Caring for the Combat Casualty
Combat medics face extraordinary challenges. As the first point of care for injured warfighters, they aim to provide continuous treatment from the battlefield all the way to the permanent hospital site. This means they must care for casualties even as they are being treated with a hemostatic, or loaded onto a helicopter or MRAP ambulance.
Before care can even begin, an important first step for the medic is detecting casualties and learning what injuries have occurred. “Say a squad is on patrol, and someone gets hit with an IED,” Brian Russell, CEO of Zephyr Technology, began, painting the picture of an all-toooften occurrence facing modern warfighters. After the squad finds cover, he said, everybody is going to commit themselves. They’ve got to decide who’s missing, who’s injured.
DETECTING THE INJURY
“The guy that got hit by the IED is probably still out there,” Russell continued. “So they’re going to have to go get him or decide whether they should go out into harm’s way and get him.” He said that with Zephyr’s PSM Defense System, the command center and the forward operating base can detect once a person is injured, so the quick reaction force can be deployed immediately. This allows commanders to make a more informed decision based on the data they have that tells them the severity of the injury.
For example, if medics and commanders can see that the injured warfighter is down but is not losing blood too quickly, the decision can be made to wait until the position is secured before risking more casualties.
“If there are multiple injuries, the medic can make the very difficult decision on who to go to first,” Russell said, “rather than go into harm’s way, visit everybody, then go back to the most injured.”
The PSM System can assist medics in other situations with multiple casualties. In the case of the medevac, medics might receive several casualties on the helicopter at once. Before PSM, medics decided what the issues were before they started treatment, “whereas now, they can see the data on the helicopter on their way in,” Russell said. “The helicopter medic can offer advice to the medic on the ground if he’s getting overwhelmed because of all the other casualties on the ground, and as soon as that casualty comes on the helicopter, he can get the treatment right away.” He said that saves a five- to 10-minute delay because the casualty can be treated immediately. “He gets continuous care all the way back to the field base.” STABILIZING THE CASUALTY “It is well documented that if you can stabilize the wounded warrior in the initial stages after injury, then they have a much higher chance of survival when they arrive at definitive care locations,” said Bill Block, president of the U.S. division of HemCon Medical Technologies Inc.
One way to stabilize the patient is to first of all stop the bleeding. Ross Johnson, CEO of Tactical Medical Solutions, said that the company recently completely redesigned its SOF tactical tourniquet. Some of the improvements include a wider frame and a more user-friendly buckle to prevent time wastage.
Another way to stop bleeding is through the use of hemostatics. The current hemostatic of choice by the Tactical Combat Casualty Care (TCCC) Guidelines is Combat Gauze, produced by Combat Medical Systems. Combat Gauze is designed to be used quickly and easily in urgent situations. It is also the current TCCC choice because it generates no heat and is cost-effective. Chris Murphy, director of research and development of Combat Medical Systems, said the most recent addition to the Combat Gauze line is the TraumaPad, designed to treat large surface wounds from blasts and explosions. “This newest solution is suitable for the kinds of injuries that are seen on the battlefield today,” Murphy said. The Trauma Pad unfolds to treat an area measuring a square foot.
HemCon’s Block discussed his company’s recent developments in hemostatic technology, which will soon be up for consideration by TCCC Guidelines. He said HemCon’s newest hemostatic dressing, ChitoGauze, is predominantly being used by U.S. Special Operations Command units. Studies have been performed to determine the effectiveness of ChitoGauze.
“The big differentiator in the studies shows we have a quicker time to hemostasis and consequently more than 2.5 times less blood loss was observed.” He added, “The fast time to hemostasis and blood loss reductions are critical because medical evacuation time can be lengthy due to the harsh terrain, for example, in Afghanistan.” He said the product also has antibacterial capabilities that allow the military to use ChitoGauze as a two-in-one solution. “The antibacterial properties are very important since most military wounds are contaminated and therefore at risk for infection.”
HemCon currently has three ongoing grants for research and development of products with DoD, including a burn dressing and an absorbable surgical dressing. The third and largest grant is for a lyophilized, or freeze-dried plasma, product.
“We are making good progress in all three areas, but our primary focus and the military medical community’s highest priority is for the rapid development and deployment of our lyophilized plasma product.”
RETRIEVING THE CASUALTY
As challenging as stabilizing life-threatening injuries is, combat medics must do it while on the move. Fortunately, the military medical community has continued to make improvements to help combat medics do this. There are several new developments in casualty transport equipment used by DoD.
The AllEvac line from Combat Medical Systems is currently used to transport injured warfighters from the battlefield. Murphy said there are two recent additions to this line. The Mantis Tri-Fold is an evacuation board that folds down to 25 inches by 16 inches to save space. Murphy said, “The Mantis is ideal for retrieving casualties by vehicle,” which is often the practical means.
Combat Medical Systems also offers the AllEvac Ant, specifically designed for technical rescue environments. According to Murphy, the Ant is ideal for rotary aircraft with limited space, and serves rescue operations well with its rapid setup.
