View Full Version : Newsweek Article on Med Advances from War Zones

02-06-2007, 20:57
Nothing really earth shattering, but interesting. I was especially intrigued by the vacuuming out wounds.

The military has rewritten the book on wartime surgery to combat the wave of injuries in Iraq and Afghanistan. The latest strategies for helping fallen warriors.

By Sarah Childress

Updated: 11:38 a.m. MT Jan 26, 2007

Jan. 26, 2007 - Medicine has always advanced on the battlefield; it was Hippocrates who said that “war is the only proper school for surgeons." But the unprecedented scope of injuries in Iraq and Afghanistan has led the military's medical corps literally to rewrite the book on war surgery. At least 24,000 U.S. soldiers have been wounded since the Iraq war began, and another thousand in Afghanistan. With 20,000 more soldiers en route to the battlefield in Iraq, top military surgeons gathered this week in D.C. to discuss new strategies and technologies to help wounded warriors.

The biggest cause of death for the injured is hemorrhaging—uncontrolled bleeding. According to the military, 20 percent of the 3,416 soldiers killed in Iraq and Afghanistan to date might have survived had they not been lost in the fog of war, unable to receive the right treatment in time. (For the other 80 percent, most of whom were hit by IED blasts, there was no chance for survival.) Since 2001, doctors have been looking for better ways to staunch the bleeding. The military has improved and reissued its tourniquet—a simple strap tied around a wounded limb to slow bleeding—with instructions based on new data. But there are also chemical powders, recently approved by the Food and Drug Administration, such as HemCon and QuikClot, which, when poured into a wound and accompanied by direct pressure, can stop bleeding within seconds. (The sterile clot can be rinsed out once the soldier arrives at a combat hospital.) The powders are so effective and easy to use that four months ago, a military advisory committee recommended that all soldiers carry one of each packet in their first-aid kits.

Many of the major breakthroughs come from doctors improvising in the field—even when their methods challenge convention. In 2004 at Balad Air Force Base, the major medical evacuation hub in Iraq, a surgeon started using a new type of vacuum to suck dead tissue and debris from a leg wound. The vacuum worked so well that the surgeon, Col. Mark Richardson, told his partner the wound seemed clean enough to sew up much earlier than standard protocol dictated. "I said, 'Dude, you're an idiot,'" recalls Col. Donald Jenkins. "'Look in the book.'" War Surgery, the field surgeon’s Bible, recommended leaving the wound open for cleaning and observation. But the wound did look clean, so Jenkins relented, just this once. The worst that would happen: they'd have to reopen the patient's wound and clean it again. But it stayed closed—and healthy. They started using the vacuum to clean and close up other wounds sooner, too. The rate of infections dropped 90 percent. "We ended up rewriting the book on war surgeries for soft-tissue wounds," Jenkins says. The vacuum pump is now being used more extensively in theater, pending additional FDA approval. At other trauma centers, when doctors discovered that a resistant strain of Iraqi bacteria was attacking wounds, they dreamed up a string of dissolvable, timed-release capsules full of antibiotics that can be tucked deep into open cavities to disinfect wounds for 72 hours at a time. Designed to work in the desert, the little beads won't even melt in the 150-degree heat. They're hoping for FDA approval in the next eight or nine months.

Military surgeons have had to take on challenges unique to this theater. During the gulf war, they often performed major operations on-site because it could take weeks for a patient to be evacuated. Now, patients can be flown out of the country much more quickly. Surgeons in the field still do triage, such as amputations, but their main mission is prepping patients for evacuation. That carries its own challenges. The eight-hour flight to the closest treatment facility outside of Iraq—a military base in Landstuhl, Germany—is a bumpy, deafening ride on a narrow, padded stretcher. Base trauma centers in theater also often care for Iraqis injured in American and insurgent attacks. Sometimes, they even treat suspected insurgents themselves. The doctors provide local nationals with the same care as they would to a fallen soldier, but must also consider cultural and pragmatic factors, such as the reality that most Iraqis will not have good long-term health care to support extensive procedures.

The war surgeons plan to rewrite the field manual this year to include their new strategies. The revised manual will be accessible to doctors online, a big advance from the previous version, which was available in paperback and as a CD-ROM. Further improvements are anticipated. At last year's meeting of top war surgeons—their first—they established the Orthopaedic Trauma Research Program to study battlefield injuries, receiving $6.8 million from Congress to fund competitive grants. They had actually asked for $25 million. This year they plan to double the request to $50 million, citing this year's progress and the potential for this research to benefit civilians as well as soldiers.

Medical advances have helped save thousands of soldiers who would have been lost in previous conflicts. The survival rate, with quick medical attention, is an extraordinary 90 percent. The question now, especially for so many young vets who aren't even old enough to legally buy a beer, is what kind of life they can lead after they leave the battlefield. On a large conference video screen before a roomful of uniformed surgeons, Marine orthopedic surgeon Michael Mazurek flashed a gory photograph of a leg that had been ripped open by a blast. "No. 1, our goal is to save his life," he says. "But you have to keep in mind that, 18 months later, he wants to do this." The leg fades, and a video clip shows a young man walking easily back and forth along a stretch of blue carpet—alive, yes, but thanks to his surgeon, also doing well.