# New way to treat gunshot



## neldarez (Apr 10, 2011)

How A Simple New Invention Seals A Gunshot Wound In 15 Seconds
An Oregon startup has developed a pocket-size device that uses tiny sponges to stop bleeding fast.
By Rose Pastore Posted 02.03.2014 at 2:30 pm 
3.6K
XStat RevMedx
When a soldier is shot on the battlefield, the emergency treatment can seem as brutal as the injury itself. A medic must pack gauze directly into the wound cavity, sometimes as deep as 5 inches into the body, to stop bleeding from an artery. It's an agonizing process that doesn't always work--if bleeding hasn't stopped after three minutes of applying direct pressure, the medic must pull out all the gauze and start over again. It's so painful, "you take the guy's gun away first," says former U.S. Army Special Operations medic John Steinbaugh.

Even with this emergency treatment, many soldiers still bleed to death; hemorrhage is a leading cause of death on the battlefield. "Gauze bandages just don't work for anything serious," says Steinbaugh, who tended to injured soldiers during more than a dozen deployments to Iraq and Afghanistan. When Steinbaugh retired in April 2012 after a head injury, he joined an Oregon-based startup called RevMedx, a small group of veterans, scientists, and engineers who were working on a better way to stop bleeding.

XStat, before and after RevMedx
RevMedx recently asked the FDA to approve a pocket-size invention: a modified syringe that injects specially coated sponges into wounds. Called XStat, the device could boost survival and spare injured soldiers from additional pain by plugging wounds faster and more efficiently than gauze.

The team's early efforts were inspired by Fix-a-Flat foam for repairing tires. "That's what we pictured as the perfect solution: something you could spray in, it would expand, and bleeding stops," says Steinbaugh. "But we found that blood pressure is so high, blood would wash the foam right out."

So the team tried a new idea: sponges. They bought some ordinary sponges from a hardware store and cut them into 1-centimeter circles, a size and shape they chose on a whim but later would discover were ideal for filling wounds. Then, they injected the bits of sponge into an animal injury. "The bleeding stopped," says Steinbaugh. "Our eyes lit up. We knew we were onto something." After seeing early prototypes, the U.S. Army gave the team $5 million to develop a finished product.

But kitchen sponges aren't exactly safe to inject into the body. The final material would need to be sterile, biocompatible, and fast-expanding. The team settled on a sponge made from wood pulp and coated with chitosan, a blood-clotting, antimicrobial substance that comes from shrimp shells. To ensure that no sponges would be left inside the body accidentally, they added X-shaped markers that make each sponge visible on an x-ray image.

"By the time you put a bandage over the wound, the bleeding has already stopped."

The sponges work fast: In just 15 seconds, they expand to fill the entire wound cavity, creating enough pressure to stop heavy bleeding. And because the sponges cling to moist surfaces, they aren't pushed back out of the body by gushing blood. "By the time you even put a bandage over the wound, the bleeding has already stopped," Steinbaugh says.

Getting the sponges into a wound, however, proved to be tricky. On the battlefield, medics must carry all their gear with them, along with heavy body armor. RevMedx needed a lightweight, compact way to get the sponges deep into an injury. The team worked with Portland-based design firm Ziba to create a 30 millimeter-diameter, polycarbonate syringe that stores with the handle inside to save space. To use the applicator, a medic pulls out the handle, inserts the cylinder into the wound, and then pushes the plunger back down to inject the sponges as close to the artery as possible.

XStat sponges RevMedx
Three single-use XStat applicators would replace five bulky rolls of gauze in a medic's kit. RevMedx also designed a smaller version of the applicator, with a diameter of 12 millimeters, for narrower injuries. Each XStat will likely cost about $100, Steinbaugh says, but the price may go down as RevMedx boosts manufacturing.

If the FDA approves XStat, it will be the first battlefield dressing created specifically for deep, narrow wounds. Gauze, the standard treatment for gunshot and shrapnel injuries, is only approved by the FDA for external use, but "everyone knows that if you get shot, you have to pack gauze into the wound," says Steinbaugh. When RevMedx submitted its application to the FDA, the U.S. Army attached a cover letter requesting expedited approval. According to Steinbaugh, RevMedx and the military are now in final discussions with the FDA.

Last summer, RevMedx and Oregon Health and Science University won a seed grant, sponsored by The Bill & Melinda Gates Foundation, to develop a version of XStat to stop postpartum bleeding. In the future, RevMedx hopes to create biodegradable sponges that don't have to be removed from the body. To cover large injuries, like those caused by land mines, the team is working on an expanding gauze made of the same material as XStat sponges.

