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Ran across this article in this week's Army Times. Thought it might be of interest. 
Lessons learned have led to better equipment, treatment
By Gina Cavallaro
Staff writer
SAN ANTONIO — Both excessive bleeding and hypothermia have taken a significant toll on the battlefield.
But those conditions, as with other types of casualties, have spawned refinements in medical treatment and advances in equipment that are saving lives. So are the lessons learned in hospitals in Iraq and Afghanistan.
“Wars always cause a leap forward in trauma care. It’s constantly evolving,” said Col. John Holcomb, trauma consultant to the Army surgeon general and commander of the Army Institute of Surgical Research, who addressed a crowd of about 300 at the San Antonio Trauma Symposium.
The joint meeting Sept. 19-21 included talks by trauma care professionals from Army, Air Force and Navy medical institutes who brought their vivid anecdotal combat experiences to the podium at dozens of breakout sessions.
In an hour-long talk, Holcomb discussed what seems like a basic premise in saving the life of a patient in danger of bleeding to death: “It’s largely about stopping the bleeding,” he said, explaining that the decades-old practice of injecting a patient with an intravenous saline solution may hurt the patient by decreasing the blood’s ability to clot.
“The IV solution doesn’t bring any clotting proteins. We’re giving a patient that’s bleeding a fluid that makes the bleeding worse,” he said.
“Ten percent of the sickest casualties, those in shock, are the ones who benefit from less salt solution and more blood.”
Artificial blood has not been used in Iraq or Afghanistan, but Coagulation Factor VIIa, a drug developed for hemophilia patients, is being used, and more units of fresh whole blood are being administered with better results for patients in danger of bleeding to death.
The incidence of hypothermia is still higher than it should be, with spikes seen in the colder months when more casualties were seen arriving at emergency rooms with temperatures lower than 96 degrees.
“This resulted in the issuance of [an order] that all casualties be transported in body bags with a hole cut out for the head,” said Lt. Col. Stephen Flaherty, Multi-National Corps surgeons director, Joint Theater Trauma System. But, he explained, the incidence began to rise again because the medical teams stopped using them because they were unnerved by using body bags for soldiers and Marines who were alive.
Consequently, medics were issued hypothermia prevention and management kits that include a heat-reflective shell and self-warming blankets that can stay warm for up to eight hours.
Flaherty also said blood products and coagulants are available all the time at all medical facilities in Iraq and Afghanistan.
And, he assured attendees that a study of the care being given head trauma patients showed that one neurosurgery team, in Balad, was sufficient to meet the needs in theater.
In addition, he said, medical evacuation helicopters were moved from control of the medical brigade to control of the combat aviation brigades, which caused some initial concerns related to the oversight of the health care provided. But aside from some “anecdotal suspicions,” he said, “there is no data to suggest adverse care” with the helicopters working under the CABs.
Established in March 2005, the Joint Theater Trauma System comprises a joint team of medical professionals whose myriad missions include improvements in patient tracking, communications and the development of a theater trauma registry to evaluate patient care and establish a direct cause and effect of the outcome of procedures performed all along the way.
Before the JTTS was developed, casualties were regularly going to the wrong locations — such as landing at a forward surgical team instead of going to a combat support hospital. Staffing and surgical placement were concerns. Medical records were not delivered reliably with the casualty.
As an example of earlier chaos in the system, Flaherty displayed a photo of a soldier whose bandaged legs and arms were covered with instructions inked by hand straight onto the dressings with arrows pointing toward wounds.
“Now, we have an electronic Joint Patient Tracking Application. It’s a Web-based tool as easy to use as Microsoft Word,” Flaherty said. Even combatant commanders can log into the system and track their troops’ whereabouts without having to call the medical team several times a day, he noted.
The patients get logged into the tracking system from the start, and basic information is input for the next level of care. Doctors at Landstuhl Regional Medical Center in Germany, for example, can call up patients’ records and prepare to receive them.
For burn victims, a separate sheet allows medics to more meticulously document fluids.
Every week, tracking teams in theater and in the U.S. have a teleconference to discuss each case and give physicians in theater feedback on the care they provided.
