Hemostatic Agents: QuikClot, Combat Gauze, and How to Use Them

What Hemostatic Agents Do

Standard gauze absorbs blood but does not actively promote clotting. In a wound with severe arterial or venous bleeding, blood saturates the gauze before a clot can form. The patient exsanguinates.

Hemostatic dressings contain an active agent that accelerates the coagulation cascade. Current products use kaolin (a type of clay) or chitosan (derived from shellfish) to trigger the intrinsic coagulation pathway on contact with blood. The result is a stable clot that can hold under pressure in wounds where plain gauze fails.

CoTCCC-Recommended Products

The Committee on Tactical Combat Casualty Care evaluates hemostatic dressings and publishes an approved list. These are the current recommendations:

QuikClot Combat Gauze

The primary CoTCCC-recommended product. Gauze impregnated with kaolin, a white clay that activates Factor XII (the Hageman factor) in the intrinsic coagulation pathway. No exothermic reaction. Works across a range of temperatures.

Specs: White Z-fold gauze, 3 inches × 4 yards. Each package contains one dressing.

Shelf life: 3 years from manufacture date when stored appropriately.

Celox Gauze

Chitosan-based hemostatic gauze. Chitosan is a positively charged polysaccharide that binds negatively charged red blood cells, forming a gel-like clot independent of the normal coagulation cascade. This means Celox works in patients who are hypothermic or on anticoagulants (blood thinners) — conditions that impair normal clotting.

Key advantage: Works when normal coagulation is compromised. If your patient is on warfarin or other anticoagulants, Celox may outperform kaolin-based products.

ChitoGauze

Another chitosan-based product, similar mechanism to Celox. CoTCCC-approved alternative.

Indications for Use

Use hemostatic gauze when:

• Direct pressure alone is failing: wound continues to bleed through standard gauze packing
• Junctional wounds: groin, axilla, neck — locations where a tourniquet cannot be applied
• Penetrating wounds to the torso: pack wound tract before applying pressure bandage
• Wounds in locations too awkward for sustained manual pressure: lower back, buttocks
• As adjunct to tourniquet: apply hemostatic gauze in the wound before the tourniquet if time permits; this may improve outcomes if the tourniquet ever needs to be removed

Do not use hemostatic agents as a substitute for tourniquet on extremity wounds where a tourniquet is possible. The tourniquet is faster, more reliable, and does not require sustained manual pressure.

Wound Packing Technique with Hemostatic Gauze

The technique for wound packing with hemostatic gauze is identical to standard wound packing, with the addition of the hemostatic agent. See the wound packing guide for full technique detail. The critical points specific to hemostatic gauze:

Depth matters. Surface application of hemostatic gauze does not work. The kaolin or chitosan must contact blood deep within the wound tract. Drive the gauze to the bottom of the wound with your fingers, packing tightly as you go.

Fill the cavity completely. Continue packing until you cannot add more gauze without difficulty. Use multiple packages if necessary.

Sustained pressure is required. Three minutes of firm manual pressure after packing is the minimum — not three minutes total, three minutes after packing. CoTCCC guidelines call for "at least 3 minutes of direct pressure after applying hemostatic gauze." Check your watch and maintain pressure without lifting to peek.

Maintain with a pressure dressing. After manual pressure, secure the packing with an elastic bandage or pressure dressing to maintain compression during evacuation.

What's In Your Kit

Minimum Hemostatic Capability

One package of QuikClot Combat Gauze per individual kit. This handles a single significant wound. It is the primary CoTCCC-recommended product and available at most tactical medical suppliers.

Better Capability

Two packages of Combat Gauze plus one package of Celox Gauze. The Celox covers anticoagulated patients or hypothermic victims where kaolin-based products may be less effective.

Full Capability

Two Combat Gauze, one Celox Gauze, and an Israeli Bandage (pressure bandage) for securing the packed wound. This handles a severe single wound from packing through sustained pressure application.

Storage and Shelf Life

Store hemostatic gauze in its sealed packaging, away from moisture and extreme heat. Most products carry a 3-year shelf life when stored correctly (below 40°C/104°F). Check expiration dates annually.

Compromised packaging — tears, holes, visible moisture intrusion — means the sterility is gone. Replace any package that does not have an intact seal.

Hemostatic gauze exposed to moisture before use may lose some efficacy. The kaolin or chitosan can absorb ambient moisture, reducing its capacity to absorb and activate on contact with blood. Store in a sealed, dry pouch.

After Action: What to Tell Medics

When transferring a patient who has hemostatic gauze in place:

• Product used and brand
• Time of application
• Location and approximate depth of packing
• Amount used (number of packages)
• Patient response (did bleeding appear to slow or stop?)
• Any complications (patient removed or shifted packing, signs of continued bleeding)

Medics removing hemostatic gauze in a hospital or surgical setting will irrigate the wound extensively, as the residual kaolin or chitosan can interfere with wound healing if left in place.