Stops bleeding. Saves lives.

1. Stops bleeding. Saves lives.

2. 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.

3. Who uses Celox? • All UK MoD military medics; • Paramedics; • HART - Hazardous Area Response Teams; • Other emergency services; • Trained responders at work.

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

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

6. 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.

7. 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).

8. 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.

9. 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.

10. 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.

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

12. 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.

13. 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.

14. 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.

15. 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 CollSurgEngl 2010: 92

16. 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.

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

18. 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.