The Battlefield's First Responders
Written by Joan Michel
“We are looking to improve both our process and our technology,” said Donald Parsons, deputy director of the Department of Combat Medic Training at Fort Sam Houston in Texas. “The Army does not have one standard for what a medic carries. There are probably 30 different medic bags on the market, but most of them are fairly large and unwieldy. They make it easy to distinguish the medic from the rest of the guys.”
This has been a problem. Medics and rescuers are targeted by the enemy because their loss is so devastating to a unit. Creating a more low-profile way for medics to carry their supplies is one of Parsons’ highest priorities. He is advocating within the Army for a three-tiered system of standardized medical gear that would integrate into the existing uniform and make the most important lifesaving equipment the most readily available.
THE ARMY SYSTEM
Called the combat medic ensemble, this new Army system would consist of three components: a small chest pouch containing the most immediate lifesaving supplies needed to treat preventable causes of death, such as gauze, a tourniquet, pressure bandages, catheters and airway adjuncts; a low-profile aid bag containing secondary medical supplies such as IV fluids, medication and hypothermia prevention supplies; and a vehiclemounted kit that offers larger storage capacity for resupply on extended missions as well as medical supplies for less urgent care—to treat flu symptoms, for instance. Parsons said this system is based on the approach used by the Ranger Regiment and expects it to be ready for fielding to regular Army units in about six months.
“The Rangers do it a little bit differently,” said Parsons. “In some ways they are light-years ahead of the conventional Army in what they do. This small pouch mounted on the front of a medic’s armor carries all of the lifesaving equipment they would need to take care of the three things we must address right away with a casualty: stop the bleeding, ensure that no pressure builds up in the chest if a torso injury, and keep a casualty’s airways open.”
Parsons said a medic can do all of those things without even having to access his aid bag with the new component system.
“We just want to make it easier for the medic to get his job done,” said Parsons, who has first-hand experience with this problem, having served as a special forces combat medic in Vietnam. “Guys have big, heavy cumbersome bags that they have to carry all day long on foot patrol that are unwieldy and heavy. Not the best when we have to provide immediate patient care—have to take off bag, get it open and find what I need. This is compounded by circumstances—maybe it is night or bad weather.”
THE USMC SUITE
The U.S. Marine Corps, in comparison, employs a four-tiered medic bag suite. First, each Marine carries an individual first aid kit that includes everything needed to address the most urgent battlefield injuries—hemorrhage, blocked airway and tension pneumothorax, which is pressure buildup caused by trauma to the torso.
The second level of gear is the combat lifesaver kit, which was developed as a result of an early and urgent need identified at the start of the war in Iraq. IEDs were causing more casualties than the usual ratio of one medic per 30 or 40 Marines could handle. The Marine Corps came up with the solution of training medic assistants, or “combat lifesavers,” to assist the corpsman in treating casualties and providing a medic bag for those medic assistants that provided an additional level of capability.
“The combat lifesaver kit was designed in response to an urgent need for a doc’s right-hand man,” said Gary Berkheimer, medical systems analyst with the Marine Corps Systems Command Family of Field Medical Equipment, who noted that the Marine Corps is adamant about providing level one trauma center medical care in the field. “This was a change in philosophy from the older schools of thought. It was identified as need and we mitigated it with training.”
The Corpsman Assault Pack is the most sophisticated field medic bag and is carried by field corpsmen. It contains approximately 125 pieces of basic and advanced trauma life support equipment, such as IV kits, large capacity needles and fieldexpedient applications to open the airways, and weighs 35 pounds when fully loaded.
It contains specialized equipment as well, such as a product that allows a medic to intubate a patient in the dark. “Our hospital corpsmen are very far forward on the battlefield and are not as readily able to move patients as a service that is farther to the rear,” said Berkheimer. “The CAP has more capability and is more robust—offers high-speed, low-drag trauma treatment devices.”
Berkheimer said that the actual bag for the CAP is identical to the day pack carried by nonmedics and includes two smaller empty bags—a fanny pack and thigh rig—so that corpsmen could outfit empty bags to accommodate specific mission of the day. This design was based on direct feedback from men and women in combat in Iraq and Afghanistan.
The fourth level of medic equipment, the Vehicle Medical Kit, provides supplies for replenishment and aid for nonurgent care.
STOP THE BLEEDING
While the services are taking different approaches to outfitting their medics, there is one product they all agree upon as the most critical part of any medic’s bag: a hemostatic agent, or material that stops bleeding.
Last year, the Department of Defense fielded a new product called QuikClot Combat Gauze to all its services. QuikClot is a gauze impregnated with hemostatic agent that is applied to traumatic wounds to stop the bleeding. While earlier versions of QuikClot have been used in the field, the latest fielded material is considered a major improvement over the previous versions.
