Amazing PDA

InfraScan Inc. has been developing an awesome piece of technology that will soon be available on the open market: the "Infrascanner System" is a PDA-based device with some very cool extras. Identifying head injuries in the field can be a difficult task, I can tell you first hand. Technologies such as CT scans and X-Ray are not something you see outside of a hospital or clinic too often, so to solve this dilemma the Infrascanner was created. Already having been proven in multiple field tests that include those of the US Navy and Marines, the device is merely awaiting clearance by the US FDA for public use.

The Infrascanner works by detecting differences in light absorption in the hemispheres of the brain. This is done by placing probes on the head of the patient in symmetrical positions, then using the scanner device to emit near-IR light and measure the absorbency. Then, if there is an area where the light is absorbed more then normal, it is likely that is the site of the intracranial bleed. This is due to the extra hemoglobin in the build up of blood that absorbs more light.

As you can imagine, this technology has huge potential. From how the procedure is described, it is as easy to use as a mobile EKG monitor. Simply place the sensors and turn the machine on, only without the wires (oh yes, it's bluetooth!).

Acu-what?

The U.S. Air Force is taking a huge initiative in a means by which to reduce the pain of injured soldiers. "Battlefield acupuncture" is becoming very popular with the military medical community, having been proven throughout ancient Chinese history. Acupuncture is a method by which tiny, hair-thin needles are inserted about one millimeter into the skin in strategic anatomical locations in order to dull a patients pain. Col. Richard Niemtzow has been developing his technique of acupuncture over the past several years, and has even trained Army Rangers this method of pain relief. In the field, this can prove to be a very valuable skill when other resources are not available. According to Niemtzow, this procedure can alleviate a patients pain for up to days at a time. Aside from the simplicity, other advantages exist such as no risk of drug addiction and allergic reactions as well.

The Air Force has arranged a training program beginning early next year for medical personnel to learn battlefield acupuncture. It is made clear this method of pain control is not meant to replace fast-acting drugs such as morphine, but offers an easy alternative for those who will benefit most from it.

Dr. Robot

Finally, in its latest stages of development, is the technology that will eventually replace us all. In collaboration with the U.S. Army Trauma Training Center, InTouch Health's RP-7 robot is in its trial stage. This robot comes complete with a tv screen and speakers, and enables doctors who are stateside to offer advice to other medical professions that are not so close to home. Currently, it is Ryder Trauma Center of the University of Miami that provides doctors for the trial program. By being able to see and communicate with the patient, these doctors can assist those on the front lines with trauma emergencies. The U.S. Army has a prototype to be used in the field at a classified location.

Currently this project leaves the robot strictly hands off, but there are talks of various attachments being available in the future. As Dr. Augenstein says, "It's OnStar on steroids."

Video Clip

Below is a link to the BBC website, where a short video clip shows what a British-run, front line hospital looks like.

Check it out.

Beam Me Up!

Professor Abrahim Katzir of Tel Aviv University has developed what used to be considered space-age technology; you know, the kind of stuff you see on Star Trek. Anyway, Prof. Katzir has been working on an invention that surgeons have been dreaming about for decades: a laser scalpel. Just as it sounds, it is a laser device used during the suturing of wounds. According to trials done on patients who underwent gallbladder surgery, the suturing done with the laser scalpel healed faster and with significantly less scarring.

Prof. Katzir also makes mention of this device being used to heal wounds on the battlefield. "Allowing soldiers to heal each other on contact with the wand." This sounds like a great idea, but chances are that the type of situation where this would be most beneficial, the wound would be so contaminated that it would need to be in a clean environment in order to properly irrigate and seal the affected area. That is just as important an issue, I believe.

New Age Training

In a recent U.S. Army press release, an outline of the modern day combat medic training program was given. Only in recent years has the military recognized the need for more advanced training in prehospital care for their healthcare providers in the field. During the cold-war era, a majority of the healthcare providers worked in hospitals alongside doctors and nurses, and generally were non-combatants. Given that enemy fighters will take any chance they get to take out a medic, knowing that they are a vital asset to any force, the need for the newly termed "combat medic" was needed. In this revamped course, brand new soldiers are being trained to act as a soldier first, medic second. Once you can assure your safety and the safety of your patient, only then can you administer care. With the most modern technology, these trainees have access to life-like manikins to make the procedures as real as possible. Trainees are also put through rigorous, real-life scenarios to simulate an active warzone where the medics must clear the area of enemy combatants before tending to patients. This cutting edge training, along with state-of-the-art technology, will lead to more soldiers being saved out in the field.

Nice Pants

Recently I visited a website that specializes in tactical clothing that a friend told me about, and found something of interest. Blackhawk.com sells trousers with I.T.S. technology, that is an integrated tourniquet system. These pants have built-in tourniquets throughout each leg that can be activated above the hemorrhaging injury when needed. Per the site, the combined weight of the I.T.S. is less than that of a traditional tourniquet. It is simple innovations like these that will save lives, and hopefully this technology will become more prevalent in military use in the near future.

