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I had no idea this existed.
https://www.techbriefs.com/component/co ... blog/28810

They talked about it in the Stop the Bleed class... sounds like a true Godsend.

Old news, actually. These have been around for a few years now. When I took my Medic 1 class from LoneStar Medics, they were leery of using these things, partly because it involves inserting a foreign object into the wound, which transcends what a non-professional is permitted to do by law. Also, sometimes packing the wound can be the wrong thing to do, and a tourniquet or direct pressure is the better alternative in a case like that. If you inject a syringe full of these things into a gunshot wound, then the trauma care team at the hospital end has to then go back into that wound and explore it make sure that all the wound packing has been removed before they can close it up, or place a drain in it, etc. It’s not just knowing when to use the XSTAT, but also knowing where it can be used, and where not. So I would not want someone sticking one of those into me if they did not have an “MD” after their name. Just slap on a tourniquet, pressure dressing, or a chest seal, and get me to a doctor.

Ah OK. I just checked to see if there would be any more classes, there's nothing within 75 miles.

The Annoyed Man wrote:Old news, actually. These have been around for a few years now. When I took my Medic 1 class from LoneStar Medics, they were leery of using these things, partly because it involves inserting a foreign object into the wound, which transcends what a non-professional is permitted to do by law. Also, sometimes packing the wound can be the wrong thing to do, and a tourniquet or direct pressure is the better alternative in a case like that. If you inject a syringe full of these things into a gunshot wound, then the trauma care team at the hospital end has to then go back into that wound and explore it make sure that all the wound packing has been removed before they can close it up, or place a drain in it, etc. It’s not just knowing when to use the XSTAT, but also knowing where it can be used, and where not. So I would not want someone sticking one of those into me if they did not have an “MD” after their name. Just slap on a tourniquet, pressure dressing, or a chest seal, and get me to a doctor.

TAM,
What is the law that prohibits a non-medical professional from packing a wound on a trauma victim? I would think the Good Samaritan law would cover that. Not saying you're wrong, just that I haven't heard that before.

Also, the wound will need to be debrided anyway since it's a penetrating trauma. I'm not familiar with the XSTAT, but the article says the little sponges have a material that shows up on X-ray (radio-opaque marker, like the little blue stripe on the Quickclot Combat Gauze).

Mike S wrote:

The Annoyed Man wrote:Old news, actually. These have been around for a few years now. When I took my Medic 1 class from LoneStar Medics, they were leery of using these things, partly because it involves inserting a foreign object into the wound, which transcends what a non-professional is permitted to do by law. Also, sometimes packing the wound can be the wrong thing to do, and a tourniquet or direct pressure is the better alternative in a case like that. If you inject a syringe full of these things into a gunshot wound, then the trauma care team at the hospital end has to then go back into that wound and explore it make sure that all the wound packing has been removed before they can close it up, or place a drain in it, etc. It’s not just knowing when to use the XSTAT, but also knowing where it can be used, and where not. So I would not want someone sticking one of those into me if they did not have an “MD” after their name. Just slap on a tourniquet, pressure dressing, or a chest seal, and get me to a doctor.

TAM,
What is the law that prohibits a non-medical professional from packing a wound on a trauma victim? I would think the Good Samaritan law would cover that. Not saying you're wrong, just that I haven't heard that before.

Also, the wound will need to be debrided anyway since it's a penetrating trauma. I'm not familiar with the XSTAT, but the article says the little sponges have a material that shows up on X-ray (radio-opaque marker, like the little blue stripe on the Quickclot Combat Gauze).

Regarding radio-opacity - yes, you’re right. The sponges are radio-opaque so that they show up on x-ray. So are bullets, and they can be really hard to actually find with the naked eye and fingers or a probe - even though you can see them plain as day on the x-ray. All radio-opacity tells you is whether that particular foreign body is still in the wound. It won’t necessarily make it any easier to find and remove that foreign body with your eyes and fingers. Wounds can be a bloody mess, and it can be difficult sometimes to even tell the difference between different kinds of tissue. At least with combat graze, you’re dealing with a continuous strip of material. If you pull on one part of it, eventually all of it will come out. XSTAT doesn’t work like that.

