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Haemostatic dressings in prehospital care
  1. Adam Hewitt Smith1,
  2. Colville Laird2,
  3. Keith Porter3,
  4. Mark Bloch4
  1. 1Department of Anaesthetics, Lister Hospital , Stevenage, Hertfordshire, UK
  2. 2Department of Education, BASICS Scotland, Aberuthven, Scotland
  3. 3 Department of Trauma & Orthopaedics, Queen Elizabeth Medical Centre, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
  4. 4 Department of Anaesthetics, Aberdeen Royal Infirmary & Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, Scotland
  1. Correspondence to Dr Adam Hewitt Smith, Department of Anaesthetics, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK; adamhewittsmith{at}gmail.com

Abstract

Massive haemorrhage still accounts for up to 40% of mortality after traumatic injury. The importance of limiting blood loss after injury in order to prevent its associated complications has led to rapid advances in the development of dressings for haemostatic control. Driven by recent military conflicts, there is increasing evidence to support their role in the civilian prehospital care environment. This review aims to summarise the key characteristics of the haemostatic dressings currently available on the market and provide an educational review of the published literature that supports their use. Medline and Embase were searched from start to January 2012. Other sources included both manufacturer and military publications. Agents not designed for use in prehospital care or that have been removed from the market due to significant safety concerns were excluded. The dressings reviewed have differing mechanisms of action. Mineral based dressings are potent activators of the intrinsic clotting cascade resulting in clot formation. Chitosan based dressings achieve haemostasis by adhering to damaged tissues and creating a physical barrier to further bleeding. Acetylated glucosamine dressings work via a combination of platelet and clotting cascade activation, agglutination of red blood cells and local vasoconstriction. Anecdotal reports strongly support the use of haemostatic dressings when bleeding cannot be controlled using pressure dressings alone; however, current research focuses on studies conducted using animal models. There is a paucity of published clinical literature that provides an evidence base for the use of one type of haemostatic dressing over another in humans.

  • major trauma management
  • pre-hospital
  • Trauma
  • treatment
  • wounds

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