... is really all we are. And on the battlefield, there are lots of hot pokey objects that can puncture our squishy sacks, letting out all the goo. To put this problem in more clinical terms: blood loss is the first and most immediate danger to injured troops. Therefore, finding ways of staunching the flow of blood from battered bodies is one of the military medical community's major priorities.
There's been a lot of advancements on this front in the past couple years, much of it motivated by the high proportion of bleeding limb injuries in Iraq and Afghanistan. Several advancements have been mentioned on this site before. Here's a comprehensive survey:
* One-handed tourniquets that soldiers can apply in seconds to wounded comrades
"Approximately 200,000 of these tourniquets have recently been ordered and shipped to theater," says Colonel Robert Vandre from Army Medical Department (AMD). "It is starting to be used now and reports are coming in from our surgeons that they are receiving patients with these tourniquets on damaged limbs."
* A pair of new bandage designs -- one based on desiccants (like you find in the pockets of new coats) and another on crushed crustaceans -- that encourage rapid clotting of wounds
Vandre again: "Since the beginning of the Afghanistan conflict, the Department of Defense has fielded two new bandaging technologies for stopping bleeding: the Chitosan Bandage, [made by] Hemcon, and QuickClot, [made by] Z-Medica. The Chitosan bandage is made of shrimp shells and sticks to the wounded area, sealing it off much like a tire patch. The QuickClot is made up of desiccant granules that physically adsorb the liquid from blood, thereby concentrating the clotting factors and encouraging rapid clotting to stop the bleeding."
* A new medicine, developed by Defense Advanced Research Programs Agency (DARPA), that helps organs survive temporary blood shortages
"The focus in this program is using the consequences of blood loss," says DARPA spokeswoman Jan Walker. "What we want to be able to do is protect the organs from the impact of oxygen loss and ensure that the wounded soldier can recover fully. What that allows us to do is it gives us more time to get the casualties to a hospital."
* A sonic blood coagulator, another DARPA project
Walker: "We have another program that is looking at acoustic energy to stop bleeding -- that is, deep bleeding, not in an extremity, not in some place where you can apply pressure. It's called Deep Bleeder Acoustic Coagulation. It uses sound waves to encourage clotting. It's a device that could be used by a layperson, a medic on the battlefield. It's portable, light and automated."
* Another clotting agent, Recombinant Activated Factor VII (RFVIIA), developed by AMD
"Through an extensive collaboration with the Israelis, we promoted the first use of RFVIIA in for the treatment of severe surgical bleeding in trauma patients," Vandre says. "RFVIIA stops bleeding in trauma patients when their own clotting mechanisms are not working properly. As a result of this collaboration, RFVIIA is now being used in major trauma centers throughout the world and has been used on over 400 wounded patients in Iraq. Currently the drug's maker, NovoNordisk, is pursuing clinical trials to gain a trauma indication for this drug with the Food and Drugs Administration (FDA)."
* New ways of freeze-drying replacement blood to facilitate transport and storage
"The Army is actively developing freeze-dried plasma and hopes to have a product available within five years," Vandre says. "Plasma is the liquid part of blood which contains the majority of its clotting factors and is highly desirable for early resuscitation of patients. Currently it exists on the battlefield only as frozen plasma and, as such, cannot be given any place but at our field hospitals. DARPA and the Navy have both pursued freeze-dried platelets, another clotting product. The Army has also developed a process to allow red blood cells to be kept refrigerated for up to 12 weeks, which is twice as long as they currently can be stored. We are working now to get funding to push this product through advanced development and FDA certification."
* A new container, developed by AMD, for transporting perishable replacement blood
Vandre: "To allow medics to bring blood products far forward on the battlefield, our researchers developed the 'Golden Hour' Blood Transport Container which can keep four bags of red cells at 10C for 72 hours with no electricity or wet ice. This container is being used in theater on evacuation missions where red blood cells may be of help to the wounded patients."
The survival rate of troops injured in Iraq and Afghanistan is better than ever. Thanks to these technologies and others, even more soldiers will survive their injuries on future battlefields.
