Attrition: A Suitcase Full Of Heart


October 27, 2010: A soldier in World War II or Vietnam was three times more likely to get killed in combat than those in the last decade. This is a trend that continues. For example, the United States has been providing its troops and combat medics with a constant flow of new first aid equipment and training. That's because more such stuff has become available, largely for the civilian emergency medicine market. But sometimes this civilian technology results in something that is mainly useful to the military. For example, a suitcase sized heart-lung machine was recently developed. Heart-lung machines were originally invented half a century ago to take over heart and lung functions for patients have heart surgery. Over the decades, the size of the device has gotten smaller and smaller. Now, it can fit into a suitcase. This makes it suitable for medical evacuation flights, that take troops with shot-up lungs back to Germany or the United States for more advanced treatment. The device can also be used in field hospitals, for troops shot through both lungs.

Over the last two decades, medical equipment has gotten cheaper, more compact and easier to use. As a result, combat medics, and troops with 40 hours of additional medical training, can perform lifesaving procedures that, previously, only a doctor could perform. The best example of this new development can be seen in the U.S. Army Combat Lifesaver Program (CLP). This is a constant evolving effort that began in the 1980s. For example, last year, the CLP cut back on training on intravenous (sticking needles in arms to administer lifesaving liquids) techniques (which had taken up 70 percent of the 40 hours of CLP training), and put more emphasis on treatments that can stop heavy bleeding, and how to safely move badly wounded troops. This change in the CLP training was based on a study of how CLP troops have handled different kinds of wounds, and the advice of first-aid experts (who had examined the evidence).

The CLP effort more than tripled the number of "medics", by putting so many soldiers through the 40 hour CLS (Combat Lifesaver) course. There they were taught 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 crucial medical treatments right after a soldier is hit. Thus they are sort of "medics lite," which is close enough if you are badly wounded and in need of some prompt medical treatment. 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.

In the last decade, there have been many new medical tools for battlefield injuries that has 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 taught to use. Then came the equipping of medics (about one for every 30 or so combat troops) and CLP trained soldiers, 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.

One of the most crucial new medical tools has been the clotting bandage, and later clotting powder (like WoundStat), to stop heavy bleeding. This was a major medical advance to come out of the war effort. But, competition being what it is, there are several clotting products available, all operating a little differently. Six years ago, the first of the bandages, the Chitosan Hemostatic Dressing (more commonly called HemCon), showed up. It is basically a freeze dried substance, that causes clotting of blood, and incorporated into what otherwise looks like a typical battlefield bandage. But these dressings greatly reduced bleeding (which is the most common cause of death among wounded American troops.) This device was a major breakthrough in bandage technology.

In the past, troops would often die from loss of blood before a surgeon could get in there to stop the bleeding. In the first two years of use, over 250,000 HemCon bandages were obtained for military needs. This was to make sure everyone in a combat zone had one at all times. While there are not a lot of casualties in base areas, the occasional rocket or mortar shell is likely to cause the kinds of wounds where HemCon can be a lifesaver. So it was a morale boost if everyone could carry a HemCon around (a small first aid kit is a standard part of combat equipment). Each CLS bag now includes three QuickClot bandages. These clotting devices are also popular with civilian emergency medical services.