Hemostatic Dressings (QuikClot, Combat Gauze)
Kaolin-impregnated gauze; chitosan-based dressings
Brand names:QuikClot Combat Gauze, Celox, ChitoGauze, iTClamp (mechanical adjunct), XSTAT (specialty cavity hemostasis)
Topical hemostatic agents (kaolin-impregnated gauze, chitosan-based dressings) that accelerate clot formation at the wound site. Standard TCCC doctrine for compressible hemorrhage not amenable to tourniquet. QuikClot Combat Gauze (kaolin) is the TCCC standard. Technique discipline is everything: pack into the wound at the source, then 3 minutes of firm direct pressure.
Pharmacology and Actions
Kaolin-impregnated gauze (QuikClot Combat Gauze) activates the intrinsic coagulation pathway (factor XII) on contact with blood, accelerating fibrin formation at the wound site. Chitosan-based dressings (Celox, ChitoGauze) work by mucoadhesion - chitosan binds to red blood cells and tissue, creating a mechanical seal. Both mechanisms work in concert with direct pressure; neither replaces it.
Indications
- Compressible hemorrhage at junctional and non-tourniquet-amenable locations (groin, axilla, neck base)
- Severe extremity hemorrhage when tourniquet is contraindicated or insufficient
- Wound packing for deep cavity bleeding
- TCCC MARCH algorithm hemorrhage control after direct pressure and tourniquet decisions
Absolute Contraindications
- Internal use - not for intracorporeal cavity hemorrhage (intra-thoracic, intra-abdominal)
- Application to active bleeding without subsequent direct pressure (the dressing alone is not adequate without 3 minutes of firm direct pressure)
- Eyes (do not use for ocular hemorrhage)
Precautions and Side Effects
Local: mild exothermic reaction (earlier generation products were significantly exothermic and caused tissue burns; current products are minimally exothermic). Foreign body reaction at debridement. Theoretical residual particulate matter in wounds with incomplete debridement. Hemostatic dressings function effectively despite systemic anticoagulant therapy in most cases, though efficacy may be reduced with severe coagulopathy. They are not specific reversal agents and do not address systemic anticoagulation. Use as indicated for life-threatening hemorrhage in pregnancy and lactation. Limited pediatric data; life-saving indications prevail over theoretical concerns. Theoretical concern with shellfish allergy and chitosan-based products (chitosan is derived from crustacean shells); kaolin-based products do not share this concern. Monitor hemorrhage control, vital signs, continued bleeding requiring additional intervention, pain at site, and signs of distal ischemia if applied near a major vessel under pressure.
Adult Dosing
Pediatric Dosing
Use the smallest quantity sufficient to control hemorrhage. Same packing and pressure technique. Pediatric data is limited; the principle of stopping life-threatening hemorrhage prevails over theoretical concerns.
Pharmacokinetics
Peak Effect: Hemostasis typically achieved within 3 minutes of application with proper direct pressure technique.
Duration: Dressing remains in place until surgical debridement and definitive wound management.
Storage and Handling
Vacuum-sealed package. Room temperature, protect from extreme heat or freeze-thaw cycles. Inspect package for integrity before deployment - any breach in the vacuum seal degrades performance. Shelf life typically 3 to 5 years from manufacture, with extension permitted by some military protocols. Operational storage in IFAK should be replaced per the unit medical SOP.
Reconstitution:
Single-use, ready-to-deploy product. No reconstitution required. Tear or cut package open with the package designed-in opening to avoid contamination.
TCCC and TECC Role
Hemostatic dressings are core TCCC doctrine. TCCC Guidelines specify hemostatic gauze (preferred: kaolin-based QuikClot Combat Gauze) as the dressing of choice for compressible hemorrhage not amenable to tourniquet. Standard IFAK contains hemostatic gauze, emergency trauma dressing, and tourniquet. The MARCH algorithm (Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia) prioritizes hemorrhage control first - hemostatic dressings are the primary tool after tourniquet decisions. Mission impact corresponds to the underlying wound, not the dressing itself - the casualty is by definition operationally non-functional once the wound is severe enough to require hemostatic packing.
Hemostatic gauze is the most important hemorrhage control product after the tourniquet in tactical and military medicine. The technique discipline is everything: pack the dressing directly into the wound at the source of bleeding (not just on top of the wound), apply 3 minutes of firm direct pressure (not the 30-second instinct), and apply a pressure dressing over the packed wound. Operators must be trained on the technique under stress - the dressing in the package on the table does not save lives. Standard issue: QuikClot Combat Gauze (kaolin) is the TCCC standard. Chitosan products are alternatives. The iTClamp is a separate mechanical adjunct that can be paired with hemostatic gauze for scalp and neck base wounds. XSTAT is a specialty product (sponge-filled syringe) for deep cavity hemorrhage in junctional locations.
Insufficient direct pressure time. The hemostatic gauze does not work in 30 seconds. The TCCC standard is 3 minutes of firm direct pressure after packing, every time. Cutting that time short is the most common reason for re-bleeding. The other mistake is packing the wound from the wrong direction - the dressing must be packed into the wound to physically contact the source of bleeding, not just laid on top. For neck wounds particularly, packing depth matters and the wound tract must be followed.
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Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
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Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Hemostatic Dressings (QuikClot, Combat Gauze)
| IV/IO | None (None) |
| IM | None (None) |
| IN | None (None) |
| PO | None (None) |