When medics need to retrieve multiple casualties, they have the option to use a helicopter evacuation rack, also in the AllEvac line. Medics can load litters bunk-style right into a UH-60 in the place of the four backseats. They also integrate with MH-60s, making transferring during transport quicker and more convenient.
EN ROUTE CARE
Once the combat medic has made initial contact and taken steps to stop bleeding, Zephyr’s Russell said that the Bluetooth network data for blood oxygen or blood pressure can be added at the casualty collection point. A single display gathers information about multiple casualties and even prioritizes the injuries by the most at risk. “That gives somebody under a huge amount of stress trying to save multiple people a really powerful tool to look after everybody.” Once the most critical person is stabilized, the medic can move on to the next. If someone who has been stabilized starts to deteriorate, the software can alert the medic.
Despite the range of ways in which the PSM can help a medic, Russell pointed out, “We don’t try to replace the training and experience of the medic; what we’re trying to do is get them the data in an informative way so that they can make a good quick decision.” The aim is to be a useful tool as the medic pulls from training and experience to make smart decisions.
The nature of today’s injuries often means a need for blood transfusions, under less than ideal conditions. One product that is used by DoD during transfusions is the Buddy Plus, a lightweight, portable fluid warmer. Produced by Belmont Instrument Corp., Buddy Plus is designed with en route care in mind with its built-in battery, charger and line power interface. Its flow control valve also prevents air entertainment during transport.
Kathi Quigley, marketing communications manager for Belmont, said the company has developed a new battery-powered blood and fluid warmer with a total weight of less than 1.6 pounds, the Belmont Buddy Lite. “The Belmont Buddy Plus has been used in the U.S. military for over two years. The Belmont Buddy Lite is a new addition to the U.S. military medical equipment being used in combat casualty care,” she said.
Also used by the military is Belmont’s Rapid Infuser (FMS 2000). “The Rapid Infuser is now available with flow rates through 1,000 milliliters per minute,” Quigley said. She added that DoD has used the infuser for more than 10 years.
Often the success of en route care and battlefield care alike depends simply on the convenience of the kits that medics have available. Chinook Medical Gear Inc. provides tactical medical kits and tactical medical modules for this reason. Jessica Denison, director of business development at Chinook, said, “These kits and modules have been specifically designed with the end-user in mind.” She clarified that kits are typically assembled in a soft pack or hard case containing a broad scope of products for providing combat casualty care. Modules are smaller, vacuum-sealed packages that are part of a kit. They tend to be injury-specific, focusing on specific areas of medical treatment. All components included in the kits and modules adhere to TCCC guidelines, she said.
Denison said customers can choose kits based on their portability needs versus their depth of care needs. The Care Under Fire Kit (TMK-CUF) is the smallest, most lightweight pouch with contents restricted to only an absolutely necessary basis. The next step up in depth of care is the Individual Operator (TMK-IO), with the Combat Lifesaver (TMK-CL) providing “superior versatility with numerous pockets, elastic loops and a unique pull-out compartment for use in a multiple casualty scenario.”
Denison said, “In many cases we understand that our off-theshelf kits and modules may only be a partial solution to our customer’s needs. What we offer is the capability to provide the 100 percent solution.” She said Chinook can make changes to existing kits or modules to meet specifications. Another option is to build a complete custom product from the ground up.
WHAT TO EXPECT
Russell said the military medical community can expect several things from Zephyr this year. “It’s a very exciting time.” At press time, Russell said the company was in the process of delivering a suite of new sensors for blood oxygen and blood pressure. Also coming later in the year are new gas sensors, “which will really bring the whole suite of looking after the person into one system,” he said.
Much of what Zephyr has added to the PSM Defense System so far include reporting features, which will be used during SOF unit training to measure fitness level and other physiological characteristics. “That’s really important for the medic and squad commander to learn his people so that he can make better decisions downrange,” Russell said.
Block said that HemCon is already developing its next-generation military hemostatic dressing solution and plans to have it on the market by the end of the year or sooner. “Additionally, we hope to have an approved product that may be used for surgical applications or used operatively by the end of the year.” He added that the company should be entering Phase II clinical trials with the lyophilized plasma product and “getting it that much closer to eventual clearance by the FDA.”
Belmont will be adding to the mix increased flow rates for its Rapid Infuser and added features to the Buddy Lite in the next six to 12 months.
A variety of deliverables will be coming from Chinook, including a new TMM and an updated Blood Donor TMM-BD. The company is in the final stages of developing its first backpack, the TMK-ME (Medic). “It will be of medium size, modulized, and will include an extra set of four battle pack pouches. This new offering will set the standard for medic aid bags for field forward medics,” Denison said. She added that feedback from the special operations community and their regular force counterparts have ensured that the bag will be versatile and durable. “Also on the drawing board is a smaller backpack and several specialty containers to complement our current TMK-MEDS/ IV pouch.” Other deliverables to expect include an IFAK kit, NSNs for several kits and modules, and “adding other new products to our offering that represent significant improvements to existing technology.” ♦