Hemostatic dressings are used in conjunction with pressure bandages when a tourniquet is unavailable or inappropriate (as in junctional or truncal bleeding). As with tourniquet use, the first step is to apply direct pressure to the site. After opening the package, wipe excess blood from the wound to clearly visualize the source of the bleeding. Firmly pack the dressing into the wound with one hand while the other hand maintains pressure. Once the entire wound has been packed, maintain manual direct pressure over the site for 3-5 minutes. Then, overpack the wound with additional gauze until it is higher than the surface of the surrounding skin and apply a pressure bandage.
While many of the first generation hemostatic agents had problems and are no longer commercially available, third generation dressings have few issues and are made with chitosan or kaolin. Dressings made with kaolin activate the intrinsic coagulation pathway. Dressings made with chitosan react with blood to form a localized clot independent of the normal clotting cascade. Unlike kaolin, that remains in the body, chitosan is naturally broken down by bodily enzymes and cleared. Since ChitoSAM 100 gauze (3 inches by six foot Z-fold) is made from 100% chitosan (rather than chitosan impregnated gauze) it can be left in the wound longer than other hemostatic dressings and is more suitable for use in remote settings when evacuation is delayed.
Click here to read an article on managing severe bleeding in the field.