Attrition: Going Deep With Tiny Sponges

Archives

June 7, 2016: As much as combat deaths have been reduced (by more than half) since 2003, there were still some types of wounds for which there was no battlefield treatment, meaning the victim would die before more extensive treatment can be applied. Chief among these are deep (abdominal or thigh) wounds where large arteries (like the abdominal aorta) are opened. When that happens the victim bleeds to death in minutes. There have been some new battlefield treatments for catastrophic injuries like this. In 2013 there appeared a mechanical solution in the form of a belt that is placed on the abdomen and activated. A bladder inflates which puts sufficient pressure on the abdominal aorta to stop the bleeding or reduce it enough to make it possible to get the casualty to a surgeon. The belt does not always work. This led, in 2014 to the introduction of another more thorough solution. This was XStat, a syringe like device that injected nearly a hundred small cellulose sponges into deep wounds. The tiny sponges were infused with anti-bacterial and clotting chemicals that will stop the most severe bleeding in 20 seconds or less. The latest version of Xstat sponges also contain a material that can be detected by X-rays and makes it possible for a surgeon to be sure all the tiny sponges are later removed.

While tourniquets have been around for thousands of years, these devices only work on limbs and not well enough when extensive damage is done to major arteries. Preventing death from most other rapid blood loss situations was achieved in the last decade with the development and widespread use of powders and granules that could quickly stop the bleeding. First (in 2004) came special bandages like the Chitosan Hemostatic Dressing (more commonly called HemCon). This was basically a freeze dried substance that caused rapid clotting of blood and was incorporated into what otherwise looked like a typical battlefield bandage. But this bandage greatly reduced bleeding, which had become the most common cause of death among wounded American troops. This device was a major breakthrough in bandage technology. Over 95 percent of the time, the HemCon bandages stopped bleeding, especially in areas where a tourniquet could not be applied. This did not work for extreme cases, especially if the abdominal aorta was involved. HemCon was followed by WoundStat powder to deal with some of the bleeding that HemCon could not handle. While medics, and troops, prefer the bandage type device, there are situations where WoundStat (a fine granular substance) is a better solution (especially in the hands of a medic). Only the medics got packets (usually two) of Woundstat powder. That's because this is only needed for deep wounds and has a theoretical risk of causing fatal clots if it gets into the bloodstream.

WoundStat was but one of many new medical tools for battlefield medicine that greatly increased the effectiveness of the immediate (within minutes or seconds after getting hit) medical care for troops. This effort consisted of three programs. First, there was the development of new medical tools and treatments that troops could be quickly and safely be taught to use. This included stuff like HemCon. Then came the equipping of medics (about one for every 30 or so combat troops) with more powerful tools, so that troops were less likely to bleed to death or suffocate from certain types of wounds that are not fatal if treated quickly enough. Finally, there was the Combat Lifesaver program, which more than tripled the number of "medics" by putting selected soldiers through a 40 hour CLS (Combat Lifesaver) course in the most common medical procedures soldiers can perform to deal with the most dangerous types of wounds usually encountered. These CLS trained soldiers are not medics, of course, but they do make available in combat crucial medical treatments. Thus they are sort of "medics lite," which is close enough if you are badly wounded and in need of some prompt medical treatment.

During the last two centuries major wars have tended to produce significant improvements in medical care. This is what has happened since 2001 but in a much accelerated fashion. For example, since September 11, 2001, over two million American troops went off to war and about two percent of them were killed or wounded. Only 12 percent of the 57,000 combat zone injuries were fatal, the lowest percentage in military history. This was largely due to major improvements in dealing with rapid blood loss (as when a major artery is severed) and the increased speed with which complex medical care could be delivered to wounded troops. New medical technologies also made it possible to detect injuries (like brain trauma) that, in the past, was very difficult to detect and treat.

The Combat Lifesaver course teaches the troops how to do things like insert breathing tubes and other emergency surgical procedures to restore breathing. The CLS troops have skills most likely to be needed in lifesaving situations when a medic is not available. The additional emergency medical training, and new emergency first aid gear (the "CLS bag"), has saved hundreds of lives and reduced the severity of even more wounds. Enough troops have taken CLS training so that there is one for every 10-15 combat troops and one for every 20 or so support troops on convoy or security duty.

These new developments were also popular with civilian emergency medical services, and many of the experienced combat medics coming out of the military went to work as EMTs (Emergency Medical Technicians), thus increasing the quality of care for civilian accident victims. This was similar to what happened to the EMT field after the Vietnam War, when ambulance crews rapidly evolved from simply transporting accident victims, after a little first aid, to EMTs who could administer procedures that previously only doctors could handle. This followed the experience in World War II, where war demands led to development of mass production of the newly created antibiotics and that led to a revolution in surgery techniques.

 


Article Archive

Attrition: Current 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 


X

ad
0
20

Help Keep Us Soaring

We need your help! Our subscription base has slowly been dwindling. We need your help in reversing that trend. We would like to add 20 new subscribers this month.

Each month we count on your subscriptions or contributions. You can support us in the following ways:

  1. Make sure you spread the word about us. Two ways to do that are to like us on Facebook and follow us on Twitter.
  2. Subscribe to our daily newsletter. We’ll send the news to your email box, and you don’t have to come to the site unless you want to read columns or see photos.
  3. You can contribute to the health of StrategyPage. A contribution is not a donation that you can deduct at tax time, but a form of crowdfunding. We store none of your information when you contribute..
Subscribe   Contribute   Close