For hundreds of years, the mystery of how to stop uncontrolled hemorrhaging could not be solved.
At the end of the last century, 50,000 Americans a year bled to death from traumatic injuries in hospitals, in traffic accidents, and as a result of gun violence. The problem of “bleeding out” was also one of the military’s top concerns on the battlefield.
Today, thanks to a clotting agent discovered by a brilliant, but obscure inventor in the early 1980s and brought to market by his visionary salesman partner 20 years later, thousands of lives have been saved in combat, and on the streets.
The remarkable and unlikely story of the clotting agent QuikClot, and the two men who persisted in bringing it into the public light, is told in a new book, “In the Blood: How Two Outsiders Solved a Centuries-Old Medical Mystery and Took on the U.S. Army” by Charles Barber (Grand Central Publishing).
Barber, a writer in residence at Wesleyan University and lecturer at Yale, chronicles the discovery of the clotting agent in a Connecticut basement in 1983, and the three decades filled with wild twists, turns, and seemingly unsurmountable challenges, that spawned a $500 million success story.
The following excerpt has been adapted from “In the Blood.”
The Story behind QuikClot: A Medical Miracle of the Iraq War
Sometime in February 2002, Lieutenant Commander Timothy Coakley of the United States Navy, who is also an emergency physician, was riding shotgun in a Humvee traveling across the deserts of southern Iraq. Coakley, who was an emergency physician, was in charge of one of the Marines’ “Shock Trauma” platoons that arrived in Iraq before the war started to build up the medical supply chain.
The Humvee in which Coakley was riding was driven by a corporal under Coakley’s command, and the vehicle was part of a much larger convoy of cargo trucks and Humvees heading towards Baghdad. Suddenly the radio system crackled to life. The division commander said in rushed tones that a Marine in a truck half a mile ahead had been shot in the neck.
Within minutes, Coakley and his driver found the cargo truck pulled over by the side of the road. On the ground was a tall, blond, blue-eyed Marine gasping for air and writhing in agony. Blood spouted out of his neck, and was splattering all over his chest and legs in dark, ever-widening crimson circles. A medic kneeled over the fallen Marine, hyperventilating and saying, “Oh my god! Oh my god!” over and over again. Coakley examined the young Marine and saw that, for the moment, anyway, he was lucky. A sniper’s bullet had passed through the Marine’s neck, but had narrowly missed his windpipe and carotid artery. Still, the solider was losing a great deal of blood, and quickly. Coakley instructed the medic to call for a military ambulance. Then Coakley got on his knees and went to work.
Coakley retrieved surgical gloves and compressed gauze from his medical kit. “Coakley depressed the gauze into the gaping cavities in the soldier’s neck, one in the front and one in the back. The Marine remained conscious but wore a stunned expression, looking stoically up toward the sky. The gauze slowed the bleeding but not much: the flow of blood was still voluminous. Coakley knew he needed to find a solution quickly or the solider was at risk of bleeding out. Coakley rifled through his medical kit. Inside he found a small beige pouch labeled QuikClot. He remembered at a pre-deployment training three months earlier that a medic had explained QuikClot was a brand-new product, derived from a simple mineral called zeolite, which was said to be capable of stopping big bleeds. No one knew exactly how QuikClot worked, but it was thought to absorb the water in blood and keep the platelets and clotting factors, thereby putting the clotting process on steroids. Of this, Coakley had been skeptical. He’d spent the early part of his career as an operating room technician. Even in the controlled environment of the operating room, Coakley had seen that nothing was particularly good at stopping large quantities of blood. But now he had no other options. He glanced at the product directions, opened the packet, and poured its contents into the hole in the Marine’s neck. Then Coakley waited, expecting nothing, a sinking feeling growing in his stomach that the soldier’s life was in the balance.
And nothing did happen at first, but then after five or ten seconds, it appeared that the blood began to slow. After twenty or thirty seconds, Coakley clearly saw the blood thickening into a kind of dark crimson Jell-O. And then, in the next minute, the bleeding effectively ceased. Coakley packed the gauze into the wounds again, and this time he was able to fully control the excess bleeding. It was like a clot had formed in front of his eyes. Holy shit, Coakley thought, the military finally came up with something that works. I can’t fucking believe it. “You’re going to be all right,” Coakley said to the Marine, this time with conviction. He held the gauze in place until the military ambulance, a modified Humvee with a red cross on it, arrived twenty minutes later. Coakley helped lift the Marine into the ambulance, and watched as the Humvee drove away, gradually disappearing across the desert. He thought the Marine would survive, but you could never know for sure. Whatever this QuikCot was, Coakley mused, it had promise. But then again, he thought, anything could work once, never to be repeated again—particularly in combat.
A few weeks later, Coakley was in another convoy. It was late afternoon, and Coakley was traveling in a line of trucks and Humvees along a meandering avenue. The four-lane road was lined with palm trees and shops and houses and schools made from stucco and concrete. Coakley heard but never saw the bomb. Even in the tightly sealed confines of his Humvee, with its bullet resistant windshield, the sound was frightening. In the ensuing chaos, it was unclear exactly where the bomb had detonated. His driver kept moving forward. The chatter commenced on the radio: “Holy fucking shit: A bomb went off!” A minute later, after crossing a bridge, Coakley spotted a man lying on the sidewalk, and Iraqi civilian who was bleeding badly and crying out. Coakley saw that a large portion of the man’s back had been ripped open. He was dazed but conscious. Coakley could see that there was no shrapnel embedded in the wounds. However, he knew that there didn’t have to be shrapnel to cause damage. The initial blast of an Improvised Explosive Device was not always the most destructive. The greater part of the damage was often meted out by the second or third or even fourth blast waves, which created hurricane-like forces capable of eviscerating and even amputating body parts.
