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 26 | Combat & Casualty Care | Summer 2016 Injury Management Trauma Reduction are now being used in military and civilian trauma patients (i.e. they are saving lives today). It's important to point out that without the expertise – scientific, engineering, business and commercialization – of industry partners, these and other materiel solutions like them would not be possible. It is the aim of the CCCRP to leverage this type of private industry expertise to ensure that the DoD's dollars go far and that the program is delivering effective products in the shortest time period. C&CC: How has military medical technology improved since 2002 (or, rather, from the time of the first U.S. interaction in the Middle East) and where do you see major areas of improvement over the next decade? Col. Rasmussen: The examples provided earlier relating to optimizing blood and blood product resuscitation, decision support technologies, hemorrhage control devices (exo- and endovascular), extra-corporeal organ support and burn and burn wound care all represent areas of significant advance since the beginning of the wars in Afghanistan and Iraq. I believe that one or two of these as well as improvement in the understanding of the diagnosis and management of traumatic brain injury (TBI) will be the areas of major improvement over the next decade. Specifically, as vascular access (i.e. introduction of small catheters and wires into the arteries and veins of the body) becomes easier and quicker our ability to stop bleeding with new and creative endovascular tools closer to the point of injury will . Additionally, easier, more rapid and more useful vascular access will allow for more assured and effective replacement of lost blood volume with new blood and blood-like products. Finally, speedy vascular access will facilitate plugging in new and smaller extra- corporeal organ support technologies that will allow for "full patient support" closer to the point of injury and throughout the continuum of combat casualty care Finally, as arguably the most challenging injury pattern to tackle over the past decade, moderate and severe TBI stands to be transformed over the next decade. With improved understanding of the diagnosis of this condition C&CC: Please feel free to add anything else of importance regarding the mission, the efforts, or upcoming challenges of/for the CCCRP. Col. Rasmussen: This volume and severity of injury from the wars laid bare the known, but overlooked fact that no other federal entity, such as the National Institutes of Health (NIH), funds combat-relevant trauma research and development. Unlike research in the areas of cancer, cardiovascular and infectious disease, and brain and mental health, the nation has no federal institutes or private foundations dedicated to spurring innovation in trauma care. As such, there's no "safety net" for the Soldier in this effort and if the DoD doesn't commit to sustained, and sizable efforts in trauma and injury research, it won't get done and CCC capabilities will stall or backslide. With this in mind, the challenge of the CCCRP is to build on the lessons from the past wars and push new innovation in the form of knowledge and materiel products to optimize military trauma care in support of "Force 2025 and Beyond". In this effort, the program recognizes that current and future care scenarios are likely to be more complex than Afghanistan and Iraq and we must build new capabilities to address the following scenarios: 1) Limited number of isolated troops executing counter insurgency operations in remote locations and encountering situations of prolonged field care; 2) Large, conventional troop formations conducting combat operations in a Pacific theater exposing the CCC system to circumstances of land to sea-based and not-yet-experienced extraordinarily long critical care air transport; and 3) Conventional troop formations deployed and conducting combat in large urban areas (i.e. mega-cities) which do not allow deployment of traditional fixed CCC facilities such as forward surgical teams or combat support hospitals. Central to the program's preparation is a reappraisal of the time between combat injury and the time of life-sustaining medical treatment (i.e. the Golden Hour standard). Specifically, the program now assumes that the "Golden Hour" is not simply framed by the time of casualty arrival and treatment at a fixed or traditional echelon of care; but instead by the time of delivery of an advanced resuscitative capability to the combat injured - regardless of his or her setting or location. Optimizing future capabilities for these types of prolonged field care and uber-long en-route critical care scenarios needs to occur in order to maintain the sub-10% case fatality rate achieved by military medicine in past conf licts. A fight medic tends to wounded personnel during a Rapid Response Evacuation effort. (U.S. Army)

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