Combat & Casualty Care

Q2 2016

Military Magazines in the United States and Canada, Covering Combat and Casualty Care, first responders, rescue and medical products programs and news\Tactical Defense Media

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tacticaldefensemedia.com 24 | Combat & Casualty Care | Summer 2016 Injury Management Trauma Reduction are looking at ways to make these machines smaller and more integrated so that they can be used in more forward locations. Extra-corporeal technologies are also being developed which may allow military providers to temporarily replace liver and heart function as well. C&CC: How have injured personnel returning from combat zones informed the CCCRP's (and, to a larger extent, the MRMC's) decision-making in the area of burn trauma? Col. Rasmussen: As with all areas of medical research, interfacing with patients and their clinical outcomes is very important in making sure the research is relevant and most translatable. Learning from injured Soldiers returning from combat zones begins with systematically collecting injury and injury management data into the DoD Trauma Registry for review and analysis. The DoD Trauma Registry started as the Joint Theater Trauma Registry (JTTR), and it now represents the largest repository of wartime injury and injury management the country has ever had. From this large registry, military providers and researchers have learned that major burn or thermal injury occurs in roughly 5 out of 100 Soldiers injured in combat. Approximately 4 out of those 5 Soldiers have severe enough burns to risk losing significant organ dysfunction and even death. So by analyzing data from the DoD Trauma Registry, the CCCRP can understand the size of the problem and specific aspect of the problem that need to be addressed. As mentioned earlier, data from injured or deceased Soldiers from the recent long wars has informed the CCCRP that the top priorities in burn research are replacing lost blood volume, reducing pain, replacing lost skin, preserving and replacing organ function and reducing the impact of burn scare formation on a patient's long term functionality. Finally, and as is the case with all significant combat-related injuries, military researchers recognize that not all wounds are physical, and that many Soldiers who return with burn injuries harbor signs and symptoms of post-traumatic stress syndrome (PTSS). It is a specific aim of the CCCRP to reduce the physiologic toll of burn injury – pain, resuscitation, number of operations, organ dysfunction and failure, etc. – and thereby reduce the incidence and severity of PTSS in Soldier (i.e., we want to make them whole again). C&CC: Can you speak to any examples of cooperation between CCCRP and industry –or CCCRP and other military/medical agencies– that has produced a standout military medical device or knowledge product? Col. Rasmussen: Recognizing the significance of non- compressible torso hemorrhage, or bleeding from sites in the body that cannot be compressed or to which one cannot apply a tourniquet, the CCCRP has worked diligently with several industry partners to leverage their innovation and commercialization expertise to solve mitigate this problem. As with the example provided in relation to burn injury, using the DoD Trauma Registry, the CCCRP knows that of the roughly 25% of deaths on the battlefield that are potentially survivable, that the majority are from bleeding within the torso (i.e. chest, abdomen or pelvis). As such, innovative solutions to slow or stop non- compressible torso hemorrhage are a top priority. Although a complete listing of the number of industry partnerships is beyond the scope of this interview, the following are a few standout examples: - Collaborations with Arsenal Medical to develop what is referred to as the Wound Stasis System - Collaboration with PryTime Medical to develop what is referred to as a resuscitative endovascular balloon occlusion of the aorta or REBOA catheter - Collaboration with REVMEDX to develop a topical hemostatic product call XSTAT - Collaboration with North American Rescue to develop the Junctional Emergency Treatment Tool or JETT device - Collaboration with Chinook Medical to develop the Abdominal Aortic & Junctional Tourniquet or AAJT device All of the above devices and a select number of others have been research in representative animal, human cadaver or other simulation type models to show early effectiveness in controlling bleeding from the torso. Several of these devices have gone on to human study and a few have received FDA clearance and

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