Medical advances on the battlefield

gf0012-aust

gf0012-aust

Grumpy Old Man
Staff member
Verified Defense Pro
This is an expanding area and has always picqued my interest ever since I attended a US Army session on advances that they had made in battlefield injury recovery times and the flow on into general trauma management in civilian hopspitals
 
gf0012-aust said:
the implications around this are enormous. interesting to note that its been cofunded by SOCOM - I'm assuming that this was picked up on one of the US visits that are run every year when the USN USAF USMC, US Army,. State Dept, Dept Commerce and NAVSEA visit Australia to look at the top 24 CTD's

'Pharmacological tourniquet' developed by Australian scientists to save soldiers, remote patients - ABC News (Australian Broadcasting Corporation)
Click to expand...

I am not sure if this is the same thing I have heard of but there is a type of medical foam which is administered via injection, which is being trialed to control internal hemorrhaging.

As for some of the other battlefield medical advances, a number of them do or have made their way into civilian emergency medicine in the US, while others, not so much...

Tourniquets, which for a long time had been removed from protocols, have been added back in as a result of military experiences in Iraq and Afghanistan. This turned out to be fortunate IMO because I suspect many of the traumatic amputation victims from the bombing of the Boston Marathon in 2014 would likely have perished had tourniquets, even improvised ones, not been applied.

However some of the clotting agents (Quikclot, Celox, and others) which have entered the marketplace for laypeople to purchase are still not in protocols for use by EMS personnel. So far the various state organizations which control what is required and permitted, as well as the doctors and hospitals providing medical control, have refused to permit the use, even for uncontrollable hemorrhaging. In a way it is kind of funny, since I personally know some of the people cleared by the manufacturers to train combat medics to use the stuff, and one of the companies is located not too far from me. Apparently the manufacturer has offered to provide the clotting agent to local ambulance services for free, but has not even been able to give it away, since currently EMT's are only allowed to use it on themselves.

As for the internal damage and hemorrhaging which occurs as a result of blast damage, there is a term for that which is, "the butterfly of death." The term coming from Israel IIRC and referrs to a pattern which commonly was showing up in bombing victims who had been injured by the pressure wave, but initially felt fine so did not seek immediate treatment. What would typically happen in such instances is that the "uninjured" victims would get released from the scene and go about their business and usually within an hour or two would start to have problems and go/get taken to the hospital. Once there, diagnostic imaging would show blot patterns resembling a butterfly which was the soft tissue damage, ruptured internal organs and blood collecting internally. AFAIK by the time the 'butterfly' pattern would show, it was too late. This occurred enough (during the First Intifada IIRC) that the Israeli response changed, with bombing victims who had been hit by the pressure wave but not showing obvious signs of trauma were being taken to hospitals to be cleared or treated as needed.

Fortunately in the US there has been little need to be concerned with injuries of this type for the most part. So far.
 
No it's different. The article is a bit misleading because it's not really just a pharmacological tourniquet, rather it prevents some of the secondary effects of trauma - probably what is killing the patients with the 'butterfly' effect.

The article doesn't mention it, but all the studies done with it include a 7.5% hypertonic saline solution which restores circulatory volume. The adenosine, lidocaine and magnesium decreases some of the nasty mediators (eg TNF) that severe trauma stimulates. It's also been tried post cardiac arrest and with animals shocked with septicaemia.. The abstract below, from one of Prof. Dunbars articles is a good summary of it's effects, the last line is very important.

Adenosine, lidocaine, and Mg2+ (ALM): From cardiac surgery to combat casualty care--Teaching old drugs new tricks.

New frontline drugs and therapies are urgently required to protect the body from primary and secondary injuries. We review more than 10 years of work on adenosine, lidocaine, and magnesium (ALM) and its possible significance to civilian and military medicine. Adenosine is an endogenous nucleoside involved in nucleotide production, adenosine triphosphate turnover, and restoration of supply and demand imbalances. Lidocaine is a local anaesthetic and Class 1B antiarrhythmic, and magnesium is essential for ionic regulation and cellular bioenergetics. Individually, each plays important roles in metabolism, immunomodulation, inflammation, and coagulation. The original idea to combine all three was as a "polarizing" cardioplegia, an idea borrowed from natural hibernators. Two recent prospective, randomized human trials have demonstrated its safety and superiority in myocardial protection over high-potassium "depolarizing" solutions. The next idea came from witnessing how the human heart spontaneously reanimated after complex operations with little inotropic support. At high doses, ALM arrests the heart, and at lower doses, it resuscitates the heart. In rat and pig models, we have shown that ALM intravenous bolus and infusion "drip" protects against acute regional myocardial ischemia, lethal arrhythmias, cardiac arrest, compressible and noncompressible blood loss and shock, endotoxemia, and sepsis. Individually, adenosine, lidocaine, or magnesium fails to protect. Protection is afforded in part by reducing inflammation, correcting coagulopathy, and lowering energy demand. We propose a unifying hypothesis involving improved central, cardiovascular and endothelium coupling to maintain sufficient tissue oxygenation and reduce primary and secondary "hit" complications. As with any new drug innovation, translation into humans is challenging.

One of the most commonly used battlefield resuscitation fluid is HES, which there are increasing questions about its benefits. 7% saline/ALM may be a big improvement on this but there needs to be human studies.
 
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