May 31, 2024

Welcome again to UH EMS-I’s Pharmacy Phriday. We hope you had a safe and enjoyable Memorial Day weekend! This holiday is often considered the unofficial start of summer (however, summer officially begins June 20th this year), and as we begin the season, we would do well to consider the increase in trauma-related calls often seen during this season. One important aspect to consider regarding the trauma patient is bleeding control. Major hemorrhage and hemorrhagic shock are common and frequently treatable causes of death in injured patients and are second only to traumatic brain injury. 

Control of bleeding can often be done through direct, even pressure at the bleeding site. In cases where bleeding is from an extremity and is not controlled quickly using direct pressure, the use of a tourniquet is recommended. In the past, tourniquets were thought to be a last resort in bleeding control, but newer data from military experience has proven the use of tourniquets can be effective with little increase in complications.  

In cases where a tourniquet cannot be placed, other options exist such as wound packing and the use of topical hemostatic agents. Though these topical hemostatic agents are not supplied in the UH drug box, they are approved for use within the UH protocols and are often purchased by individual agencies. 

Topical agents include a wide range of products that come in the form of powders, granules, liquids, soaked sponges, impregnated gauze, and membranes. In our arena, it seems that the topical hemostatic agents most often used are gauze products impregnated with the agent, which can work in various ways. When used, they can absorb liquid, concentrated red cells, platelets, and clotting proteins, and enhance clot formation at the site of the bleeding. 

Typical steps in using these hemostatic gauze products include:  

1. Open the package and keep the empty package for help later. 

2. Pack the wound. More than one product may be required for use. A key to its effectiveness is to pack the wound very tightly.  

3. Hold pressure for at least three minutes (or until the bleeding stops). 

4. Use standard bandaging over the hemostatic agent to hold it in place. 

5. Take the packaging to the ER for the staff’s reference regarding the removal of the product. 

It is very important to stress that where hemostatic gauze is not available, packing with normal gauze is still the recommended treatment. Wound packing with standard gauze can still absorb liquid and concentrate clotting factors, as well as placing direct pressure on deeper vessels causing the bleeding.

Another example of the use of a hemostatic agent would be the external use of tranexamic acid (TXA,) permitted in our UH protocols for nose bleeds or bleeding from a tooth socket following a dental emergency - such use of TXA was covered in an earlier series this year of Pharmacy Phriday. In such cases, the protocol allows the paramedic provider to soak traditional gauze with TXA and pack the nostril or place the gauze in the tooth socket.

We would like to recognize members of our UH team who were recently honored at the Ohio EMS Star of Life Awards held at the Ohio EMS offices in Columbus last week:  

• Dr. Jay Carter was recognized as the Medical Director of the Year.

• Patty Willson received the Frank Giampetro Distinguished EMS Educator Award.  

• Natalie Krill of Physicians Ambulance received an EMS Stars Award for her actions during an emergency involving a coworker.  

For more information on these and other statewide awards click here. 

Till next time, stay safe!

Sincerely,



The UH EMS-I Team

University Hospitals