Com­bat in­juries lead to rapid med­i­cal ad­vances, in­no­va­tions for so­ci­ety

The Washington Times Weekly - - National - By Chris­tian Toto

Sol­diers fight­ing in Iraq and Afghanistan have the high­est ca­su­alty sur­viv­abil­ity rate in mod­ern his­tory, ac­cord­ing to the U.S. mil­i­tary. Of those in­jured, more than 91 per­cent will re­turn to duty.

Those re­sults re­veal not just the tenac­ity of the mod­ern sol­dier, but also the work done by the roughly 11,000 med­i­cal pro­fes­sion­als work­ing to save their lives and re­turn them to peak health.

Doc­tors to­day have more tools than ever be­fore to save a sol­dier’s life.

It’s an un­in­tended con­se­quence of war.

Any time the coun­try sends its men and women off to com­bat, the med­i­cal com­mu­nity learns some­thing new about the heal­ing arts. Even­tu­ally, that in­for­ma­tion reaches the civil­ian pop­u­la­tion.

Among the many in­no­va­tions help­ing to­day’s sol­diers, and there­fore avail­able to in­jured peo­ple across the coun­try, in­clude a variety of blood clot­ting ban­dages. Un­con­trolled bleed­ing is a key cause of death dur­ing com­bat op­er­a­tions, forc­ing physi­cians to come up with im­proved treat­ment meth­ods.

The latest ban­dages are made from a variety of ma­te­ri­als, from a biodegrad­able car­bo­hy­drate typ­i­cally found in lob­sters and shrimp to wrap­pings that ab­sorb the liq­uid out of the blood to in­crease clot­ting.

Dr. David Ciesla, Wash­ing­ton Hospi­tal Cen­ter’s di­rec­tor of trauma ser­vices, says trauma care ad­vances “can hap­pen very rapidly” dur­ing com­bat years.

“It’s a for­tu­nate side ef­fect of an un­for­tu­nate is­sue. Peo­ple get a lot of ex­pe­ri­ence very quickly,” Dr. Ciesla says.

In Iraq to­day, the most com­mon in­juries in­volve blast wounds, pri­mar­ily caused by im­pro­vised ex­plo­sive de­vices (IEDs). Ad­vanced body ar­mor pro­tects the sol­dier’s trunk, but other parts of the body such as pelvis, neck and face are more vul­ner­a­ble, Dr. Ciesla says.

One of the ma­jor dif­fer­ences be­tween to­day’s med­i­cal treat­ment and what hap­pened in the past in­volves the evac­u­a­tion of se­ri­ously in­jured sol­diers.

Rapid evac­u­a­tion means sol­diers are given just enough treat­ment at the first stag­ing area to keep them alive and stable, then they are trans­ferred to a bet­ter-equipped sta­tion.

An­other re­cent change to sol­diers’ care in­volves what he calls “dam­age con­trol surgery.”

“You pro­vide only enough sur­gi­cal care to pre­serve meta­bolic func­tion and stop bleed­ing,” he says. “Then, you evac­u­ate them to a more ap­pro­pri­ate fa­cil­ity.”

“All this,” he says, “evolved in the most re­cent [Op­er­a­tion] Iraqi Free­dom.”

Col. John B. Hol­comb, an Army sur­geon gen­eral trauma con­sul­tant and com­man­der of the U.S. Army In­sti­tute of Sur­gi­cal Re­search, says his­tory has shown war al­ways ad­vances trauma care.

“This war is go­ing to be no dif­fer­ent,” Col. Hol­comb says.

War pro­vides doc­tors with a con­cen­trated ex­po­sure to a large num­ber of sig­nif­i­cantly in­jured, but pre­vi­ously healthy, peo­ple, Col. Hol­comb says.

In World War I, doc­tors in­tro­duced ad­vances in blood trans­fu­sions and en­gi­neered the “Thomas splint” for frac­tured legs. Blood trans­fu­sions ad­vanced fur­ther dur­ing World War II, Col. Hol­comb says.

Dur­ing the Viet­nam War, com­bat medics be­gan pool­ing data on the var­i­ous in­juries suf­fered on the bat­tle­field, “a reg­istry of what hap­pened,” Col. Hol­comb says.

