by Tiffany Holloway
USAMRMC Public Affairs
With over 120,000 soldiers deployed in Iraq and Afghanistan, undoubtedly someone will suffer an injury; therefore, medical solutions have to be effective because there's no place for faulty products.
The U.S. Army Institute of Surgical Research (ISR), a subcommand of the U.S. Army Medical Research and Materiel Command, is dedicated to both laboratory and clinical trauma research. Its mission is to provide combat casualty care medical solutions and products for injured soldiers, sailors, airmen and marines.
The Army has documented that the survival rate in ongoing conflicts is over 90%, the highest recorded in modern combat. This survival rate is the product of numerous innovations such as improvements in protective equipment, evacuation, and the training of combat medics; and innovations in the medical equipment and techniques available at all levels of care—from self/buddy aid, through field care given by medics, to hospital care delivered in theater and in the U.S.
Statistics show that battlefield survival rate has increased. According to defenselink.mil, a soldier who sustained an injury in World War II would have had a 69.7% survival rate. A soldier in the Korean War would have had a 75.4% survival rate. A soldier who served in the Vietnam War would have had an 86.5% survival rate and, in Operations Enduring Freedom and Iraqi Freedom, the survival rate has increased to 89.8%.
However, getting a medical solution from the laboratory to the battlefield isn't a drive-through process. First, the project must be funded.
"We looked for technologies that met a real Army need and also had application in the civilian sector. The medical tube securing device showed outstanding initiative and creativity on the part of MEDCOM soldiers," said Mele.
Since there are many products, they are put on a priority list.
"Our office funds the products. We look at how much the product will significantly address the wound or injury. Also, the products that will help the injury that more troops are suffering from will have a higher priority. We use research databases like the Joint Theater Trauma Registry. Some products get funded more quickly than others. It just depends on available funds," said Col. Dallas Hack, Army Combat Casualty Care Research Program Director.
Products go through an assessment of risks and benefits. If the benefits outweigh the risks and usability requirements are met, medics are asked to carry it downrange with them. While all products require thorough review, the review is tailored to the individual products. Those that will be used inside the body present a particular challenge and the review of these products can take substantially longer than those that are used on the outside of the body.
"A solution that goes outside the body, like a dressing, could take up to a year after testing," said Blackbourne. "Relying on the FDA is just a minimum."
"We do our own testing. We read up on literature. We also work closely with the Army Medical Department Center and School," said Dave Baer, director of research at ISR.
That's the "easy" part.
After fielding, doctors and other healthcare professionals are asked to observe whether or not the product actually works through an observational retrospective study. This means the doctor will record medical accomplishments. This effort is to ensure that products perform well in actual use.
The challenging part of fielding the product is to receive feedback, since doctors are more concerned with saving soldiers' lives versus reporting how a product worked or taking notes in the middle of surgery.
"We know that health care providers are busy taking care of the soldier, so we have dedicated nurses at each military medical hospital collecting data on whether or not the product was successful," said Hack.
However, once a deployed unit is back, the scientists at ISR can make the product better with the data they receive.
Combat wounds are different than civilian wounds. They have different wounding patterns. For instance, in combat, you receive penetrating wounds, not blunt (ones). Military gunshot wounds are from high velocity weapons, whereas civilian trauma centers see mostly low velocity injuries.
Again, in combat soldiers are involved in explosions and civilians may be involved in car crashes. "Soldiers on the battlefield have different requirements when it comes to medical attention," said Baer.
Some of the top products in the battlefield today are the tourniquet; the hemostatic dressing, which is more effective than cloth gauze; Nomex gloves, which are fire-resistant; improved needles for treatment of pneumothorax; and hypothermia prevention kits.
These products are the result of a careful study of injuries on the battlefield and close collaboration with industry partners and civilian academic centers. Some of them are new, and some are existing products that have been updated.
"Soldiers expect to get the very best. It's our goal to provide them with world-class care. This should give them security. They should know that the Army will do everything humanly possible if they get hurt," said Blackbourne.
Hack, who served as the theater surgeon for Iraq, said he was deployed one day before the Sept. 11 attacks and helped stand up military hospitals.
"Our office believes that from our efforts soldiers will be less concerned about health care and be more focused on winning the war. It's a morale builder. I'm lucky to be in this position because I've been in theater and I know what the need is. Now, I can have more of an impact on our military. We are impacting civilian medical care as well," said Hack.
