A gift from the battlefield: QuikClot can stop massive blood loss

WASHINGTON — One of the Iraq War's most dramatic lifesaving technologies is expected to make its civilian debut this fall, when it becomes available for household use, according to its maker.

QuikClot is a granular powder, a refined mineral called zeolite that looks like cat litter and has many industrial uses. But when poured into a grievous, bleeding wound, QuikClot stanches blood loss almost instantaneously.

Civilian doctors acknowledge the material's effectiveness, but some also worry that in the wrong hands, it could be risky.

QuikClot is one of a group of new "hemostatic agents" on the market or in development. Two were sent into battle. A small bag of clotting agent was carried in every Marine rucksack and appeared to spell the difference between life and death for 19 soldiers wounded in Iraq, according to the Defense Department, which helped speed Food and Drug Administration clearance for QuikClot last year.

In one case, a Marine was shot through the neck. The bullet nicked his carotid artery before exiting. As the Marine bled profusely, QuikClot was poured onto the wound, sealing it immediately. He made it to a field hospital and later to a hospital ship — a casualty that probably would have been a fatality back in the 1991 Persian Gulf War.

Z-Medica, the small Connecticut company that makes QuikClot, now has its eye on saving those wounded in civilian life: in auto wrecks, shootouts, airline disasters and home accidents. Late this summer, the company expects to begin selling QuikClot in retail stores with no prescription required. The sales pitch: Having the product handy could help a person with no medical or emergency training stop the massive bleeding that causes some 50,000 deaths a year, mostly from auto accidents.

The military-issue "trauma pack" costs about $22; the home version will sell for less than $10.

Products not risk-free

Experts say the growing number and availability of hemostatic agents such as QuikClot and HemCon, another military clotting product, could make almost anyone with a well-equipped first-aid kit an emergency first responder.

But these wonder products are not risk-free. Because of the speed with which it draws water to itself, QuikClot can create enough heat to burn tissue if too much is used.

In a study to be published next month in the Journal of Trauma, researchers with the Uniformed Armed Services Health Services found that, compared with two other clot-boosting bandages and traditional wound dressing, QuikClot performed best overall. But the product HemCon, which the Army favors, is believed to stem blood loss better in certain smaller injuries. It may have to be removed more quickly than other hemostatic bandages, however, and is much pricier than QuikClot.

Fibrin, another clotting agent under development by the Army and the American Red Cross, is derived from human blood and could cost $2,000 per application.

What doctors say

"I don't like it, but when you ask me one of the best ways to stop bleeding, it's QuikClot," said Dr. Peter Rhee, a trauma surgeon at Los Angeles County-USC Medical Center, who has used it extensively in the past year.

"It does stop bleeding, and it does save lives. In trained hands, it does work well," said Rhee, who also directs the Navy's Trauma Training Center at County-USC.

Rhee is concerned that QuikClot could be risky if used by consumers with a poor knowledge of the product and of traumatic injury. He has higher hopes for other coagulant bandages due out soon.

Dr. Hasan Alam, a trauma surgeon at Washington, D.C., Hospital Center who participated in the testing of QuikClot, said the product should be put in a form different from the 3.5-ounce packets provided to Marines.

"If you start selling it in Wal-Mart, you have to come up with a strategy to prevent its misuse," he said. Given the risks of burns, pouring QuikClot onto skinned knees and shaving cuts is "like using a sledgehammer to kill a fly."

Extending the 'golden hour'

On the battlefield as well as closer to home, uncontrolled bleeding kills many in the first hour following injury. For others, massive blood loss can cause shock, which can cause complications and death later.

When emergency medical technicians (EMTs), fire and police units, and even ordinary citizens can apply dressings that stanch bleeding well before a victim arrives at the hospital, doctors such as Terry Soldo, a Navy "Devil Doc" who served in Iraq and saw QuikClot used twice, are certain that more lives can be saved.

"They talk about the 'golden hour' " in which EMTs and doctors can keep a bleeding victim from dying, he said. "If you could control hemorrhage earlier, the 'golden hour' can last longer. If they can control that, in my opinion, it would make a huge difference."

It started with shaving nick

Francis X. Hursey, who developed QuikClot, discovered the properties of zeolite, a granular volcanic material, when he was developing equipment for medical and industrial uses. One day more than a decade ago, he sliced himself shaving and decided to apply a bit of the water-absorbing zeolite.

To Hursey's astonishment, the nick sealed itself in seconds.

Other "hemostatins" seek to achieve the same effect with different materials and in different ways. Some add coagulants at the wound site; others constrict bleeding arteries near the wound and activate platelets to speed healing.

QuikClot and Emergency Medical Products' TraumaDex, one of the early entrants into this field, work on the "aquasponge" principle. HemCon and Marine Polymer Technologies' RDH bandage effectively plug a wound. All but QuikClot are made of a sugar-related substance called chitosan that comes from shrimp shells, seaweed and algae.

Doctors say each has an area of strength. The RDH bandage, for instance, has shown promise in stemming bleeding from liver lacerations but may be less effective in larger wounds. The TraumaDex bandage is absorbed by the body; unlike HemCon and QuikClot, it doesn't have to be removed by a doctor before repairs can be made.