When troops in battle — or cops on the street — get shot, immediate treatment has two goals: mitigating shock and blood loss. The degree to which shock affects people is sometimes a product of training. Someone who believes they will die if they get shot will often live up to the promise and lie down and die. Modern training teaches people to stay in the fight, getting the victim to stay operational until the threat is neutralized.
Blood loss is more a matter of biology. If you lose too much blood, the body can’t keep oxygen and glucose flowing to the brain and other vital organs. Without these, metabolic function ceases. Catastrophic wound treatment has often meant cramming gauze into the bullet hole, which is painful and not always effective. When it isn’t effective, the medic has to pull it all out and start over, increasing the pain and sometimes the effect of shock on the victim.
Some agencies have issued wound treatment kits to their officers, so they can treat wounds on themselves, another officer or a citizen more quickly and effectively. One of these kits proved its worth recently in Dallas, when a police officer took bullets to his body armor, shoulder, and leg. Another officer used the “Downed Officer Kit” to mitigate blood loss and shock.
Saving Lives on the Streets
Dallas PD’s kits consist of some traditional gauze bandages, a tourniquet, and “combat gauze” impregnated with kaolin — a naturally occurring clay formed of hydrated aluminum silicate. When bleeding tissue is exposed to kaolin, substances in the blood called Factor XI, Factor XII, and prekallikrein become active and start the coagulation process. The blood quickly clots, blocking the wound path and stemming blood loss.
Tourniquets got a bad rap for many years, mainly because of misuse and overuse. People who didn’t know better applied tourniquets when they weren’t needed, or applied them so tightly they injured underlying tissue. When the tourniquets were left on too long, the blood supply to the entire limb distal to the tourniquet was cut off, which sometimes led to amputation.
Now that people on and off the battlefield are usually within an hour of a hospital or other advanced life support, tourniquets are having a comeback. Applied properly between a heavy bleed and the heart, they can stop the flow of blood and keep the victim from exsanguinating. Before permanent damage can occur to the affected limb, the wound can be repaired surgically.
Packages like Dallas’ Downed Officer Kits are small enough to be carried in a cargo pocket or on body armor. Dallas PD distributed the $50 kits to 3,200 officers last November. Another invention still in the pipeline may be even more effective in treating gunshot wounds. This one injects pill-size sponges coated with a clotting agent directly into the wound cavity.
The Future Meets the Past
The use of custom-fitted dressings for treating bullet wounds is an idea at least 50 years old. During the Vietnam War, U.S. post exchanges in Vietnam were selling tampons at a rate inconsistent with the relatively low numbers of women deployed there. It turned out that innovative and often ill-equipped medics recognized the products as just the right size to treat bullet wounds in the field. They were individually packaged, sterile, and even included a handy string to help retrieve the dressing once the victim was in the hospital.
Working on a similar theme, a company called RevMedx is testing an applicator that is inserted directly into the wound to dispense aspirin-sized sponges coated with clotting agent. The sponges are pliable, and their small size and large number allows them to conform to the shape of the wound and stem blood flow at every point.
Each sponge also has a radiopaque cross attached to it, so the sponges will easily show up on x-rays and not be sewn into a wound by a surgeon. The applicators come in 30mm and 12mm diameter sizes to fit large or narrow wounds.
The new device — called the XStat Dressing — is in the investigational stage and has not been approved for sale by the FDA. The device has gotten the attention of the U.S. Army, which might speed its delivery to the marketplace.