primary site of bleeding would appear:
- Blood is pumping out or gushing forth from the wound.
- The bleeding may stop or slow when you apply pressure but resumes as soon as you remove the pressure.
- The blood is saturating one gauze after another.
5. Apply Direct Manual Pressure
Apply direct manual pressure to the major site of bleeding.
Remember, hemostatic dressing isn’t a substitute for sustained direct manual pressure.
Researchers say hemostatic dressing is no more effective than standard gauze when used without direct manual pressure.
6. Read the Usage Instructions on the Dressing Package
Read the usage instructions on the dressing package thoroughly. There may be additional instructions or warnings for the specific type of dressing you are using. Read the package for application instructions if you’re not trained in using hemostatic dressing.
Open the package and take out the dressing.
DO NOT throw away the package. If you have to transfer the wounded person to another care facility, you must inform the receiving health professionals about the type of dressing you have used.
7. Pack the Wound With the Dressing
Packing the wound requires care and precision.
Here’s how to use a gauze-type hemostatic dressing to pack a wound:
- Ensure that you’re maintaining direct manual pressure on the wound at all times during the packing.
- Remove one end of the gauze.
- Pack the unfolding gauze directly over the source of the bleeding.
- You may have to splay open some tissue to place the dressing above the bleeding site.
- If blood saturates the first layer of dressing, apply another layer.
- If the wound is deep, continue filling in the gauze until the wound is packed above the skin level.
- You can use abdominal battle dressings or plain gauze above the hemostatic dressing to add bulk if the wound is deep.
- Ensure that you cover the whole wound or the entire bleeding surface with the dressing and not just the primary bleeding site.
- To keep the hemostatic dressing in place, you can use a pressure dressing, such as a roller bandage.
- Continue applying constant direct manual pressure to the wound for three minutes after packing the site.
If you use a granular or powder form of hemostatic dressing, pour it over the bleeding site and wait for it to turn into a gel-like substance and physically seal the wound. You may want to cover the wound with more bandages or gauze while maintaining direct manual pressure at all times.
8. Monitor the Wound Site
Visually monitor the wound site for bleeding. You should be vigilant to ensure that the bleeding does not continue unabated or signs that the dressing is ineffective in reducing the bleeding. Reapply manual pressure if you notice bleeding and continue applying pressure till bleeding stops.
9. Prepare for the Next Stage of Care
You should remove the hemostatic dressing within 24 hours of application. The type of dressing you have used determines how easy or challenging it would be to remove it. So, you must inform the healthcare provider who receives the wounded person at the next stage of care what hemostatic dressing you have used.
After ensuring the bleeding has stopped, document what steps you have taken to manage the hemorrhage. Experts recommend that you preserve the dressing package and hand it over to the receiving physician or nurse at the next stage of care.
What To Consider When Buying and Using Hemostatic Dressings
Many brands of hemostatic dressings are available in the market. These use different agents and work best for some wounds and not for others. The differences arise from the peculiar ways in which hemostatic agents react with the various components of blood and the kinds of wounds they treat.
You should consider the following qualities when buying or using hemostatic dressings in pre-hospital, hospital, or military settings:
1. The Dressing Should Stop Extensive Bleeding Quickly
Prolonged severe bleeding can be fatal. The most effective hemostatic dressing can stop extensive bleeding within two minutes of application. Some rapid-action agents show results in even less time.
However, you must remember that hemostatic dressings are effective only if the aid provider uses them with direct pressure.
2. You Can Apply the Dressing Through a Pool of Blood
Hemostatic dressings are used to stem heavy bleeding. You may apply the most effective ones through a pool of blood flowing from the wound site.
Hemostatic dressings with granules cannot be applied if there is a fast blood flow. Gauze-type hemostatic dressings are effective in this regard.
Granular dressings also don’t work against gravity, such as when the wound is on the back of the body.
3. The Dressing Should Have No Toxic Effects Like Burns
Some older-generation hemostatic dressings caused the temperature at the wound site to rise when they reacted with the aqueous components of blood. Such reactions sometimes caused temperatures to rise as high as 76OC (168.8OF), which burned the tissues surrounding the wound site.
Look for dressings that don’t have this drawback, such as the QuickClot Dressing, which does not create exothermic reactions on the wound site.
4. The Dressing Should Be Sterile
Some hemostatic dressings comprising biological materials can cause infection. For instance, some products are known to transmit viral agents. However, most products approved by the FDA are safe.
You can consider chitosan-based hemostatic dressings that have antimicrobial properties.
5. Your Dressing Should Not Leave Any Residue
Granule-based hemostatic dressings tend to leave behind residue in the blood vessels, which can obstruct the normal flow of blood. It’s prudent to choose a gauze-type dressing that does not suffer from this drawback.
On the other hand, hemostatic dressings that work by activating the body’s clotting mechanism to stem blood loss also increase the risk of the clots spreading to other parts of the body. This condition can injure the lining of the blood vessels and cause thrombosis, a situation where a blood clot completely blocks an artery or vein.
6. The Dressing Should Be Easy To Use
I highly recommend that you look for hemostatic dressings that are easy to use even by:
- A wounded person who may have limited mobility
- A health professional with minimal training in using such dressings
- A battle “buddy” who may not be trained to use medical supplies.
Look for products that do not need to be “prepared” or mixed before application—for instance, dressings containing fibrin sealants that you can apply directly to the wound site.
7. The Dressing Should Suit Large, Deep, or Irregular Wounds
Improvised explosive devices are now being used in battlefield situations and in civilian settings. These devices cause irregular depth and geometry in wounds, and not all hemostatic dressings work for such injuries.
Also, not all hemostatic dressings can effectively control bleeding in intracavity sites or non-compressive tissues and organs like the spinal cord, brain tissue, and fragile organs.
