Newer hemostatic dressings became available
in 2008 and underwent testing at the USAISR and
the Naval Medical Research Center. These studies found that both Combat Gauze and WoundStat
were consistently more effective than HemCon and
QuikClot granules. As a result, the CoTCCC modified the TCCC guidelines to recommend Combat
Gauze as the first-line option for the treatment
of life-threatening hemorrhage not amenable to
tourniquet placement because the combat medics
involved in the decision expressed a strong preference for a gauze-type hemostatic agent rather than a
powder or granules. WoundStat was recommended
for use when Combat Gauze was not successful
in controlling the hemorrhage. Subsequent safety
testing at the USAISR found that WoundStat produced thromboembolic complications in animal
models. 14 These findings caused the CoTCCC to
remove WoundStat as a recommended agent, and
its use was subsequently discontinued in the U.S.
Combat Gauze is now the hemostatic dressing
most widely used by U.S. forces on the battlefield.
The first report of Combat Gauze use in combat
noted a 79 percent success rate in 14 uses among
Israeli Defense Force personnel. 15 Large U.S. retrospective studies of Combat Gauze effectiveness in
U.S. casualties have not yet been done.
Newer hemostatic dressings are the subject of
ongoing research. A study from the Naval Medical
Research Unit–San Antonio, TX, found that both
Celox gauze and ChitoGauze produced higher 150-
minute survival rates in the standardized USAISR
femoral bleeding model than Combat Gauze. Survival was nine of 10 animals with Celox gauze, seven
of 10 with ChitoGauze, seven of 10 with Combat
Gauze XL, and six of 10 with Combat Gauze. 16 These
differences are noteworthy but were not statistically
significant. As of this writing, neither Celox gauze
The TCCC has given these individuals a vastly improved set of
tools and skills to better accomplish their heroic and lifesaving
deeds on the battlefield, and tourniquets and hemostatic
dressings are now a permanent fixture in their aid bags.
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