Rule Number Two

Rule Number Two, by Dr. Heidi Squier Kraft, is about the experiences of a clinical psychologist in an active warzone. This book is a very powerful firsthand view of how the effects of battle have serious mental repercussions on everyone involved, including the doctor herself. In the TV series M*A*S*H*, there are two rules: "Rule number one is that young men die. Rule number two is that doctors can't change rule number one."

I enjoyed this book imensley, and certainly reccomend it to anyone who is interested. Dr. Kraft also offers much insight as to the difficulties of being a mother who is away from her family for so long, and what effects it had on them as well.

Available at amazon.com

Dr. Chip

$1.6 Million was given to a research team lead by professor Joseph Wang of UC San Diego, a nanoengineer, to develop a technology that will actively monitor soldiers on the battlefield. Similar to modern glucose monitoring systems for diabetics, these implants will be able to distinguish when the body is injured. This is possible by breakthrough technology in reading the sequencing of biomarkers, for when the body sustains injury, a certain sequence develops. The complex systems of the implant reads these markers, and can administer certain medications to treat accordingly.

Even though this is truly cutting edge technology, I think that the practicality of it will not be very beneficial. In some instances, such as pain management, this will definitely make a difference. But in others such as major trauma (often the case), there is only so much that this chip will be able to do for the patient; it cannot apply pressure to a wound, or provide necessary fluid resuscitation because of its size.

MOVES

For the past several years, Thornhill Research Inc. has been developing for the Marine Corps. a means to eliminate oxygen canisters from the battlefield. The Monitoring Oxygen Ventalation & External Suction system (MOVES) is designed to do just that. MOVES can be hooked up to a patient and is able to generate its' own oxygen, ventilate, suction, and monitor vitals. The need arose for this technology when aircraft were being lost to exploding oxygen canisters during fires.

MOVES is expected to go into production by spring of next year with 50 units available by the following fall. Also, as you can imagine, MOVES has large possibilities in the civilian prehospital sector, so expect to so it available soon after mass production for about $55,000 a unit.

I was very excited to read about this, it is a leap and a bound in the field of not only combat medicine, but emergency medicine as a whole. This is technology that was once thought to be impossible, but is now a reality. Who knows what else lies ahead in the near future.

Training with the Best

On October 9th, USS Boxer's Medical Dept., Fleet Surgical Team (FST) 5, and the 13th Marine Expeditionary Unit conducted a mass casualty drill to evaluate their readiness to handle medical emergencies. Skills practiced involved the receiving of casualties from onshore conflict, and triaging on the flight deck before sending patients down to the intensive care unit. According to Senior Chief Hospital Corpsman Stephen Richardson, these types of drills are important so that the Marine counterparts onshore know the workings and capabilities of the Boxer group. Also, it makes certain that everyone knows their role and understands it.

Boxer's medical team and the FST are capable of performing surgery, x-rays, laboratory work, and hosting a blood bank while at sea. Richardson attributes their excellent training regiment to learning from past challenges and how to overcome them.

"Doc-in-a-box"

The Shock Trauma Platoon (STP) is an invaluable asset to the Fox Company Marines in Operation Enduring Freedom. Complete with 2 medical doctors, 2 nurses, a physicians assistant, and multiple corpsmen, the STP provides the best care to Marine casualties. The STP also employs a Mobile Trauma Bay (MTB), which is an ISO container on back of a flatbed truck with everything you could ever need for an emergency room setup inside. Equipment such as an ultrasound machine and an electrocardiogram can be found inside the MTB, hence yielding the nickname "Doc-in-a-box".

Lonestar

As most people know, since the Vietnam War, evacuating battlefield casualties by helicopter has greatly increased their chances for survival. The "Lonestar" dustoff company, from Fort Worth, TX, is currently in its fourth deployment serving in Operation Iraqi Freedom. These men and women are dedicated to helping those in need of immediate medical attention, and put themselves into the most dangerous of situations to do so. It is the improvements made to aircraft like these and advances in medicine that contribute to why soldiers have a better chance than ever of surviving a traumatic incident.

The MEDEVAC crew consists of two pilots, a flight medic, and a crew chief. Shifts start with a check of the aircraft and medical supplies, and run 48 hours long with a 24 hour break in between.

The Magic Cuff

Recently, Siemans Healthcare acquired a contract from U.S. Defense Advanced Research Projects Agency to develop a new technology to quickly stop severe bleeding in battlefield casualties. It is called the Deep Bleeder Acoustic Coagulation (DBAC) cuff, and is essentially an ultrasonic tourniquet. The purpose of the cuff is to be placed over a wound to a limb, using ultrasonic waves detect where the bleed is originating, and then use high-energy waves to quickly clot the blood. Even though this may stop the bleed, it does not necessarily mean it will save the affected limb; but still may save the soldiers life. In animal studies, such technology has proven successful in stopping bleeds in major blood vessels, as well as organs. Siemans is hoping to have the prototype ready in about 18 months, at which point it will be sent straight into the field.