On the other hand, powder or granular hemostatic dressings are ineffective when the bleeding vessel is located at the bottom of a narrow wound.
Some hemostatic dressings have a square shape and a stiff consistency. They work best only for wounds on flat surfaces with a limited area.
Some formulations of hemostatic dressing that can fill large wounds are not suitable for small and deep injuries, such as gunshot wounds where the bullet has penetrated deep into the layers of the skin.
Some powder-type hemostatic dressings come with special applicators that make it easy for you to pack deep and penetrate stab and gunshot wounds. However, these require some skill to apply and are usually not part of standard first-aid kits.
Depending on the use case scenario, it’s crucial that the hemostatic dressing you use has high injectability and flowability. These types of dressings are suited to irregularly-shaped wounds and intracavity injuries.
Consider buying hemostatic dressing with hydrogel-based biomaterials if you work somewhere where you may come across a large number of people with large, deep, and irregularly-shaped wounds.
You may apply these dressings to almost all types of wounds with varied shapes, sizes, depths, and at various body sites. Additionally, these dressings are safe for the wounded person, biodegradable, promote drug delivery, and can stimulate the body’s natural healing mechanism.
8. Your Dressing Should Offer Drug-Delivery Properties
Some clinical settings require the application of a hemostatic dressing that can effectively deliver one or more drugs to the targeted tissue.
For instance, medical personnel use oxidized cellulose dressings in many operative settings, such as:
- Abdominal surgery
- Pelvic surgery
- Head and neck surgery
- Cardiovascular surgery
- Thoracic surgery
- Skin and subcutaneous tissue procedures.
Besides possessing hemostatic properties, chitosan dressing containing microporous polysaccharide microspheres can deliver drugs to a specific site at a controlled rate.
Alternatively, you may find products such as the Seasorb Alginate, which offers a silver complex with broad microbial action for up to seven days of wear.
9. The Dressing Should Be Easy To Remove
Many cases of traumatic injuries that cause severe blood loss require surgery even after physicians have managed to stem the bleeding with a hemostatic dressing. Medical personnel have to remove the hemostatic dressing before the surgery.
Medical personnel often use hemostatic dressings after surgery to control bleeding. They have to also remove these dressings because they’re non-degradable and can cause secondary injury, additional pain, and delayed healing.
Some hemostatic dressings are difficult to remove. In the case of some products, some portion of the dressing remains even after several washouts.
Mineral-based dressings containing a potassium ion salt and any form of an absorbent polymer are challenging to remove because they bind too tightly with the tissues.
10. Dressings Should Be Lightweight and Durable
Lightweight and durable hemostatic dressings are easy to carry and store, especially in battlefield scenarios. In the instance of multiple injury victims, EMTs can carry multiple dressings to the site without returning to collect more which saves time vital in emergency scenarios.
11. Dressings Should Be Stable at Extremes of Temperature
Hemostatic dressings may need to be stored and applied at extremely high and low temperatures. If you work in a setting where temperature extremes are common, consider buying hemostatic dressings that can withstand the highs and lows of temperature.
This versatility allows the storage of homeostatic dressings without the need for temperature-controlled storage equipment.
12. The Dressing Should Have a Minimum Shelf-Life of 2 Years
In some civilian settings, hemostatic dressings may not have regular use. However, medical personnel still need to have them on hand.
If you work in such settings, ensure that the product you buy has a minimum shelf life of two years. Store them such that the ones with the earliest expiration dates are on the front of the row or top of the stack so that they get used first.
Even better quality products such as the Gauze Combat QuickClot offer five years of shelf life for extended use and durability.
13. Your Dressing Should Be Affordable
Most FDA-approved hemostatic dressings are readily available as over-the-counter products. However, prices of similar formulations vary across brands.
The decision to choose one product over another hinges on factors like the nature of the wound site, the medication the wounded person is currently on, the future course of treatment, and which product is available on hand.
Hemostatic dressing is slightly more expensive than plain gauze. The decision to include hemostatic dressing in your first-aid kit depends on how often you think you might need it.
If you work or live in an area with a high probability of people sustaining life-threatening injuries, price considerations must not keep you from stocking up on these dressings. Having a hemostatic dressing in such circumstances can mark the difference between life and death.
Meanwhile, hemostatic dressings are being developed and improved upon to ensure they deliver more effective results safely and quickly.
If you’re looking for an easy way to order medical supplies in bulk, such as hemostatic dressings, consider checking out our supply here at Allied USA! We’ve made it easier than ever to get everything you need for your medical practice, giving you more time to focus on delivering quality care for your patients. Check out our selection today!
- Military Medicine (Vol. 169, September 2004): Hemostatic Dressings for the First Responders: A Review
- San Mateo County Emergency Medical Services: Wound Packing – Hemostatic Gauze
- PMC: Overview of Agents Used for Emergency Hemostasis
- Science Direct: Hemostatic Dressing: Damage Control
- Science Direct: Hemostatic Dressing: Drug delivery dressings
- Frontiers in Bioengineering and Biotechnology: Hydrogel-Based Biomaterials Engineered from Natural-Derived Polysaccharides and Proteins for Hemostasis and Wound Healing
- My Health Alberta: Mild, Moderate, and Severe Bleeding
- Journal of Emergency Medical Services: Use of Hemostatic Dressings in Civilian EMS
- EMS1 by Lexipol: When to use hemostatic agents in EMS
- CE Safety Ltd: Haemostatic Dressings First Aid Kit
- Real First Aid: A brief guide to Hemostatic Agents
- Oxford Academic (Military Medicine): Review of New Topical Hemostatic Dressings for Combat Casualty Care
- Allied USA: Medical Waste and Supplies