Second in a series of articles on advances in military health care and technology since the Persian Gulf War, 30 years ago this year.
Read Part 1, here.
Tactical casualty care – an application of the lessons learned based on data collected during the Vietnam War and analyzed with computers in the 1990s – evolved since being initially published in 1996, noted Alan Hawk, manager of historical collections for the Defense Health Agency’s National Museum of Health and Medicine.
Hawk noted that this resulted in the development of improved hemorrhage control techniques and even early versions of telemedicine, allowing for medical consultations by physicians far from the point of care. He also included rapid vaccine development, from a concept developed by the Defense Advanced Research Projects Agency (DARPA), to develop defenses against novel biological warfare agents.
Tourniquets and gauze
But other tools have been less tech-oriented and just as effective in saving lives. Former Army Col. (Dr.) Leopoldo “Lee” Cancio and Dale Smith, a longtime author and a professor of military medicine and history at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, mentioned advanced forms of battlefield gauze, clotting agents, and combat application tourniquets (“CAT,” or “ratchet” tourniquets) as key ingredients in the rucksacks of not just medics, but all ground troops.
"In 2001, we were using a strap-and-buckle tourniquet," Smith said, which were about 80% efficient - meaning that, above the elbow or above the knee, blood vessels are "big enough that 20% leakage is going to kill you. So, in theater, some surgeons and some medics built a ratchet tourniquet." He described it as "a loop - you can put it on over your own arm and tighten it down. They are more than 98% efficient."
Exsanguination (bleeding to death) is the most common cause of potentially survivable death for wounded warfighters, according to the Army. To be blunt about it, Smith added, once you've already lost a limb, it's about saving your life.
"Today, the ratchet tourniquet is in everybody's kit bag, you can put it on yourself, you can put it on your buddy, and you can stop bleeding in less than 10 minutes," he said. "That's what I mean by survivability. You would've died in 2000 with this injury, but now you're alive and we've got a decent prosthetic device. It's not as nice as (the limb) you were born with, and there's a whole lot of psycho-social issues to being an amputee and a whole lot of learning to do."
The newer tourniquet is "a very nice piece of technology," Cancio agreed. "The concept is simple, but you've got to make it user-friendly."
He added that the mindset of the tourniquet as a last resort also had to be changed as it was introduced. With arrival times from point of injury to aid station of perhaps 30 to 60 minutes, he said, "even if you put it on unnecessarily, you're not going to do any permanent damage to that extremity."
The development of topical dressings to replace traditional gauze has been another big development that saves lives, Cancio said. Several iterations of the new dressings since 2003 have resulted in the "combat gauze" used today - so effective at stopping bleeding that it is not just carried in battle but used in the burn center where he works.