Army's casualty treatment innovation saves lives

Combat casualty care is one of the areas where military medical professionals have made tremendous strides with each major conflict, and the current wars in Iraq and Afghanistan are no exception. One such innovation has garnered the Army's award for being one of the top 10 inventions of 2007:

FORT SAM HOUSTON, Texas -- A new lifesaving standard of care has garnered the Institute of Surgical Research here a prestigious Army title - invention of the year.

The innovation, called Damage Control Resuscitation of Severely Injured Soldiers, was named one of the Army's "Top Ten Greatest Inventions of 2007."

"The American Association for Trauma Surgeons calls this one of the biggest improvements to trauma care in the last 10 years," said Dr. Michael Dubick, senior research pharmacologist for the ISR.

The invention is aimed at saving severely injured Soldiers with non-compressible injuries, meaning internal injuries that cannot be compressed using a tourniquet or other device, Dubick said.

The ISR focused its attention on severely injured Soldiers after analyzing data from an autopsy study, which showed that 79 percent of service members killed in combat died of hemorrhage, and 70 percent had an injury that couldn't be compressed.

"We needed to find a better way to stop bleeding," Dubick said. "In theater, there was no solution for people with non-compressible injuries."

The innovation involves the fluid resuscitation process, which is when IV fluids and blood products are used to stabilize a patient's physiology.

The standard method is to administer IV salt solutions in an amount that is three times the patient's blood volume. If the patient is still bleeding, blood transfusions are given to restore lost blood.

In most cases, this method is effective for the wounded, but for some severely injured warriors, the massive volume of fluids and blood can create a negative effect, Dubick said. "The body has only a finite amount of clotting factors, and a large volume of fluids can dilute those clotting factors, which reduces their ability to slow down or stop the bleeding."

Under the new standard of care, fluid resuscitation with salt solutions is limited, which keeps the blood pressure from rising too high and "popping" newly formed blood clots. Additionally, blood volume is restored using plasma as the primary resuscitation fluid, along with packed red blood cells.

But rather than using the standard of four times the amount of red blood cells to plasma, "we use a ratio of 1:1 of plasma to red blood cells," Dubick said.

Dubick said early use of a clotting factor called rFVIIa has also been beneficial. The factor is normally used for hemophiliacs but has proven beneficial for severely injured warriors. Additionally, other blood products, such as platelets and cryoprecipitate, are used as needed.

The reduction in fluids not only increases the patient's short-term chances of survival, but also the long-term treatment since "there is less fluid built up in organs and surgeons have a better field of operation," Dubick said.

While the innovation is gaining recognition stateside, the invention has already had a striking impact downrange on the survivability of severely injured Soldiers in the field, decreasing the mortality rate from 65 to 17 percent.

The impact of this change in the standard of care is so striking, Dubick said, that "some liken this standard of care to the first time someone applied antibiotics."

The military innovation is also gaining civilian attention.
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Read the rest here. As the article notes, these life-saving innovations will spread to the civilian arena, helping to save lives there as well.