2010 Issues   /   October 2010

DoD Conference Addresses Battlefield Bleeding

By U.S. Medicine

WASHINGTON, DC—Preventing servicemembers from bleeding to death on the battlefield is a top priority for military researchers, according to Col Dallas Hack, director of the Combat Casualty Care Research Program at the US Army Medical and Materiel Command at Fort Detrick.

Military and civilian researchers gathered in August at the annual Advanced Technology Applications for Combat Casualty Care Conference in Florida to discuss the latest research on a range of injuries incurred on the battlefield, including TBI and hemorrhage.

Hack said that hemorrhage is still a “huge issue.” While tourniquets are making a difference in addressing extremity injuries on the battlefield, servicemembers are still dying from noncompressible hemorrhage.

A presentation given at the conference showed that 50% of servicemembers who died at a deployed medical facility from their wounds had potentially survivable injuries. Eighty percent of these deaths were due to hemorrhage. Of those deaths due to hemorrhage, half are due to truncal penetrating trauma. “These are areas you cannot press manually, and you cannot put a tourniquet on. We currently do not have an answer to this injury in the pre-hospital arena,” said Col Lorne Blackbourne, MD, commander of the US Army Institute of Surgical Research.

Medics currently attempt to keep these injured individuals alive in the pre-hospital setting before they make it to a fixed facility with the intravenous infusion of clear fluids. The problem with these clear fluids is that they dilute clotting factors. Then the injured person cannot form clots, which increases the propensity to continue bleeding.

One of the challenges that military medics face is that evacuating injured servicemembers can be prolonged due to weather, geography, or enemy activity, so there is a unique need to be able to resuscitate the injured individual before he gets to a surgeon who can stop the bleeding, Blackbourne said.

He added that researchers are excited that there are new dried blood products in the pipeline that could potentially allow medics to give clotting factors to the injured servicemember before they reach a deployed medical facility. This could decrease deaths on the battlefield due to hemorrhage.

Hack said two products, freeze-dried plasma and spray-dried plasma, could be FDA approved in the future. Freeze-dried plasma is currently in human trials, while spray-dried plasma is about six months behind.

Researchers Address Battlefield Injuries

Patrick Kochanek, MD, director of the Safar Center for Resuscitation Research at the University of Pittsburgh, said that important research on TBI injuries was addressed at the conference.

One important piece of research that is emerging is that the axons seem to be particularly vulnerable to blast, Kochanek explained. This could be important in trying to develop a new therapy for TBI patients. “We need to determine when it is not important, when it becomes important, and what therapies might be able to target it.”

He stated that researchers in the field of mild TBI and severe TBI are beginning to collaborate, which could help in the development of new therapies.

In addition to the focus on hemorrhage and TBI research, Hack also said that a number of products were on display at the conference that have already been introduced on the battlefield, such as new oxygen generators. “With new technology we have these nice little oxygen generators now that produce a medical grade of oxygen in a rather compact package that can continuously work, and we don’t have to worry about continuing to refresh it with new oxygen tanks. You would think that would be a simple thing, but it actually turns out to be a major issue for us.”

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