Z-MEDICA · Hemostatic Dressing · Oversized 2-Ply Format

QuickClot Combat Gauze® XL
4 in. × 4 yd Double-Ply

The heavy-duty, oversized hemostatic dressing for large wound cavities and high-volume bleeds. Double-ply, double-width. CoTCCC-recommended for the U.S. Department of Defense. NSN 6510-01-600-4705.

• U.S. Military Medics & Combat Life Savers — The NSN-stocked DoD standard for large wound hemorrhage control in combat operations
• Tactical Medics (18D / Special Operations) — High-volume hemostatic gauze for complex penetrating wounds requiring maximum fill volume
• Trauma Bay & Emergency Medicine — Hospital-based providers using Combat Gauze for field-to-hospital continuity
• SWAT Medical Officers — Law enforcement teams needing the DoD-standard dressing in trauma kits
• Fire & Rescue — Mass Casualty — MCI scenarios requiring rapid hemorrhage control with a familiar dressing

Compliance Note: QuickClot Combat Gauze XL is a sterile Class II medical device. For use by trained medical personnel. Single-patient use only. NSN 6510-01-600-4705 listed on DAPA.

When to Choose Combat Gauze XL

• Large Penetrating Wound Cavities — When a standard 3" gauze roll is insufficient to fill the wound volume — high-velocity gunshot wounds, blast injuries, and large shrapnel tracks.
• Junctional & High-Output Hemorrhage — Groin, axilla, and neck bleeds where the wider 4" format provides faster fill and better contact pressure against major vessels.
• Military Medic & Combat Life Saver Kits — For DoD-standard kit builds requiring the NSN-listed, DAPA-listed hemostatic dressing.
• Trauma Team Pre-Hospital Packs — Flight medics carrying extended-range trauma kits where a single oversized dressing can handle the worst-case wound.
• Casualties Taking Anticoagulants — Therapeutic anticoagulation does not take Combat Gauze XL off the table. Kaolin retains substantial hemostatic activity in anticoagulated blood, and the TCCC Guidelines contain no drug-history-based selection rule. Pack directly onto the bleeding source, hold sustained pressure, reassess frequently, and escalate if the packing fails.

Combat Gauze XL vs. Alternatives

• vs. Combat Gauze LE (Standard 3"×4yd) — XL is 4" wide and double-ply, providing roughly double the fill volume per roll. Choose LE for standard trauma kit builds; choose XL when wound volume demands more hemostatic material.
• vs. CELOX Rapid (Chitosan) — Combat Gauze XL uses kaolin, which works by contact activation of Factor XII. CELOX Rapid uses chitosan, which is mucoadhesive and works largely independently of the coagulation cascade. Both are effective hemostatic dressings, and both appear in the TCCC Guidelines (25 JAN 2024): Combat Gauze as the CoTCCC hemostatic dressing of choice, CELOX Gauze as an alternative hemostatic adjunct. The guideline contains no drug-history-based selection rule. Choose XL when wound volume is the deciding factor; choose CELOX Rapid for narrow wound tracks and speed of deployment. Either way, packing technique and sustained pressure decide the outcome.
• vs. ChitoGAUZE XR PRO (Chitosan) — Different chemistry, not just a different label. Combat Gauze XL is kaolin-impregnated and works through the intrinsic coagulation cascade; ChitoGAUZE XR PRO is a chitosan-coated gauze that works primarily by cellular aggregation and tissue adhesion. Combat Gauze XL carries the NSN, the DAPA listing, and the CoTCCC hemostatic-dressing-of-choice designation; ChitoGauze sits in the guideline as an alternative hemostatic adjunct.
• vs. Plain Kerlix / Standard Gauze — Standard gauze has no hemostatic agent. Combat Gauze XL accelerates clotting via kaolin activation of Factor XII, reducing time to hemostasis in life-threatening hemorrhage.

Frequently Asked Questions

What makes the XL version different from standard Combat Gauze?

Combat Gauze XL is 4 inches wide versus 3 inches, and features a 2-ply double-layer construction. This delivers more hemostatic surface area and absorptive capacity per roll — designed for large wound cavities, junctional bleeds, and high-output hemorrhage.

Is Combat Gauze XL the same as the DoD military-issue product?

Yes. Combat Gauze XL carries NSN 6510-01-600-4705 and is listed on DAPA, confirming it as a DoD-procured item and the CoTCCC-recommended hemostatic dressing of choice for the U.S. Department of Defense.

Does kaolin generate heat when it contacts blood?

No. Kaolin is an inorganic mineral that is chemically inactive. It does not generate heat, contains no animal or human proteins, and does not cause botanical reactions. It works by activating Factor XII in the coagulation cascade.

Does Combat Gauze XL still work on a patient taking blood thinners?

Yes. Therapeutic anticoagulation does not make kaolin-based hemostatic gauze ineffective. In a 2023 viscoelastic study using blood drawn from patients on enoxaparin, heparin plus aspirin, apixaban, and phenprocoumon, kaolin produced the largest improvements in clot formation — ahead of the chitosan dressings tested — and the authors stated explicitly that the hypothesis that kaolin is ineffective in anticoagulated blood is inaccurate (Lechner et al., Transfusion 2023;63(S3):S159–S167). The TCCC Guidelines (25 JAN 2024) contain no rule that selects a hemostatic agent based on a casualty's medication history. Operationally, this matters more than the agent: never delay hemorrhage control to work out which anticoagulant the casualty takes. Expose the wound, pack directly onto the bleeding source, use enough material, and hold sustained pressure. Anticoagulation does raise the risk of failure and recurrent hemorrhage, so reassess frequently and escalate mechanical hemorrhage control and systemic anticoagulant reversal when available.

How much pressure time is required with Combat Gauze XL?

Apply firm, direct pressure for a minimum of 3 minutes after wound packing. For arterial bleeds, maintain pressure until transport to definitive care. Do not lift the packing to inspect a clot that is holding. If the packing fails and bleeding continues, remove it and repack with a fresh dressing of the same or a different type — the TCCC escalation rule is driven by failure of the packing, not by the casualty's medication history.