A tourniquet solves a limb. A groin, an armpit or a neck has to be packed — and Combat Gauze is the dressing the TCCC Guidelines name first for that job.
At a glance
12 things to know about Combat Gauze
What it is, why the military picked it, and what separates it from every other gauze in a kit.
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01
It works by switching on your own clotting
Kaolin activates Factor XII, the first step of the contact pathway of coagulation, which accelerates the body's own clot formation wherever the gauze touches blood.3,12 It is the same mineral clinical laboratories have used since the 1950s to trigger clotting in the kaolin clotting time test.13
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02
It produces no heat
The original QuikClot was a loose zeolite granule that gave off heat as it absorbed water. Combat Gauze binds kaolin to the gauze instead: no exothermic reaction, nothing to pour, and nothing to blow away in rotor wash.3
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03
It has been the U.S. military's hemostatic since 2008
Combat Gauze was fielded in 2008 to replace earlier hemostatic products,4 after U.S. Army Institute of Surgical Research testing in a swine arterial-bleeding model.11 The TCCC Guidelines dated 1 May 2026 still name it the evidence-based hemostatic dressing of choice.1
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04
Its record in real patients is consistent
Hemorrhage control in 88.3% of documented uses on U.S.-treated casualties in Afghanistan;4 89% effective across rural civilian trauma centers;5 95% success in a civilian ground and flight EMS service.6 These are retrospective case series — real patients, no comparison group — and three separate settings all landed between 88% and 95%.
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05
It packs exactly like plain gauze
No mixing, no measuring, no applicator. The Z-fold feeds out one fold at a time as you work it into the wound, so the technique you train on plain gauze is the technique you use here.3
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06
Four yards is a lot of gauze — on purpose
Twelve feet fills a deep groin or armpit cavity and still leaves a tail to lay over the top of the packed wound under your pressure bandage. On a shallow wound, pack what fits tightly and use the rest as the outer layer.
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07
The X-ray strip is there for the surgeon
A radiopaque strip runs through the gauze and shows on X-ray, so the receiving team can confirm every inch came out of the wound.3 Tell them a hemostatic dressing is packed in the wound and hand them the empty pouch.
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08
Eight tear points, vacuum-sealed
The pouch tears open from any edge with gloved, slick hands, and the vacuum seal keeps the dressing a compact brick that rides in an individual first aid kit or a plate-carrier pouch.3
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09
Five-year shelf life, no cold chain
Store it sealed at ordinary room conditions and check the expiration date printed on the pouch. A torn or punctured pouch means the dressing is no longer sterile — replace it.3
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10
Safe to carry for people with shellfish allergy
Kaolin is an inorganic mineral. Combat Gauze contains no shellfish-derived chitosan and no animal or human proteins.3
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11
Laboratory data on blood thinners
In blood drawn from eight people taking rivaroxaban, both kaolin- and chitosan-based hemostatics shifted clotting measurements toward improvement.10 That is a test-tube result, not a field outcome: pack and hold exactly the same way, and keep a closer eye on the wound for re-bleeding.
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12
Owned by Teleflex since 2020
Z-Medica, the Wallingford, Connecticut company that created QuikClot, became part of Teleflex on 28 December 2020.14 The dressing, its item number and its NSN carried over unchanged.3
How to pack Combat Gauze
The technique taught in TCCC, TECC and public bleeding-control courses, in order.
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1Find the source. Expose the wound and find where the blood is actually coming from. Keep direct pressure on it with your hand while you open the pouch at any tear point.
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2Start with a tight wad. Make the first few folds into a firm ball — the "power ball" — and press it directly onto the bleeding vessel.
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3Feed it in. Work the gauze in one or two folds at a time, keeping pressure on what is already packed.
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4Fill every corner. Pack tightly, leave no empty space, and keep going until the gauze sits slightly above the skin.
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5Hold firm pressure. Press straight down on the packed wound for at least 3 minutes — longer if it is still bleeding.1 Do not lift your hands to look.
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6Lock it in. Wrap a pressure bandage over the packed wound so your hands are free for the next problem.
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7If it keeps bleeding, repack. Remove the packing and pack again with a fresh dressing, the same type or another hemostatic.1 Piling more gauze on top of a failed pack does not fix it.