Lessons learned have led to better equipment, treatment
By Gina Cavallaro
Staff writer
SAN ANTONIO — Both excessive bleeding and hypothermia have taken a significant toll on the battlefield.
But those conditions, as with other types of casualties, have spawned refinements in medical treatment and advances in equipment that are saving lives. So are the lessons learned in hospitals in Iraq and Afghanistan.
“Wars always cause a leap forward in trauma care. It’s constantly evolving,” said Col. John Holcomb, trauma consultant to the Army surgeon general and commander of the Army Institute of Surgical Research, who addressed a crowd of about 300 at the San Antonio Trauma Symposium.
The joint meeting Sept. 19-21 included talks by trauma care professionals from Army, Air Force and Navy medical institutes who brought their vivid anecdotal combat experiences to the podium at dozens of breakout sessions.
In an hour-long talk, Holcomb discussed what seems like a basic premise in saving the life of a patient in danger of bleeding to death: “It’s largely about stopping the bleeding,” he said, explaining that the decades-old practice of injecting a patient with an intravenous saline solution may hurt the patient by decreasing the blood’s ability to clot.
“The IV solution doesn’t bring any clotting proteins. We’re giving a patient that’s bleeding a fluid that makes the bleeding worse,” he said.
“Ten percent of the sickest casualties, those in shock, are the ones who benefit from less salt solution and more blood.”
Artificial blood has not been used in Iraq or Afghanistan, but Coagulation Factor VIIa, a drug developed for hemophilia patients, is being used, and more units of fresh whole blood are being administered with better results for patients in danger of bleeding to death.
The incidence of hypothermia is still higher than it should be, with spikes seen in the colder months when more casualties were seen arriving at emergency rooms with temperatures lower than 96 degrees.
“This resulted in the issuance of [an order] that all casualties be transported in body bags with a hole cut out for the head,” said Lt. Col. Stephen Flaherty, Multi-National Corps surgeons director, Joint Theater Trauma System. But, he explained, the incidence began to rise again because the medical teams stopped using them because they were unnerved by using body bags for soldiers and Marines who were alive.
Consequently, medics were issued hypothermia prevention and management kits that include a heat-reflective shell and self-warming blankets that can stay warm for up to eight hours.
Flaherty also said blood products and coagulants are available all the time at all medical facilities in Iraq and Afghanistan.
And, he assured attendees that a study of the care being given head trauma patients showed that one neurosurgery team, in Balad, was sufficient to meet the needs in theater.
In addition, he said, medical evacuation helicopters were moved from control of the medical brigade to control of the combat aviation brigades, which caused some initial concerns related to the oversight of the health care provided. But aside from some “anecdotal suspicions,” he said, “there is no data to suggest adverse care” with the helicopters working under the CABs.
Established in March 2005, the Joint Theater Trauma System comprises a joint team of medical professionals whose myriad missions include improvements in patient tracking, communications and the development of a theater trauma registry to evaluate patient care and establish a direct cause and effect of the outcome of procedures performed all along the way.
Before the JTTS was developed, casualties were regularly going to the wrong locations — such as landing at a forward surgical team instead of going to a combat support hospital. Staffing and surgical placement were concerns. Medical records were not delivered reliably with the casualty.
As an example of earlier chaos in the system, Flaherty displayed a photo of a soldier whose bandaged legs and arms were covered with instructions inked by hand straight onto the dressings with arrows pointing toward wounds.
“Now, we have an electronic Joint Patient Tracking Application. It’s a Web-based tool as easy to use as Microsoft Word,” Flaherty said. Even combatant commanders can log into the system and track their troops’ whereabouts without having to call the medical team several times a day, he noted.
The patients get logged into the tracking system from the start, and basic information is input for the next level of care. Doctors at Landstuhl Regional Medical Center in Germany, for example, can call up patients’ records and prepare to receive them.
For burn victims, a separate sheet allows medics to more meticulously document fluids.
Every week, tracking teams in theater and in the U.S. have a teleconference to discuss each case and give physicians in theater feedback on the care they provided.
