Stops bleeding. Saves lives.

What is Celox? Dressing to stop life-threatening bleeding (“haemostatic agent”). For use by trained emergency responders. Not a drug. Based on the material chitosan. Chitosan in Celox is a highly purified derivative of shrimp shells.

Who uses Celox? All UK MoD military medics; Paramedics; HART - Hazardous Area Response Teams; Other emergency services; Trained responders at work. Celox Gauze is the haemostat of choice for the UK MOD. Other emergency services include Firefighters and Police firearms units. First aid at work is typically for situations with risk of injury and/or remote location e.g. shipping industry, tree surgeons, motor racing, gun clubs.

Celox Granules The original form for versatile use. Simple: pack and press.

Celox Gauze Gauze with Celox granules bonded to surface. Preferred format of military and most emergency services. Can be used in challenging environments.

US Military test results 2012 Survival. Most recent test by US Department of Defense to re-evaluate choice of haemostat. Ref: Rall J et al. Technical Report, NAMRU-SA, April 2012.

Clinical field reports Italian Army, Afghanistan1. 21 Gunshot Wounds. Treated with Celox granules. 21/21 cases successful. 18/21 within one minute. (1) Pozza M, Millner R, Eur J Emerg Med. 18:31-33 (2011).

Dutch experience. Dutch military and Civilian HEMS use2. Celox Gauze. Stopped bleeding where pressure dressings / gauze failed. No re-bleeding in transfer. No leakage throughout monitored period – up to 24 hours. (2) Tan ECTH, Bleeker CP, MCI Forum .3/4-2011.

Example case: Road traffic accident High energy trauma to cyclist hit by car. Venous bleeding, left side of neck. Normal pressure bandage did not help. Celox gauze stopped bleeding. Transport to hospital and care in hospital with no leakage. Tan ECTH, Bleeker CP, MCI Forum .3/4-2011.

How it works A compound on the surface of the gauze interacts directly with red blood cells to form a plug at the site of the injured vessels Celox in contact with bleeding site. Positively charged chitosan attract negatively charged red blood cells, locking them together in a plug. Pressure applied allows the gel plug to form and stop bleeding.

Using Celox gauze (adopted from UK MoD training) This is ideally a two-person technique Operator 2 Operator 1 Open a fresh bandage Open Celox Gauze Apply pressure into the wound through dressing. Now work closely together Remove dressing 1 Insert Celox Gauze, packing wound tightly 2 Apply pressure through bandage for 3 minutes. 3

Packing gauze Identify bleeding site. Pack directly onto source of bleeding maintaining pressure on bleed point. Pack as taught in controlling severe bleeding for first aid courses – don’t wrap.

Where? Used to stop bleeding from limbs, groin, shoulder, neck, face, scalp. Abdomen (considered “incompressible”) – depends on level of experience. Thorax: most protocols indicate Chest Seal only. These areas of the body where you can press on to the injury. The chest and abdomen are considered “incompressible”. In the thorax the usual treatment is to seal any penetrating chest injury and transfer to medical help urgently. Celox has been used in the abdomen, whether it is recommended depends on the level of experience of the user.

Final steps.... Transfer patient to medical help as soon as possible. Show the pack to the receiving team – attach it to the patient if possible.

Advantages Does not rely on the body’s clotting mechanism; Works on hypothermic blood1; Works on blood containing “blood thinners”2; The most effective haemostat in military tests; Safe. (1) Koksal O et al. Turk J Trauma & Emerg Surg. 2011; 17 (3):199-204. (2) Milner R, Lockhart AS, Marr R. Ann R Coll Surg Engl 2010: 92

Safety testing No shellfish allergic reaction: tested on subjects with known shellfish allergy. No heat generated. Composed of substances that occur naturally in the body, or have a proven history of medical use. Left over chitosan is broken down and excreted by the body.

Now Celox Rapid, reduces treatment time. 60 second compression.

Conclusion Proven success in life-threatening bleeding. Chosen by multiple NATO forces as well as civilian emergency services. Stops hypothermic bleeding as found in severe traumatic injuries.