Regarding the law - I can’t quote you chapter and verse. I am repeating what was told to me (and the rest of our Medic 1 class) by Caleb Causey of Lone Star Medics. A lay person is apparently barred by law from performing a procedure that crosses the skin barrier, unless that person has the specific certications/degrees permitting them to do so - for instance doctors, paramedics, nurse practitioners, etc., etc. The exceptions would be if you were to do so under the direct supervision of an MD. This jibes with everything I was ever taught when I worked in the ER. For instance, I have put in stitches, and tied off bleeders while helping to repair a deep hand laceration, while under the direct supervision and watchful eye of an orthopedic surgeon. But left to my own devices, I would never have been permitted to do those things. The surgeon’s presence and guidance is what made it legal. And that speaks to something else.....

When Causey told the class that laypersons were not allowed to do anything that crossed the skin barrier, he included the use of combat gauze to pack a wound.....which would require the attending person to stick their fingers into the wound to pack it - a legal no-no. BUT.... he also said with a wink and wry grin, words to the effect of “do what you have to do” if someone’s life hangs in the balance. If you actually save a life, it’s not that likely that anyone is going to come after you for having exceeded your mandate. Using stitches as an example.... having done it myself on a live human being under actual conditions, I know my own skill and trust my own judgement. Consequently, I would not hesitate to stitch myself up under extreme conditions, nor would I hesitate to stitch someone else up if they gave me consent and the situation demanded it. Having done it, I know I could do it again.

Meaning no offense however, but I don’t know your skill and judgement or anyone else’s for that matter, so I would not be comfortable having you stitch me up - unless it was absolutely necessary to saving my life, and there was no alternative. Ditto wound packing with either combat gauze or XSTAT. If I have a gunshot or stab wound in my guts, I don’t want you or anyone else sticking anything into that hole. The risk of causing sepsis or further injury just isn’t worth it. Just sprinkle some clotting agent on top of it if necessary, put a pressure dressing over it, and get me to a hospital as fast as possible. If I were to suffer a gunshot wound mid-thigh on the medial aspect of that leg, I would MUCH rather have someone tie off my upper thigh with a SOFTT-W tourniquet and have them put a pressure dressing over the gunshot wound, than to have that same person try and pack that wound, and in the process coming anywhere near my femoral artery (which might be ready to blow out any second now) with either their finger and some gauze, or a XSTAT injector........UNLESS there were some letters that come after their name indicating that they know what the heck they’re doing. This is exactly why I previously mentioned knowing when and where to use such a thing.

It might be possible now that the military is already using these things. I don’t know. But if they are, they are being used by very well trained medics - many of whom train to an extremely high level of knowledge and skill, and earn degrees like Nurse Practitioner and Physician’s Assistant along the way. That does not describe most of us.

That’s why I’m not overwhelmed by XSTAT, and I’ll likely not add any to my IFAK or larger medical bag.

laypersons were not allowed to do anything that crossed the skin barrier, he included the use of combat gauze to pack a wound.....which would require the attending person to stick their fingers into the wound to pack it - a legal no-no.

This is the exact opposite of the legal and medical info presented at Stop the Bleed... in fact we spent half an hour on properly packing deep and gunshot wounds.

flechero wrote:

laypersons were not allowed to do anything that crossed the skin barrier, he included the use of combat gauze to pack a wound.....which would require the attending person to stick their fingers into the wound to pack it - a legal no-no.

This is the exact opposite of the legal and medical info presented at Stop the Bleed... in fact we spent half an hour on properly packing deep and gunshot wounds.

Interesting. If your class was more recent than mine (3 years ago), maybe the protocols have changed. Even so, I would not want someone not trained in their use to stick one of those in me, or to pack a wound by hand with combat gauze unless they had been trained.

The Annoyed Man wrote: Interesting. If your class was more recent than mine (3 years ago), maybe the protocols have changed.

Maybe so, we took it a few weeks ago. They also talked at length about the sponge packed syringes and the trauma surgeons were big fans of them... thinking they must be a newer version/model than what your class talked about. They said they had the clay base clotting agents and also the markers for scan/x-ray.