The man’s blood ran in rivulets down the sidewalk. This time Coakley didn’t hesitate. He ripped open two packets of QuikClot. The blood once again congealed within 30 seconds and in a matter of minutes, the massive wound was controlled simply with gauze. Coakley tried to assure the man that everything was going to be okay, even though neither spoke the other’s language. It took a full two hours for an Iraqi ambulance to arrive. Coakley sat with the man the whole time.
Coakley wondered what it was about QuikClot that made it such an effective blood-clotting agent. It was a little like science fiction. He resolved that whenever the war was over, if he survived, he would study QuikClot in the Navy labs once he got home.
In November 2005, Lieutenant Ryan Kules, of the Army’s First Armed Division celebrated Thanksgiving dinner with the 24 soldiers under his command, at his base near Taji, Iraq, That dinner was the last thing he would remember for weeks. Early in the morning of Nov. 29, 2005, his patrol was on the way back to from an early morning mission. As the senior officer in the command, Kules had chosen to ride in the lead Humvee even though he didn’t need to. “I rode in the lead because part of being a leader is putting yourself out in front,” he said later. The Humvee ran over artillery shells buried in the road. Two soldiers in the vehicle with Kules were immediately killed. Kules was thrown a hundred feet, landing in an irrigation creek.
Medics found his right arm and left leg, which had been blown off his body, before they found what remained of Kules. Remarkably, Kules was conscious, and—this defies belief—trying to stand up. One medic applied the same product -- QuikClot -- to what little was left of his leg and arm, which stopped the bleeding enough to stabilize Kules. One the helicopter ride to the combat hospital in Baghdad, Ryan had lost his pulse more than once and could have been pronounced technically dead on two occasions. When his family first saw him in the hospital in Germany, he was almost entirely wrapped in bandages. The only visible parts of him were his forehead, a toe, and his ears, which were caked with dried blood. Doctors told Kules they weren’t sure he was going to live. He underwent three dozen surgeries and remained an inpatient at Walter Reed for four months. But Kules survived. Eighteen years later, he is the father of three teenage children and a senior officer at the Wounded Warrior Project. In the 2020 federal legislation named in his honor to boost funding for adaptive technologies in housing for wounded veterans was signed by the President.
The physician William Mayo said, “Medicine is the only victor in war.” All wars lead to medical progress – World War II for example led to greater use of antibiotics, the Vietnam War led to advances in burn care and frozen blood products, to cite just two examples. QuikClot, the product which saved Kules and the young marine, has since been called the medical miracle of the War on Terror. The product had actually been invented two decades before it was ever actually used, by Frank Hursey, an obscure mechanical engineer in Connecticut who ran a struggling company in a corner of an industrial park. Some months Frank couldn’t pay his rent. He used zeolite in the machines he built to generate oxygen, and studying zeolite, he realized it was a perfect natural sieve which caught things within his cavernous crystalline structures. He knew very little about blood, but he knew about half of blood is comprised of water. What if he put zeolite into the bloodstream, he thought: wouldn’t it capture the water in the blood, and make the result mixture saturated with the things that created blood clots? As simple as the idea was, no one had ever thought about trying to clot blood in this way. Doctors had always tried to promote clotting by adding something to the blood, not taking it away. But Hursey -- who had no medical training -- was right.
Getting the product to battlefield, however, would take another twenty years. Hursey wrote a patent but it expired, as he was unable to pay the maintenance fee. He contacted drug companies but none were interested. It wasn’t until he took on a business partner, Bart Gullong, who was a marketing powerhouse, that Hursey got his invention to the Marines and the Navy in the months after 9-11. But even once in Iraq QuikClot was controversial. The Army believed that the product could at times burn the surrounding tissue in the wounds of soldiers in the intensity of its mechanism of action; the Navy acknowledged this side effect, but said it only occurred about three percent of the time and given that soldier’s lives were in the balance, the risk-reward ratio tilted heavily toward QuikClot.
But in 2008, Hursey, now working closely with the Navy, found another mineral that clotted blood just as well but caused no heat. As I write now, QuikClot (also called Combat Gauze) is in every first aid kit of every American warrior, and used by first responders all over the world. The company that Hursey and his marketing partner created was sold a few years ago for more than half a billion dollars.
Most importantly, soldiers like Ryan Kules and the young blond Marine (in the chaos of the moment, Dr. Coakley never did get his name) are still alive.
From “In the Blood: How Two Outsiders Solved a Centuries-Old Medical Miracle and Took on the U.S. Army” by Charles Barber. Copyright © 2023 and reprinted by permission of the author and Grand Central Publishing.
Charles Barber is the author of “In the Blood: How Two Outsiders Solved a Centuries-Old Medical Miracle and Took on the U.S. Army”, to be published May 30, by Grand Central Publishing. He is a writer in residence at Wesleyan University, a lecturer in psychiatry at the Yale University School of Medicine, and the author of the critically acclaimed books “Songs from the Black Chair: A Memoir of Mental Interiors” (Univ. of Nebraska, 2005), “Comfortably Numb: How Psychiatry is Medicating a Nation” (Pantheon, 2008), and “Citizen Outlaw: One Man’s Journey from Gangleader to Peacekeeper” (Ecco, 2019). The title essay of his first book won a 2006 Pushcart Prize. His work has appeared in The New York Times and the Washington Post, among dozens of publications. He has been a guest on the Today Show, the Morning Show, CNN, BBC, and NPR’s Fresh Air. He was educated at Harvard and Columbia universities, and lives in Connecticut with his family.
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