Army Invention Saves Severely Injured Servicemembers’ Lives

American Forces Press Service ^ | Elaine Wilson

[SandRat]

FORT SAM HOUSTON, Texas, June 13, 2008 – A new lifesaving standard of care has garnered the U.S. Army Institute of Surgical Research here a prestigious recognition: invention of the year.

The innovation, called Damage Control Resuscitation of Severely Injured Soldiers, was named one of the Army’s “Top Ten Greatest Inventions of 2007.”

“The American Association for Trauma Surgeons calls this one of the biggest improvements to trauma care in the last 10 years,” said Michael Dubick, senior research pharmacologist for the Institute of Surgical Research. The invention is aimed at saving severely injured soldiers with internal injuries that cannot be compressed using a tourniquet or other device, Dubick said.

The institute focused its attention on severely injured soldiers after analyzing data from an autopsy study that showed 79 percent of servicemembers killed in combat died of hemorrhage, and 70 percent had an injury that couldn’t be compressed.

“We needed to find a better way to stop bleeding,” Dubick said. “In theater, there was no solution for people with noncompressible injuries.”

The innovation involves the fluid resuscitation process, in which IV fluids and blood products are used to stabilize a patient’s physiology. The standard method is to administer IV salt solutions in an amount that is three times the patient’s blood volume. If the patient is still bleeding, blood transfusions are given to restore lost blood.

In most cases, this method is effective for wounded troops, but for some severely injured warriors, the massive volume of fluids and blood can create a negative effect, Dubick said.

“The body has only a finite amount of clotting factors,” he explained, “and a large volume of fluids can dilute those clotting factors, which reduces their ability to slow down or stop the bleeding.”

Under the new standard of care, fluid resuscitation with salt solutions is limited, which keeps the blood pressure from rising too high and “popping” newly formed blood clots. In addition, blood volume is restored using plasma as the primary resuscitation fluid, along with packed red blood cells.

But rather than using the standard of four times the amount of red blood cells to plasma, “we use a ratio of 1-to-1 of plasma to red blood cells,” Dubick said.

Dubick said early use of a clotting factor called “rFVIIa” also has been beneficial. The factor normally is used for hemophiliacs, but it has proven beneficial for severely injured warriors. Other blood products, such as platelets and “cryoprecipitate,” are used as needed.

The reduction in fluids not only increases the patient’s short-term chances of survival, but also helps long-term treatment, since “there is less fluid built up in organs, and surgeons have a better field of operation,” Dubick said.

While the innovation is gaining recognition stateside, it already has had a striking impact in the combat theater, decreasing the mortality rate from 65 to 17 percent.

The impact of this change in the standard of care is so striking, Dubick said, that “some liken this standard of care to the first time someone applied antibiotics.”

The military innovation also is gaining civilian attention.

“We’ve met with over 26 civilian centers and are working with 16 of them,” Dubick said.

As word of the lifesaving measure begins to spread, Dubick said, he and his fellow scientists already are looking ahead, working with a company to produce freeze-dried plasma. In its natural state, plasma has a limited shelf life and is subject to temperature requirements.

The scientists also would like to develop a shelf-stable artificial blood with clotting factors that would enable medics to provide early intervention at the site of injury, Dubick said.

“The majority of patients bleed to death in the first five to 10 minutes,” Dubick said. “We believe that procedures like this one can save soldiers who survive beyond 10 minutes -- keep them alive long enough to get to the hospital and to surgery. It’s a remarkable innovation.”

Dubick’s team for the project includes Jill Sondeen and Charles Wade, from the Institute of Surgical Research; Philip Spinella, Brooke Army Medical Center; Army Maj. Jeremy Perkins, Walter Reed Army Medical Center, Washington, D.C.; Air Force Maj. Matthew Borgman, Wilford Hall Medical Center; and Army Col. John Holcomb, ISR commander.

The invention was the only medical innovation to make the Army’s Top Ten cut, and marks the third year of the last four that the Institute of Surgical Research has made it to the Top Ten list. The winning programs are selected based on their impact on Army capabilities, inventiveness and potential benefit outside the Army.

U.S. Army Institute of Surgical Research http://www.usaisr.amedd.army.mil/

(Elaine Wilson works at the Fort Sam Houston Public Information Office.)

Related Sites:
Institute of Surgical Research

[tubebender]

Life Saving Bump...

[magslinger]

Self ping for future reference.

[paterfamilias]

Thanks for posting this, Sandrat

[oprahstheantichrist]

Wow, I can only imagine the potential impact for traffic acccident victims. Do we still lose 50k/year?

[SandRat]

In answer to your question, I don’t know.

[therut]

John Holcomb, M.D. was in my Medical School Class in Arkansas. I am very proud of him.

[SandRat]

Now you know what he’s been up to lately.

[yefragetuwrabrumuy]

One tantalizing possible treatment in the future is a combination metabolism depressant and oxygen therapeutic blood substitute.

That is an IV that would radically slow down the bodies metabolism, given at the same time as a blood replacement that carries much more oxygen than hemoglobin. Maybe two or three breaths a minute, but carrying much more oxygen to the vital organs.

If they are bleeding, their induced low blood pressure both keeps them from bleeding to death and encourages clotting.

The idea is to buy them some precious minutes en route to and through emergency surgical care. Once they were no longer critical, then a gradual process could be used to bring them up to a normal metabolic rate.

[therut]

He has done more than I have. I salute the man.

[bpjam]

In all seriousness, these guys are doing better medical research than half the rest of the medical industry combined. This outfit has already radically changed the way wound treatment, rehabilitation and triage will occur from here on out.

They have already revolutionized head trauma treatment. They’ve invented ways to regrow tissue and are working on ways to use powedered growth factors along with adult stem cells to regrow muscle, nerves and skin on burn wounds.

The speed at which they are advancing trauma treatment is mindboggling. Typically, wartime creates the opportunity for this kind of thing but the DOD has really taken advantage of this war to advance battlefield care by a generation at least and we’ll be seeing these techniques in ERs around the country already.

[bpjam]

Save a soldiers’ life and you do at least three things:

- You save our nation a valuable resource which we trained, equipped and transported into the field of conflict

- You save the life of someone who has earned the right to be saved.

- You defeat our enemies by depriving them of success.

- And you never feel better about saving the life of a patient who risks his life to protect yours.

[neverdem]

Thanks for the ping & post, respectively.

In the United States, fatalities have increased slightly from 40,716 in 1994 to 42,884 in 2003. motor vehicle accidents

[SandRat]

Not to mention prosthetic advancements that are quantum leaps from what was.

[ClayinVA]

Why is it that the simplest thing we always miss in EMS. We have been pushing 3 liters of NS for 30 to 40 years for Trauma patients. Soon, that will rank up there with Sodium Bi-carb, pre-cordial thumps and MAST pants. One day someone might really do some research instead of flying by the seat of their pants.

[Marie]

Don’t forget, these guys are young. Many of them with young families. So:

- You give a woman back her husband and provider
- You save many children who would’ve grown up without a father

(Hubby left for Iraq on Tuesday. I’m very proud of him and *very* grateful for the DOD for going above and beyond to do everything possible to bring him home safely to us! I’d also like to thank the FReepers and US citizens who fought so hard to make sure these guys had the right equipment and training from the very beginning of this war. This continued support makes it possible for me to sleep at night! Now I just miss him, but we aren’t sick with worry.)

Can anyone give me a list of the advances which have been made in this area over the last few years? I think it would be a comfort to the other wives and I’d like to share some of this with them at the next FRG meeting.