Back then, about 4 per­cent of the to­tal in­juries were ex­plic­itly cap­tured in what was termed the Joint Theater Trauma Reg­istry, he says.

To­day, about half of wounds are in­cluded in this reg­istry.

“It’s an amaz­ing ef­fort in the mid­dle of a war,” he says, adding it helps the Army know the sta­tus of pa­tients and how to best take care of them.

“The lessons learned aren’t lost,” he says.

Dr. Christo­pher At­tinger, di­rec­tor of the wound heal­ing cen­ter at Ge­orge Wash­ing­ton Hospi­tal, says the ca­su­al­ties caused by IEDs have led to “a qual­i­ta­tive leap in our un­der­stand­ing of head trauma.”

When sol­diers ar­rive with mas­sive brain swelling, com­bat doc­tors can re­move part of the skull and bury it in the ab­domen so the or­ganic mat­ter stays alive. The brain is al­lowed to ex­pand and settle back to its orig­i­nal size. Doc­tors then re­turn the skull tis­sue.

He adds that ABC news re­porter Bob Woodruff, who suf­fered a se­ri­ous head in­jury last year while cov­er­ing the Iraq war, “should have been dead” if not for mod­ern med­i­cal tech­niques.

Television view­ers got an un­ex­pur­gated look at doc­tors treat­ing sol­diers last May in the HBO doc­u­men­tary “Bagh­dad ER,” which won a Pe­abody Award and is now avail­able on DVD. The film doc­u­ments a two-month pe­riod at the 86th Com­bat Sup­port Hospi­tal, where physi­cians deal with all man­ner of in- ju­ries, in­clud­ing the dev­as­tat­ing ef­fects of IEDs.

“Bagh­dad ER” co-di­rec­tor Matthew O’Neill says de­spite the chaos swirling around wartime hos­pi­tals, the as­sem­bled medics rou­tinely doc­u­ment pa­tient care.

“They keep such a de­tailed list of ab­so­lutely ev­ery tiny part of the in­juries as they come in,” Mr. O’Neill says. “In a triage, there is a medic who is tak­ing notes on the shape of the in­jury, the size of the in­jury.”

That in­for­ma­tion could lead to a change in how doc­tors treat wounded sol­diers, or even how body ar­mor can be ad­justed to bet­ter pro­tect them.

“At the same time, as the U.S. Army fig­ures out new ways to save lives, the in­sur­gents are find­ing new ways to end them,” he says.

“Bagh­dad ER” co-di­rec­tor Jon Alpert says he watched a num­ber of doc­tors pho­to­graph the sol­diers’ in­juries for later con­sid­er­a­tion.

“It was a learn­ing op­por­tu­nity [for them]. It’s things they never saw in the class­room,” Mr. Alpert says.

He also re­calls a meet­ing with a hospi­tal’s chief of staff in which he urged the as­sem­bled doc­tors to take notes when­ever pos­si­ble “and to think about ways in which they could memo­ri­al­ize their ex­pe­ri­ences for the ben­e­fit of other doc­tors.”

Mr. Alpert was amazed at how com­bat doc­tors kept their com­po­sure de­spite the hor­rors of war.

“They were just fo­cused on what they had to do,” Mr. Alpert says. “If any­body takes a step back and looks at the hor­ror of what’s com­ing in the doors of th­ese hos­pi­tals, you can get par­a­lyzed.”

Any­one who ever needs to visit the lo­cal emer­gency room may one day ben­e­fit from their sin­gu­lar fo­cus.

Dr. Ciesla says civil­ians ben­e­fit from trauma care ad­vances even though their lives are not nearly as haz­ardous as those of the sol­diers in harm’s way.

The physi­cians com­ing back from Iraq go to the same in­for­ma­tional meet­ings as doc­tors who never see the front lines, Dr. Ciesla says.

“We share in­for­ma­tion. A lot of their ex­pe­ri­ences can be trans­lated to what we treat here,” he says. “We see com­plex car crashes, which look like blast in­juries.”


Medics of the 86th sup­port group un­load an in­jured Iraqi Na­tional Guard sol­dier. Sol­diers’ med­i­cal con­di­tions are sta­bi­lized on the bat­tle­field be­fore they are trans­ferred to a fully equipped hospi­tal.

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