Hemostatic agents: These have gained popularity since their fielding during the current overseas contingency operations in Iraq and Afghanistan. Several different compounds and delivery methods are available for use by the civilian EMS providers, and it is incumbent on each individual provider and department to rigorously evaluate the merits, design features, and efficacy of each dressing before committing to purchase.
Hemostatic agents must be placed directly on the bleeding vessel for the patient to experience the full benefit of their use. To ensure they work, blot away excess blood in the wound cavity when possible, allowing the provider to visualize the bleeding vessel. This is a large contributor to the successful deployment of a hemostatic dressing. If the wound is too small to be able to visualize the bleeding vessel, then blindly packing the hemostatic into the wound cavity is appropriate. However, there is a risk of only concealing external hemorrhage instead of controlling it if the packing does not generate enough pressure to occlude the bleeding vessel or it does not allow for sufficient contact with the dressing to form a clot and arrest the bleeding. In addition, pressure dressings are an absolute must to aid in the control of non-compressible hemorrhage because they hold the hemostatic dressings in place during transport to the emergency department.
