Evaluation of topical hemostatic agents for combat wound treatment

Uncontrolled hemorrhage remains the leading cause of potentially preventable death in combat casualties. In the current conflict, nearly two-thirds of these deaths occurred as a result of torso injuries with noncompressible hemorrhage and one-third from extremity injuries with compressible bleeding. The natural ability of blood to clot rapidly and stop bleeding from large vessels is far less than needed in the face of severe injuries and may even be diminished as a result of a massive tissue trauma (acute coagulopathy). Therefore, the use of a pressure device (ie, tourniquet) or topical hemostatic dressing is essential to stop compressible hemorrhage and prevent possible shock or death of casualties at the point of injury. To provide combat medics with the best means of treating hemorrhages, it is essential to understand the mechanism of action, efficacy strength, and possible adverse effects of each available hemostatic agent. In this article, we review the risks and benefits of the agents/dressings that have been used on the battlefield, the process that led to the selection of the new agents, and the present deficiencies that must be addressed in the development of new products.