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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ultimately going to improve servicemembers' lives or through direct patient care– it's just contagious. I find that those we work closely with in collaboration really start to feel that passion when they see it in action. Broad Spectrum of Care The Combat Casualty Care Research Program spreads its interests across four distinct portfolios: Neurotrauma and Traumatic Brain Injury, Hemorrhage Control and Resuscitation, Forward Surgical-En Route Care, and Photonics and Light-Based Innovation for Severe Injury. As program director, my prime responsibility will be to create both the mid-term and the long-term plan for developing materiel and knowledge products designed to close capability caps in military trauma care. Indeed, while trauma is the leading cause of death for U.S. civilians under the age of 46 years old, there is very little federal investment in trauma research outside the DoD; so I will also serve, in essence, as the de-facto director of the overall U.S. investment in trauma research. On the military side, the primary focus of the CCCRP is the care delivered to warfighters on the battlefield; from the point- of-injury to the use of field hospitals and combat support hospitals. From a research and development standpoint, the CCCRP is currently focused on improving care on future battlefields, including a specific focus on the "Multi-Domain Battle," a concept which encompasses early-entry operations, near-peer battle situations, and operations which are not dependent on large logistic bases and air superiority. Current Key Efforts at the CCCRP Naturally, the CCCRP lends a substantial amount of its overall effort towards the early detection and combatting of traumatic brain injuries; with a specific goal of finding a solution for increased morbidity and mortality from TBI. Since 2000, more than 360,000 servicemembers have been diagnosed with a TBI according to federal data. These numbers, coupled with the rising cultural visibility of head injuries, means a tightly-focused, continuous effort from CCCRP officials. "One of the things we have to balance is walking the line between moving the program forward and also letting our senior leaders and the public know what we're doing with the money they've entrusted us," says Dr. Tammy Crowder, manager of the CCCRP's Neurotrauma and Traumatic Brain Injury Portfolio. "Regardless, the end result is always the same – to do what we can to make sure that potentially survivable injuries are not limited by lack of knowledge, capabilities, or technology." According to Crowder, one of the leading technologies in the portfolio is the I-Portal PAS tool developed by Pennsylvania-based Neuro-Kinetics, Inc. The device, which is designed to diagnose concussions both early and accurately, uses a virtual-reality headset to assess possible brain injury by measuring a specific series of oculo-motor pathways. The I-Portal PAS has received financial support from both the DoD and the National Football League, and is currently being tested at a number of military medical facilities. "We're excited about it," says Crowder, "but in many ways it's just one part of the whole." To that end, Crowder says the CCCRP will look to a more of "Frankenstein's monster" approach to early detection of possible brain injury; meaning that while she's confident an oculo-motor assessment device may be able to diagnose a concussion in a large majority of people, the possibility exists that similar injuries to the brain may manifest themselves in different people in different ways. As such, the program is currently in the midst of launching a search for a technologically-mature device that will allow first responders to measure brain function that's associated with morbidity and mortality at the point-of-injury. "We're hoping that one of these devices will enable first responders to better adhere to the clinical practice guidelines, which we know are better associated with reduced morbidity and mortality, " Crowder noted. As severe bleeding remains the number one cause of death on the battlefield, the topic of hemorrhage continues to play a key role in the CCCRP's investment efforts as well. While the main thrust of the program's Hemorrhage and Resuscitation Portfolio is to provide improved methods and technologies to control bleeding, more specific and long-term goals are baked into the portfolio's day-to-day efforts. "We're looking for ways to reduce mortality by at least 25 percent," says Hemorrhage and Resuscitation Portfolio Manager Crystal Hill- Pryor. "At the same time we're also trying to develop blood products that can be used wherever needed on the battlefield, instead of only where freezers and specialized laboratories are available – all of which will make the earlier use of blood products possible." Here too we see the incremental shift towards the battlefield of the future –as envisioned in the "Multi-Domain Battle" concept– with the use of a number of established technologies augmented by the development of a number of emerging products. For instance, while the use of abdominal tourniquets, junctional tourniquets, and the REBOA tool are now commonplace in the military medical world, there continue to be a number of other avenues to explore. Members of the Critical Care Air Transit team, 149th Medical Group, Texas Air National Guard, practice on a simulated critical-care patient onboard the C-130H2 aircraft from the 136th Airlift Wing during Air-X 2015, the largest joint force domestic operations exercise at College Station, Texas. (Air National Guard photo by Master Sgt. Charles Hatton/released) 6 | Combat & Casualty Care | Summer 2017 BATTLEFIELD INNOVATION COMBAT CASUALTY CARE RESEARCH

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