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8Hand it off. Tell the receiving team a hemostatic dressing is in the wound, give them the pouch, and keep reassessing.
Where it fits
- Junctional wounds — groin and armpit — where a limb tourniquet cannot be applied
- Neck wounds, packed with care so the airway is not compressed; the lower neck above the collarbone can be packed
- Deep limb wounds where a tourniquet is not possible, or as an adjunct when a trained provider converts a tourniquet1
- Any deep, packable wound with life-threatening bleeding
- The chest or abdomen — never pack into the chest or abdominal cavity
- Life-threatening limb bleeding a tourniquet can control — tourniquet first1
- Minor cuts and scrapes — an everyday first aid dressing does that job
- The eyes — keep the dressing away from the eyes3
- Practice — train with inert trainers, not live dressings
The evidence
Every number above, where it comes from, and how strong it is.
| Study | Evidence type | What was studied | What it found |
|---|---|---|---|
| Schauer et al., J Spec Oper Med 2017 | Human · combat registry | 118 casualties treated with Combat Gauze out of 705 in the DoD Prehospital Trauma Registry, Afghanistan | Hemorrhage control in 88.3% of uses where the outcome was documented |
| Leonard et al., J Trauma Acute Care Surg 2016 | Human · civilian series | 95 rural civilian trauma patients treated with Combat Gauze and/or C-A-T tourniquets, 2009–2014 | Combat Gauze 89% effective |
| Zietlow et al., J Spec Oper Med 2015 | Human · civilian EMS | 62 hemostatic dressings in 52 patients, Gold Cross Ambulance and Mayo One flight service | 95% success; half were applied to the head and neck |
| Ran et al., Prehosp Disaster Med 2010 | Human · combat series | 14 uses by Israel Defense Forces advanced life support providers, Gaza, January 2009 | Authors judged it effective and safe for prehospital use |
| Johnson & Johnson, Am J Disaster Med 2019 | Animal · randomized | Combat Gauze vs Celox Rapid, 6 mm femoral artery injury, 21 swine, 3-minute hold plus simulated pressure dressing | Hemostasis held at 1 hour in 100% with Combat Gauze vs 60% with Celox Rapid |
| Kunio et al., Am J Surg 2013 | Animal · randomized | Plain gauze vs Combat Gauze vs Celox Rapid, femoral artery injury, 36 swine, no pressure held after packing | Success not statistically different (10/12, 10/12, 12/12); less secondary blood loss with Celox Rapid |
| Bar et al., Prehosp Disaster Med 2017 | Laboratory | Blood from 8 people taking rivaroxaban, tested by rotational thromboelastometry | Kaolin- and chitosan-based agents both shifted clotting toward improvement |
Strongest to weakest: human trials and registries, then animal studies, then laboratory studies. Case series show real-world performance but have no comparison group; animal results depend heavily on the injury model, the hold time and the endpoint chosen.
How it compares
The four packing options a buyer most often weighs against each other.
| Combat Gauze | Celox Rapid | Celox Gauze | Plain compressed gauze | |
|---|---|---|---|---|
| Active agent | Kaolin (mineral) | Chito-R™ chitosan | Chitosan | None |
| How it stops bleeding | Speeds the body's own clotting cascade | Forms an adhesive gel that binds blood cells | Forms an adhesive gel that binds blood cells | Pressure alone |
| Strip | 3 in. × 4 yd (12 ft) Z-fold | 3 in. × 5 ft Z-fold | Z-fold | 4.5 in. × 4.1 yd roll |
| Labeled pressure hold | At least 3 min | 60 s, or until bleeding stops | 3 min, or until bleeding stops | Longer than a hemostatic — pressure is the only mechanism |
| evidence-based standard | Yes — hemostatic dressing of choice | Yes | Yes | No — not a hemostatic |
| Shellfish-derived | No | Yes | Yes | No |
Combat Gauze XL is the double-layer member of the same kaolin family. Labeled hold times come from each manufacturer's instructions; the TCCC Guidelines set at least 3 minutes of direct pressure for any hemostatic dressing.1
Build the system
What goes in the kit around it — the bandage that holds it in, the alternatives, and the trainer to practice on.
Questions buyers ask
Package & specifications
Specifications coming soon. Contact us for detailed product information.
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