Earlier versions used zeolites as the hemostatic agent to stop the bleeding, but the formula caused burning at the site of a wound, said Dr. Galen Stucky, a University of California Santa Barbara materials scientist and developer of the new hemostatic material for QuikClot.
“We first looked at modifying the zeolites to reduce the side effects, but the big issue was whether zeolites would be effective once it stopped burning the wound site,” he said. “What we found was that when we reduced the heat we also reduced its effectiveness, so we began to look for different materials.”
Stucky and his team of researchers, working in conjunction with the Office of Naval Research and Connecticut-based Z-Medica, which manufactured QuikClot, discovered a layered clay compound that increased the efficiency of QuikClot and eliminated the side effects.
“With blood clotting, there are many processes taking place. We needed to understand how they affect each other,” said Stucky. “We came to successfully understand the relationship between the clotting agent and the body’s clotting system and identifying how blood clotting was promoted or inhibited by that agent.” For his role in developing the new material, Stucky was given DoD’s Advanced Technology Applications for Combat Casualty Care Award.
NEW THINKING ON TOURNIQUETS
A process change adopted by all the services in recent years was the decision to use a tourniquet as a first line of offense for trauma patients. That’s something of a reversal from the old school of thought about tourniquets—that they not be applied unless absolutely necessary, USMC’s Berkheimer said.
Now, tourniquets are the first line of recourse. Berkheimer said the military conducted extensive industry research and testing to make sure they are fielding the best tourniquets on the market. He said that in previous wars, even as recently as the first Gulf War, warriors used any material of opportunity as a tourniquet, such as a belt or weapon strap. Now soldiers have a dedicated strap that has a winch and is designed to be applied with one hand.
“An individual who has his wits about him can apply it to himself, and it is part of every first aid kit,” Berkheimer said. “This was a major protocol change for the military as a result of injuries specific to circumstances in Iraq and Afghanistan.
The Army’s Parsons noted that each conflict helps the military relearn lessons about medical care and gather better data on injuries, with medics able to take advantage of new technologies and philosophies about care. Great advances have been made, Parsons noted, but the number-one killer remains hemorrhage.
“We haven’t cracked that nut yet,” he said. “The big issue is how medics can stop internal hemorrhaging, or even know that a patient is suffering in that way.”
USAF ENLISTS RADAR
The Air Force is looking at a technology that would allow combat medics to know the location of any casualties and the acuity level of their injuries. Ann McCaughan, chief operating officer and chief technology officer of Las Vegas, Nev.-based Noninvasive Medical Technologies, was part of a team that developed a technology that integrates a noninvasive hemodynamic monitor with Air Force radar technology.
Part of the Air Force’s Multiple Casualty Assessment and Management System, the sensor—which lays on top of a warfighter’s clothing and is called Etag—uses radar to interrogate the chest and send back information about heart rates, respiratory rates and how much blood is going through the heart. It also tracks the data over time and provides an analysis with the casualty’s location. This type of information is critical to battlefield commanders, said McCaughan, so they can make operational decisions based on real-time data.
In explaining why tracking location can be so important, McCaughan referenced Operation Anaconda, which took place in 2002 in Afghanistan. During this operation, a Navy SEAL fell out of a helicopter on the top of a ridge while it was under siege. Rescue attempts were made and additional troops were killed. The military came to find that the Navy SEAL had been killed long before the rescue attempts were made. In this case, intelligence about the Navy SEAL’s wellbeing may have resulted in a different logistical response and saved lives.
“Hemodynamic and respiratory data together can be used to predict injury and health and predict survival,” McCaughan said. “We can tell someone is going into shock, and we don’t need to be anywhere near them. We can do a better job triaging and making decisions out on the field.”
FUTURE APPLICATIONS
In addition to its military use, the civilian applications are numerous, said McCaughan. The system can be used for mission monitoring and worn beneath a level C Hazmat suit, under arctic gear or underwater. Currently the system is undergoing environmental testing for sand, water, heat and cold. McCaughan said it may be ready for fielding at the beginning of next year.
McCaughan said the company continues to make new discoveries about how radar interrogates the inside of the body. In fact, all Noninvasive Medical Technology employees wear a numbered sensor as part of the company’s testing, and an engineer at the company discovered that he was able to recognize people by their signal alone.
“One thing we learned is that everyone’s signal is different,” she said. “Radar interrogates how the heart moves in relationship to the lungs and how they sit in geography to one another. The size of the heart and lungs and the relationship to each other is unique to each person.”
USMC Berkheimer is also looking for more field tools for brain injury, given that traumatic brain injury is affecting a large percentage of Marines and soldiers serving in Iraq and Afghanistan. Traumatic brain injury is defined as a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain, commonly caused by explosions.
“I’d like to be able to detect traumatic brain injury earlier,” said Berkheimer. “Companies are looking at sensors and helmets to identify force of impact. We would like to see really a small handheld device that would be able to detect traumatic brain injury and closed head injury and do it very early after the injury.” ♦