"I spent the whole war on terror in the Middle East, so I know what a medic needs when someone has been shot, " Steinbaugh says. "I've treated lots of guys who would have benefitted from this product. That's what drives me."

Rose Pastore is an assistant editor at Popular Science. Follow her on Twitter at @RosePastore.









3.6K


----------



## Sentry18 (Aug 5, 2012)

That is very interesting. While war definitely has its horrors and sadnesses, a lot of inventiveness comes from it. Inventiveness that tends to benefit all of society.


----------



## FrankW (Mar 10, 2012)

This is real interesting.

I wonder how much it would cost once available?


----------



## mojo4 (Feb 19, 2012)

If they can make them out of a material similar to the internal stitching that the body can dissolve some ER's are gonna go out of business! Toss in a medical staple gun and you have certified street surgeons on the prowl!

Sent from my SCH-I535 using Survival Forum mobile app


----------



## SammyP (Jan 17, 2014)

This would be a temp solution, it would stop immediate bleeding, but would need to be removed by a surgeon so that the artery can be repaired. That being said, blood stoppage at the point of injury has greatly reduced deaths, and any innovation on that saves lives is good in my book. 


Sent from my iPhone using Survival Forum


----------



## Iafrate (Oct 9, 2013)

So tell me how that will help/ prevent peritonitis from a perforated bowel or damage to say a gall bladder? Peritonitis must be managed in the surgical suite


----------



## camo2460 (Feb 10, 2013)

Iafrate said:


> So tell me how that will help/ prevent peritonitis from a perforated bowel or damage to say a gall bladder? Peritonitis must be managed in the surgical suite


It won't help or prevent it, surgical intervention is still necessary to repair tissue damage. This is just a temporary measure to stop initial blood loss.


----------



## Iafrate (Oct 9, 2013)

camo2460 said:


> It won't help or prevent it, surgical intervention is still necessary to repair tissue damage. This is just a temporary measure to stop initial blood loss.


Several years ago I ran a gunshot patient who was shot at approximately the right mid axillary line at about the 4th or 5th intercostal space. The bullet was a 125 grain JHP .357. She was conscious, alert and oriented with a baseline b/p of about 90 systolic.she was a little tachycardic and her initial SaO2 was around 88 which implies a PaO2 of about 60. Not good. I started a 14 ga external jugular with LR. Enroute to the hospital she was conscious alert and oriented and made appropriate responses to questioning. Due to the hemopneumothorax she developed, get SaO2 dropped which is expected. Her b/p stayed roughly 90 systolic and her tachycardia didn't increase appreciably. When the thoracic surgeon placed a chest tube to relieve the hemopneumothorax. She died in less time than it takes to read this post after tube placement. The reason? The hemorrhage into her thoracic cavity tamponaded the hemorrhage from her aortic arch which was perforated by the bullet. Once the hemothorax was relieved she bled out. In this situation I would be loathe to stick one of these gizmos into that bullet wound to try and stop hemorrhage. The risk of exacerbating the already existing aortic arch injury is immense and not in the patient's best interest. IMHO, that violates the first rule of medicine, " first, do no harm" . My point here is this gizmo is not, by any stretch, a "silver bullet" for management of gunshot injuries.


----------



## Sentry18 (Aug 5, 2012)

If a buddy of mine goes down out in the field and my choices are this unit or a compression bandage, I'll go ahead and give this device a try. Not everyone keeps an actual surgeon in their medical bag.


----------



## camo2460 (Feb 10, 2013)

Iafrate said:


> Several years ago I ran a gunshot patient who was shot at approximately the right mid axillary line at about the 4th or 5th intercostal space. The bullet was a 125 grain JHP .357. She was conscious, alert and oriented with a baseline b/p of about 90 systolic.she was a little tachycardic and her initial SaO2 was around 88 which implies a PaO2 of about 60. Not good. I started a 14 ga external jugular with LR. Enroute to the hospital she was conscious alert and oriented and made appropriate responses to questioning. Due to the hemopneumothorax she developed, get SaO2 dropped which is expected. Her b/p stayed roughly 90 systolic and her tachycardia didn't increase appreciably. When the thoracic surgeon placed a chest tube to relieve the hemopneumothorax. She died in less time than it takes to read this post after tube placement. The reason? The hemorrhage into her thoracic cavity tamponaded the hemorrhage from her aortic arch which was perforated by the bullet. Once the hemothorax was relieved she bled out. In this situation I would be loathe to stick one of these gizmos into that bullet wound to try and stop hemorrhage. The risk of exacerbating the already existing aortic arch injury is immense and not in the patient's best interest. IMHO, that violates the first rule of medicine, " first, do no harm" . My point here is this gizmo is not, by any stretch, a "silver bullet" for management of gunshot injuries.


