Combat & Casualty Care

Summer 2017

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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banking, trauma-induced coagulopathy, and ischemia-reperfusion injury, all of which leverages our work to improve the research we conduct. NAMRU-SA serves as the Navy Medicine lead for the Joint Operational Evaluation of Field Tourniquets, providing feedback from military users regarding application feasibility and ease of use. These data are used to determine which tourniquets are best suited for field situations. Expeditionary and Trauma Medicine In combat environments, hospital surgery assets are not readily available, so it is critical to be able to preserve life by providing prolonged field care. "NAMRU-SA's Expeditionary and Trauma Medicine Department focuses on the protection, resuscitation, and stabilization of combat casualties at frontline points of care in combat environments," said Mallory. The Trauma Medicine group conducts primary and pre-clinical research for the development and optimization of drug products and advanced therapies for the treatment of hemorrhagic shock. The Expeditionary Medicine Group works to identify and effectively mitigate stressors and improve survivability through the evaluation of products and agents that deliver capabilities to meet rapidly evolving expeditionary warfare requirements. "In the field, time is of the essence and reducing the time it takes to provide definitive care improves survival," said Cmdr. Jacob Glaser, Department Head of the Expeditionary and Trauma Medicine Department. NAMRU-SA researchers are investigating novel, low- volume, permissively hypotensive resuscitation strategies to pharmacologically target aspects of cardiovascular function and metabolic stabilization. "Studies are also under way to explore coagulation and immune system functions to improve casualty stabilization, decrease resuscitation fluid volume requirements, and improve pre-hospital survival and long-term outcomes," said Mallory. NAMRU-SA researchers are at the forefront in testing combinations of FDA-approved therapeutics to stabilize patients, pre-hospital and during transport. Therapeutics that are recognized as having great potential for battlefield use are tested by Glaser and his team in a unique poly-trauma pressure-targeted hemorrhagic shock model system, developed and validated by NAMRU-SA scientists. It is essential new investigational therapies are stringently tested in an appropriate and relevant preclinical model. "The model system simulates multiple injury patterns that include hemorrhagic shock, soft tissue injury, and musculoskeletal injury and that permits acute and long-term assessments of outcomes," said Glaser. It is anticipated that these studies will lead to higher survival rates once implemented into clinical practice guidelines. Cellular and Immune Based Adjuncts for Casualty Care The Cellular and Immune-based Adjuncts for Casualty Care Department investigate stem cell and immune-based therapeutics intended to improve warfighter outcomes and survival. Led by Alexander Burdette, head of the department, the division of stem cell therapeutics studies the comparison and assessment of stem cells from different tissue sources. Investigations include the assessment of protein secretomes or exosomes for preventing and reducing injury from trauma/hemorrhagic shock, and the targeted treatment of severe tissue defects in order to promote tissue repair. "Our current efforts include testing different types of scaffolding that are customized to release therapeutics for the treatment of critical size bone defects as well as long bone defects," said Burdette. The immune system of a warfighter in the combat environment can be severely dysregulated in the event of trauma and hemorrhage. The division of immune based therapeutics focuses on immunomodulation to prevent and reduce tissue and organ damage resulting from trauma and hemorrhagic shock. Burdette's department also houses a unique initiative that is investigating a bacteriophage-based therapy for treatment of snake bites. "This project shows great promise as snake venom is extremely toxic and the current standard of care relies on an antibody based antisera, which is difficult to store in the combat environment," said NEW TOOL FOR AIRWAY MANAGEMENT Dual-Air TM Adjustable Oral Airway | 1-888-812-7474 | Adjustable Oral Airway DA 200 Pediatric : 50 – 70 mm DA 100 Adult : 70 – 100 mm DA 300 XLg Adult: 80 – 120 mm Non-Gagging: Unconscious Semi-conscious Alert Improved: • Ventilation Port • Suctioning access • Adaptability • Comfort • Stays in Place Simplified: • Selection • Storage • Application • Rapid MCI Response Three Sizes: (Cage Code 6JA31) All with 5 mm half-steps Summer 2017 | Combat & Casualty Care | 23 MOBILE FIELD CARE COMBAT & OPERATIONAL MEDICINE

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