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Military Researchers Working to Lower Rate of Combat Deaths

By Sgt. 1st Class Kathleen T. Rhem, USA
American Forces Press Service

WASHINGTON, Feb. 21, 2001 – Ninety percent of people who die in war die before they reach a medical facility, and military researchers are working to lower that number.

"We have to look at where people die - they don't die in hospitals, with rare exceptions for very serious injuries. The major cause of death from combat injury is bleeding to death," said Dr. Howard Champion. "You've got a limited window of opportunity to treat people who bleed to death, and that tends to be on the battlefield."

Champion is a professor of military and emergency medicine and the senior advisor in trauma to the Uniformed Services University of Health Sciences in Bethesda, Md.

"We're looking for something to use on the battlefield that will make a difference," Dr. Jeannine Majde-Cottrell said. Majde-Cottrell is the program officer for casualty care and management with the Office of Naval Research in Arlington, Va.

She said nearly 50 percent of combat casualties die from bleeding, and most of them die between five and 30 minutes after injury. Both experts were speaking to a group of military healthcare professionals attending the 2001 TRICARE Conference here Jan 21-25.

If researchers can develop products to treat these patients, they can cut down these numbers. But combat imposes practical limitations on what medics can use, Majde-Cottrell said.

"They have to be stable. They have to be small and very lightweight so they can be transported by an individual. They have to be useable by a minimally trained individual in extremely difficult conditions," she said. "Also, we're often trying to deliver a treatment to a heavily clothed individual in the dark."

In December, the Food and Drug Administration approved a new hemostatic dressing that works to reduce blood loss. Navy and civilian researchers developed a bandage impregnated with algal polysaccharide, which constricts blood vessels in the wound and traps red blood cells. "It promotes clot formation," Majde-Cottrell said.

Navy researchers are also working on a hand-held ultrasound cautery device. "This will allow us to deal with some internal injuries," she said. "We hope to be able to use ultrasound first to detect a bleed by a Doppler imaging system and then focus ultrasound in such a way that we can cauterize that bleed without having to (surgically) open the patient."

Champion said limitations of the modern battlefield make the situation even more complicated. Troops in Vietnam had an advanced system of field hospitals and great evacuation capabilities. The U.S. military wouldn't necessarily have that infrastructure today. He noted one of the American service members killed in Mogadishu, Somalia, in 1993 bled to death over 2 1/2 hours from a groin wound.

"He would not have died if he had received the same injury in Washington, D.C.," Champion said. "We can not get people out of these settings as fast as we could in Vietnam, so we've got to rely more and more on point-of-wounding care. There are things we should arm our combat medical teams with to stop people from bleeding to death."

Lack of experience in dealing with major traumas will also limit military doctors' effectiveness in future conflicts. Champion explained that in previous conflicts medical professionals had a steep learning curve in effectively treating combat casualties.

During World War II, for instance, the 2nd Auxiliary Surgical Group serving in Italy was able to reduce their mortality rate for chest and abdominal surgeries 33 percent over the two years they operated there.

When they set up shop in 1943, 36.7 percent of patients undergoing this type of surgery died. By 1945, that number had dropped to 24 percent.

"They operated on 22,000 combat injuries over a period of 2 1/2 years," Champion said "There is no way we're going to find anybody on this planet with that type of experience now. We need to really do something about institutionalizing the legacy of things learned."

He told the group the United States wouldn't tolerate such a learning curve today. "They've got to do it right the first time, because CNN is over there -- and they are going to get increasingly critical," Champion said.

And this isn't just a military problem. "Injury is the most significant public health challenge in the 21st century," Champion said. Motor vehicle injuries cause 1.5 million deaths a year, so civilian researchers are working on these issues for their emergency medical technicians as well.

"We have to use some advances in civilian care to care for military casualties," Champion said.

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