First of all I did not say that the device was a silver bullet, and I recognize your reluctance to use it in this instance, however you did say that her Aortic Arch had been compromised, and that she had died in spite of a Surgeons intervention. The fact is that since her Aortic Arch had been compromised, she was lucky to even make it to a surgeon. Further I submit that since you are speaking from hind sight, maybe you are not being fair, as the Battle Field Medic mentioned in the article said that he thought that it would help to save many lives. The bottom line is that people are going to die due to gun shot wounds whether that gizmo is used or not, and whether they have access to a surgeon or not.


----------



## Dakine (Sep 4, 2012)

without a shit ton of training I dont think injecting 1cm sponges is going to solve a lot of problems, but training is something that can be managed... so.... ok? is it worth it to spend $100k a year in a police dept to train people on mannequins to handle GSW with the new stuff?

Yep! 

Make it happen.

and TQ are the way to save lives. the Boston bombs proved that. lets not forget. That will not help people in SHTF/WROL but while things are still okay... yeah.. it makes the difference.


----------



## Mase92 (Feb 4, 2013)

Dakine said:


> without a shit ton of training I dont think injecting 1cm sponges is going to solve a lot of problems, but training is something that can be managed... so.... ok? is it worth it to spend $100k a year in a police dept to train people on mannequins to handle GSW with the new stuff?
> Yep!
> Make it happen.
> and TQ are the way to save lives. the Boston bombs proved that. lets not forget. That will not help people in SHTF/WROL but while things are still okay... yeah.. it makes the difference.


:congrat: Great post and stated wonderfully.

There is so much new about this and could go wrong with this. Just a few years back we heard how amazing the hemostatic agents were going to be. Until they started burning people and even worse causing further problems by causing emboli. They aren't quite the miracle once portrayed. In a pinch they will do and so does direct pressure. Short of a surgeon, most things we can do in a field are stop gaps and dare I say, snake oil. Definitive care is the way to go, while and if you can.

After a PAW event hits, then do whatever you can.


----------



## Iafrate (Oct 9, 2013)

camo2460 said:


> First of all I did not say that the device was a silver bullet, and I recognize your reluctance to use it in this instance, however you did say that her Aortic Arch had been compromised, and that she had died in spite of a Surgeons intervention. The fact is that since her Aortic Arch had been compromised, she was lucky to even make it to a surgeon. Further I submit that since you are speaking from hind sight, maybe you are not being fair, as the Battle Field Medic mentioned in the article said that he thought that it would help to save many lives. The bottom line is that people are going to die due to gun shot wounds whether that gizmo is used or not, and whether they have access to a surgeon or not.


She bled out because evacuating the blood in the thoracic cavity caused a pressure differential, which led to the remaining blood in her vascular system to pump out of the aortic wound. Prior to the surgeon placing the chest tube, the pressures in both her aorta and thoracic cavity had equalized which was essentially stopped the aortic hemorrhage. Since no pressure gradient, no blood loss. She died BECAUSE the surgeon did what is protocol in thoracic gunshot management. That does not mean the surgeon screwed up, there was way to know her aortic arch was compromised. It was truly a sheit happens situation. My concern about this gizmo is while it may have valid efficacy in field situations, I see the potential to exacerbate a bad situation. Are there risk/benefit data available? What potential complications to surgical management does thus create, if any? I gave always had issues of blindly inserting devices into unnatural openings in the body as well as natural openings. I'm simply playing devils advocate based on my 31 years in the field. I am fully cognizant that medicine changes quickly, and standards of care evolve over time. Having been retired since 2006 I know I am behind the current curve of trauma care standards.


----------



## LincTex (Apr 1, 2011)

I started to read the article and thought tampons would be the suggested answer... I was wrong.

*Last I heard*, tampons and feminine pads have been the "go-to items" to have on hand in the battlefield to stop bleeding.


----------



## Sentry18 (Aug 5, 2012)

The first aid kits we issue our officers include several compression bandages, a combat tourniquet, Celox granules (new version), Quick Clot sponges and other items. The kit was put together by a pair of officers / paramedics who were 68W combat paramedics in the military with multiple deployments. The kits have served us very well.


----------



## Jim1590 (Jul 11, 2012)

Iafrate, I think of this as something like NTG for a chest pain. Patients are not taught to determine if the MI is hurting preload or afterload. They just take it and deal with the consequences later vs dying now.