I think this is a great idea, though the technology seems a bit far-fetched even for our time. To have such a complex device in a rugged environment does not sound like a very good match. Also, taking into consideration that soldiers already have 40+ pounds of equipment to carry, I doubt that every one of them will be able to carry this as well. Assuming this, only certain personnel (probably medics) will carry the cuff, thereby defeating its' self-automated purpose of anyone being able to use it.

Medical Elite

At the Grafenwöhr Training Area in Germany, soldiers strive to earn the Expert Field Medical Badge by the end of the week. This qualification is given to those who pass the rigorous course that test one's medical skills, as well as physical ability and weaponry skills. This course is available to doctors, nurses, and medics alike, and those who successfully pass acquire a heightened proficiency at performing medical care in a war zone. Exercises include caring for casualties under fire, loading them into ambulances for transport, and learning to deal with different types of ordinance (biological, chemical, etc..).

One candidate, Capt. Lori Metcalf, is a family nurse practitioner in the U.S. Army. Due to the need of physician assistants in the field, the Army Nurse Corps has approved the deployment of nurse practitioners to fill the void. Expecting to be deployed into active service in the near future, Capt. Metcalf took this course to better ready herself.

Volunteer Surgeons

Dr. David Gillespie, of the Society of Vascular Surgeons, started a volunteer program for stateside vascular surgeons to go out on two week rotations to the Landstuhl Regional Army Hospital in Germany. This allows the surgeons to assist the staff at Landstuhl with more serious surgeries that include the repairing of arteries and veins of battlefield casualties. Since the need for such expertise is not in high demand at the facility, this program allows local doctors to assist our soldiers as needed, and have the satisfaction of doing so.

Recently, Dr. Yaron Sternbach returned from his time in Germany as a volunteer surgeon. Although he does not agree with the current War on Iraq, Dr. Sternbach says he felt taking care of our wounded soldiers over seas was "professionally gratifying" and encourages other doctors to do the same.

Pain Management

Dr. Buckenmaier, III, is Chief of the Army Regional Anesthesia and Pain Management Initiative (ARAPMI) at the Walter Reed Army Medical Center in Washington, DC. This program has been on the front lines of pain research over the past several years. Medscape.com interviewed Dr. Buckenmaier concerning the program's research and practical application. ARAPMI has been around since 2000, but really took off at the start of the War on Iraq in 2003. Its' primary responsibility is to enhance the ability to manage the pain of battlefield casualties, emphasizing the multimodal approach to pain management. In short, this means that the method of treating each patients' pain is best suited to their situation.

Dr. Buckenmaier describes pain as a disease process, and like all diseases can be appropriately treated. Such methods include patient-controlled dosage, which allows the patient to administer a dose of painkillers as they need it. This may sound dangerous, but the system is a safety within itself; should the patient become over-sedated, he or she will not be able to press the button for additional doses. Also, another example is the pill pack carried by Special Forces that contains a painkiller, an anti-inflammatory, and different anti-biotics that are to be taken when a soldier is initially injured. This is a great first step to the treatment of not only pain, but the injury itself. Another point that Dr. Buckenmaier touches on is the idea of having, at the least, a clinician dedicated to the pain management of casualties. Studies show injured soldiers having very high levels of pain prior to their arrival at definitive care, suggesting the need for better pain management of these patients before transport.

More harm than good?

Recently the U.S. Air Force gave a grant to researchers at the University of Cincinnati in the amount of over $2 million to determine if evacuating severe casualties from the battlefield can do more harm then overall good. Since field hospitals in a war zone are aimed at stabilizing patients until they can get to definitive care, it is imperative to be able to transport those injured soldiers as fast as possible. This is most commonly done via a "medical evaluation plane", which flies the casualties out to safety, at high altitudes of about 8,000 feet. Because of the higher altitude, there is less oxygen concentration in the air, which a body in a state of shock is desperately in need of. The job of these researchers is to determine when it is appropriate to fly these more serious patients out as to not cause any additional injury.

This is an area where little or no research exists. It has always been thought that getting patients to the proper treatment as soon as possible will yield the best outcome. Though I find the reason for this research credible because with any battlefield casualty, the condition is often severe. Should the field hospital work to stabilize this casualty, fly them out too soon only to have the stress of the flight send them into a severe state of shock, then all their hard work was in vain.

On Call In Hell

On Call In Hell, by CDR. Richard Jadick, is a very accurate account of combat medicine in the modern battlefield. In his book, written in a first-person recollection of events, CDR. Jadick describes in great, and sometimes gruesome detail of what is really happening on the frontlines in the War on Iraq.

CDR. Jadick helped to revolutionize the way in which battlefield causulties reached medical care more quickly and efficiently than ever before. I highly reccomend this book to anyone who wants a true feel for what it's like to be a trauma doctor in todays modern warfare.

Available at Amazon.com

Welcome

Hi, my name is Joe, and through my blog I intend to bring the field of combat medicine more visibly into the eyes of the public. Many advances have been made in the battlefield, including the care of injured soldiers. I will give reviews of news article, as well as books, concerning these advances, and the people making them possible. I hope you enjoy my blog and stay tuned for updates.