Once a bullet pierces the skin is there still a skin barrier?

I am a Paramedic and this is just an opinion. You can stop all the external bleeding you can see but it is the INTERNAL bleeding that is going to kill the patient. The only cure for that is a Trauma Surgeon and I know I am not qualified or legal to do that.

Mike S wrote:What is the law that prohibits a non-medical professional from packing a wound on a trauma victim? I would think the Good Samaritan law would cover that. Not saying you're wrong, just that I haven't heard that before.

flechero wrote:

The Annoyed Man wrote: Interesting. If your class was more recent than mine (3 years ago), maybe the protocols have changed.

Maybe so, we took it a few weeks ago. They also talked at length about the sponge packed syringes and the trauma surgeons were big fans of them... thinking they must be a newer version/model than what your class talked about. They said they had the clay base clotting agents and also the markers for scan/x-ray.

One thing though .....and this is a SERIOUS risk..... you have to understand that if you’re going to pack a wound (with gauze or XSTAT), you have a high likelihood of introducing bacteria into the wound - which WILL ultimately result in a septic wound. So unless you’re either doing it in sterile conditions, or can first scrub/wash the area with betadine and then create a sterile field around the wound to work in, you wouldn’t want to do this to someone who was more than a few hours away from a trauma room with IV antibiotics.

And I probably don’t need to tell you this, your having had a class in this stuff, but other people read these pages. So it goes without saying that nobody ought to pack a wound without wearing surgical gloves - both to protect the patient, and to protect you from whatever they might already be carrying. You just never know these days what somebody might be carrying.

Typically though, a gunshot wound has probably already had a fair amount of bacteria dragged into it from the patient’s clothing and skin by the passage of the bullet. A local cop friend of mine back in CA accidentally/negligently/whatever shot himself in the thigh one night with his duty weapon while reholstering his gun after having had to draw it. The bullet entered the lateral side near his hip, and exited just above his knee on the medial side. I was on duty when the paramedics brought him into our ER. The bullet hit no major blood vessels or bone; it just punched a hole through the muscles of his anterior thigh. But the bullet did drag fragments of his holster and uniform pants along the wound path, thoroughly “salting” it with bacteria. My friend ended up with a heck of a wound infection. Instead of being admitted overnight for observation and sent home the next day - which is what would have happened had there been no infection - he spent several days in the hospital getting some pretty stout IV antibiotics to knock the infection down.

Even so, that is not an argument in favor of packing a wound without exercising sterile technique if at all possible. This is where the “first, do no harm” rubber meets the road, and it’s why I was arguing above against the practice of wound packing by anyone not trained and certified in the techniques. If you don’t know what you don’t know, you can cause great harm......harm which a badly injured person cannot afford.

So XSTAT might be a godsend in the right hands - as you previously posted - but not such a good thing in the hands of someone who hasn’t been trained it its use, who saw and ad for it, had the $300/unit available, and bought some online.

The class was put on by the Scott & White lead Trauma surgeon, his nursing staff and a hand full of EMT's - several that were Army and served in Iraq/Afganistan. I hear your concerns about infection but they were not concerned about infection... they were confident that they could save/fix 95-99% of infection related issues but could save 0% of DOA patients. Every single one of them said not to worry about infection, because if they bled out first, it was all for not.

They spent a good deal of time showing slides and examples of wounds better suited for direct pressure vs. packing or tourniquet. So please don't mistake anything I've written for an over zealous aim to pack a wound.. it was presented as a way to asses a life threatening wound and keep someone alive long enough to get to the hospital.

Also, the concern was not hours, it was minutes... A good gusher can bleed someone out in as little as about 10 minutes... thus packing or using a tourniquet just to buy enough time to get them to the trauma center. If it's bleeding slow enough that you have hours, you can wait for the emt's and the ambulance.

I'm sure there are significant drawbacks to a lot of products out there but I also fall into the camp that "it's much better to deal with a serious infection than to plan a funeral." The Surgeon's words, not mine.