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To read the first three articles of the Army Institute of Surgical Research’s capstone publication in the Journal of Trauma, visit http://journals.lww.com/jtrauma/toc/2012/12005.
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas — The military's push to field the best and most efficient care to troops on the battlefield — from the use of lifesaving tourniquets to rushing the wounded to combat hospitals in less than an hour — is outlined in a capstone publication in one of medicine's leading journals.
The series of articles, published by the Army Institute of Surgical Research, summarizes the key medical advances from the past 10 years of war. It was published in the December issue of the Journal of Trauma and Acute Care Surgery, the journal of record for numerous professional associations for trauma care providers around the world.
The Army ISR, which is based here, conducts research to provide innovative solutions for burn, trauma and combat casualty care. It also is responsible for the burn center at the San Antonio Military Medical Center, the Defense Department's only burn unit.
The goal of the publication was to "put out a mile marker of the things that are complete, partially so we don't have to relearn lessons" for future wars, said David Baer, ISR's director of research.
"Ten years is a nice, round number to stop, take a look back and review where we started and where we are now to make combat casualty care better," Baer said.
The publication also will disseminate the military's lessons learned to civilian trauma care providers, he said.
"In times of war, the military innovates trauma medicine, and that gets adopted by the civilian world," Baer said. "This is an important part of making sure the advances we made get pushed out to the civilian world."
Covering a 10-year period beginning in late 2001 to late 2011, the publication highlights the major medical advancements the military has made and the lessons it has learned from fighting two wars. They include:
• Bleeding control. "Stopping bleeding is one of our major accomplishments," Baer said.
This includes widespread use of tourniquets, which are credited with saving countless lives on the battlefield.
The military also worked to improve the dressings used on wounds, graduating from gauze to combat gauze, which has a coating that helps blood clot faster, Baer said.
ISR researchers also advocated treating blood loss by injecting into the patient fluids that can help stop the bleeding, he said. One example is tranexamic acid, which helps the blood to clot and is being used in military hospitals downrange, Baer said.
Lessons learned also pushed the military to transition to giving patients blood products — red cells, plasma and platelets — instead of just saline, Baer said. This is commonly practiced in combat hospitals and by forward surgical teams, and could, in the future, be added to medevacs en route to pick up severely wounded troops, Baer said.
• Clearing airways. "Airways are difficult, so we're still working on that," Baer said. "It's not a trivial problem."
But one improvement includes issuing nasal trumpets — to treat troops whose mouths are wounded or blocked — in individual first aid kits for soldiers.
• Treating hypothermia. This is a great hazard to severely wounded patients, Baer said, and the Army has developed a suite of products to help medics keep their patients warm.
One example is a blanket that works like a hand warmer. It contains chemicals to actively heat the patient. The Army also has pushed for medics to infuse patients with warmed fluids to avoid cooling down the body even more, he said.
• Improved rehabilitative and regenerative care. The Army has made great strides in these areas, including some of the most advanced prosthetics in the world for amputees.
Another example, developed here, is the Intrepid Dynamic Exoskeletal Orthosis.
Made from carbon fiber, the IDEO is a custom-made, custom-fitted device powered solely by the inert energy of the carbon fiber and the user's movements. When worn, it helps propel a service member's damaged leg, enabling him to walk and run.
• Advanced vascular surgery techniques and tools. As more and more troops survive devastating wounds, the military has had to step up its ability to repair the body's major vessels.
A wounded leg or arm that's not amputated is still of no use to the service member unless doctors can repair the vessels inside, Baer said.
"As we've improved bleeding control, we've had to innovate techniques to repair major vessels," Baer said.
• Better burn care. As the Defense Department's only burn unit, the ISR burn center has treated the hundreds of troops who suffered burns in Iraq or Afghanistan.
One major development in caring for these troops is improved organ support, Baer said.
"For a burn, we do a good job of stabilizing the patient until they get here to the burn center," Baer said. "Then you have a very sick patient, and we need to close their wounds, but the patient is also at risk for organ failure."
One critical risk for burn patients is kidney failure, Baer said.
"Kidney failure used to be universally fatal for burn patients," he said. "But we have innovated machines to get patients through it."
Using a machine that provides continuous renal replacement therapy, the staff at the burn center can care for a burn patient until his kidneys heal.
Baer said he's proud of the work and advancements that have been made in the last 10 years, but research continues with or without the wars.
"For us, one constant is people getting hurt by explosions, fragments, bullets, and we keep working," he said.
Baer said two primary areas of concern are bleeding and brain trauma. Another aim is continuing to improve rehabilitative and regenerative medicine for severely wounded troops from Iraq and Afghanistan who need long-term care.
"We will continue to innovate to continue to decrease mortality in combat," he said.