Also by your logic, removing debris from a building collapse could exacerbate a bad situation by allowing the onset of crush syndrome.

I understand the point you are trying to make that one should just not go sticking something in there, but in the case of these wounds, something already went in there! Also a valid point about the testing. But it shames me to say that for good or bad, it will be tested on the battlefield. Our nations bravest always seem to be used as a guinea pig.


----------



## Zeev_Zwaard (Jan 27, 2010)

Waiting for a silver bullet will let a lot of people that didn't need to, die. Perhaps proper training will avoid its usage when it might be a bad idea.

I will definitely buy some for my kit when they become available. And try to learn how to use them properly.


----------



## HamiltonFelix (Oct 11, 2011)

This really is interesting. I wonder how far we'll go with the concept. Maybe eventually, a true expanding foam that has antiseptic and clotting qualities and is later slowly absorbed by the body if not removed in a surgical intervention. I still don't expect a magic bullet, but I want to see where this concept goes.


----------



## Jim1590 (Jul 11, 2012)

Would they even be for sale to the general public? I would figure we are a few years away from that.


----------



## Padre (Oct 7, 2011)

Sentry18 said:


> If a buddy of mine goes down out in the field and my choices are this unit or a compression bandage, I'll go ahead and give this device a try. Not everyone keeps an actual surgeon in their medical bag.


Yes...but only if you have a hospital handy does this thing help. Its foam does not degrade, it needs to be surgically removed. Thus its nice in the sandbox or perhaps for a Leo today but has limited SHTF applications. Personally I would be worried about missing some foam an the pt getting sepsis.

Sent from my XT1080 using Survival Forum mobile app


----------



## Tradecraft (Mar 3, 2014)

I have never used this product but I have heard and read some negative things about its effectiveness. It seems that it is not ready for prime time. But, it is interesting and innovative.


----------



## labotomi (Feb 14, 2010)

Tradecraft said:


> That is your opinion. As I have stated if it is in his signature line it is fair game. Maybe you should tell him to take it out of his signature line.


It is my opinion. It also happens to be covered in the forum rules as well as general forum etiquette. Perhaps you should read the rules and also spend some time learning how to conduct oneself on a message board.

Here's a link to the rules so you can review them
http://www.preparedsociety.com/forum/f45/standard-rules-guidelines-preparedsociety-5866/#post60700

It's covered in the first paragraph.


----------



## Mase92 (Feb 4, 2013)

labotomi said:


> It is my opinion. It also happens to be covered in the forum rules as well as general forum etiquette. Perhaps you should read the rules and also spend some time learning how to conduct oneself on a message board.
> 
> Here's a link to the rules so you can review them
> http://www.preparedsociety.com/forum/f45/standard-rules-guidelines-preparedsociety-5866/#post60700
> ...


Labotomi, thank you for posting up the rules. Some folks just really like the attention of the public forum.

I took the liberty to PM this gent about the topic at hand and while I won't make anything of our conversation public I will say, he has had MUCH more to say here out in the public forum than he wanted to via the PM.

Sorry I had to mention the PM but I think its tactless to, even after others have stated to stick to the topic at hand, to continue the discussion where others don't want it.


----------



## Tradecraft (Mar 3, 2014)

Mase92 said:


> Labotomi, thank you for posting up the rules. Some folks just really like the attention of the public forum.
> 
> I took the liberty to PM this gent about the topic at hand and while I won't make anything of our conversation public I will say, he has had MUCH more to say here out in the public forum than he wanted to via the PM.
> 
> Sorry I had to mention the PM but I think its tactless to, even after others have stated to stick to the topic at hand, to continue the discussion where others don't want it.


I had more to say here because your PM doesn't warrant a response. You clearly have drank from the MSM kool-aid. Oh, I apologize as I am off topic again. I am so apologetic. I'll just post my thought in the signature line where apparently anything goes but is not open for debate. Kind of like the obama presidency. Damn it, I did it again.


----------



## UncleJoe (Jan 11, 2009)

Tradecraft said:


> That is your opinion. As I have stated if it is in his signature line it is fair game. Maybe you should tell him to take it out of his signature line.


No. It is not his opinion. If someone's sig line disturbs you, take it directly to that person via PM. If someone has a problem with something in my sig line I want it addressed in private as to not derail the thread

If you have something to add to the topic at hand, by all means, contribute. If not, don't join the conversation.


----------



## Jim1590 (Jul 11, 2012)

Bashing presidents in a thread about gsw's probably is not very smart.

Tradecraft, we have a politics forum. Once you have been here long enough, opt in and do your soap box there.

As for sigs. Who cares what people think. We are all in this crap pile together.


----------

