Aug. 18--Top scientists gathered this week at an annual conference to discuss therapies for traumatic brain injuries and lifesaving medical tools to deploy to the battlefield.
The annual Advanced Technology Applications for Combat Casualty Care Conference, which is being held this week in St. Pete Beach, Fla., includes presentations on topics ranging from regenerative medicine to pain control to more sensitive vital system monitors. But the two biggest issues talked about were traumatic brain injury and hemorrhage research, said Col. Dallas Hack, director of the Combat Casualty Care Research Program in the U.S. Army Medical and Materiel Command at Fort Detrick.
"We want to save the most lives we can, and that's hemorrhage," Hack said during a phone conference Tuesday morning.
Col. Lorne Blackbourne, commander of the U.S. Army Institute of Surgical Research in San Antonio, Texas, said his command presented a paper on Monday showing that half of the service members who died of injuries suffered "potentially survivable" wounds. Eighty percent of those were hemorrhages, Blackbourne said. Of those hemorrhages, 30 percent were in the legs and arms, where a tourniquet can be used to stop bleeding; 20 percent were in the neck, groin, armpit and areas where a tourniquet cannot be used but pressure can be applied to stop bleeding; and 50 percent were in the chest or abdomen, where pressure cannot stop the bleeding.
Blackbourne said combat medics are better trained than ever before and the tourniquet technique, in use for about 300 years, is "the most valuable piece of equipment" in the battlefield. He said the more certain way of saving lives is to find ways of bringing blood products to the field though.
In the civilian world, bleeding patients may be pumped with salt water or other clear liquids to keep their blood pressure up until they reach the hospital in a matter of minutes. In a combat zone, on the other hand, bad weather or enemy fire may keep a bleeding service member from being airlifted to a hospital for hours. Without plasma to promote clotting, or a blood transfusion, the patient can bleed to death before reaching the hospital.
Hack said two products showcased at the conference, which is sponsored by the Department of Defense, may be approved for use within a few years. Freeze-dried plasma is already in human trials, and spray-dried plasma is about six months behind, he said.
The conference also revealed promising research into traumatic brain injuries, said Patrick Kochanek, a professor and vice chair of Critical Care Medicine and director of the Safar Center for Resuscitation Research, both at the University of Pittsburgh.
Kochanek, who called this moment in traumatic brain injury research unprecedented, said work on the issue has been developing gradually but has "really crystallized" during the conference.
A main theme of the research at the conference is that axons, the long fibers that connect brain cells, appear to be sensitive to blast injury, he said. Blast injuries differ from other brain injuries and need to be researched separately. Reseachers also acknowledged that brain damage from blasts is too complex to try to rate or categorize and instead occupies more of a continuum.
The conference showcased several tools already in use in combat zones, Hack said. One is a compact oxygen generator, which is a great advantage over heavy oxygen tanks with limited oxygen supply.
"You'd think (providing oxygen) would be a simple thing, but it actually turns out to be quite complicated for us," Hack said.
The military also fielded diagnostic monitors that are more sensitive than the ones that read vital signs in a hospital. Because many of the service members are young and fit, they often have good vitals for a while after their injuries but then crash quickly. Monitors need to detect signs of distress better than the average monitor, particularly because the loud sounds and vibrations of a war zone or a transport helicopter may prevent the medic from noticing a problem until it is too late to save the patient.
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