When a servicemember is injured on the battlefield, stopping the bleeding can be a matter of life and death. Uncontrolled hemorrhage is the leading cause of preventable combat-related deaths and is a problem that Col Dallas Hack, MD, director of the US Army Medical Research and Materiel Command’s Combat Casualty Care Research Program (CCCRP), and his military colleagues have not stopped working on since the current conflicts began. “Our military wounds tend to be very severe and a lot of time the therapy that would normally be appropriate for most civilian wounds would not be adequate for the large wounds that our military troops are getting,” he pointed out.

The aim of the CCCRP is to reduce the mortality and morbidity resulting from injuries on the battlefield through new products and technologies. As part of this goal, Hack’s program is continuing to evaluate and seek better tools for the medic to stop bleeding on the battlefield. “We want to stop the bleeding as far forward as possible because chances are if the servicemember gets to a hospital, they will survive,” he said.

Need for Improved Bandages

Bleeding is a major problem on the battlefield. Over 80% of preventable deaths on the battlefield are due to hemorrhaging. According to the CCCRP, evidence suggests that the majority of deaths due to hemorrhage in potentially survivable casualties involved non-compressible hemorrhages or hemorrhaging in areas that were not conducive to a tourniquet.

Hack recalled that when he arrived for a military assignment in Kuwait the day before the terrorist attacks of Sept 11, 2001, he was carrying a triangular gauze bandage issued by the military that he said had not changed in many years. Since then the military has worked on improving tourniquets as well as other hemostatic dressings to effectively address the numerous types of wounds that servicemembers are sustaining.

HemCon®, which is a bandage that uses chitosan from shrimp shells, was the first hemostatic agent deployed to the battlefield during the current conflicts. “When we came up with chitosan we stopped looking for a while, but then we realized that we had wounds that we weren’t able to treat with what we had.”

With the realization that there was a need for improved products, a hemostatic agent called QuikClot® Combat Gauze™ made by Z-Medica was approved for use and is currently used on the battlefield. QuikClot is a synthetic gauze material with kaolin, which is a pro-coagulant, and is intended for areas where a tourniquet cannot be used.

Hack said that the military continues to seek out an array of additional dressings that can be used on the battlefield. One product in development is a sprayable liquid wound dressing called GelSpray Liquid Bandage that was approved by the FDA in 2008. This product will undergo clinical trial for use on the battlefield.

Hack said that this sprayable liquid wound dressing could be potentially helpful for wounds that are deep or need a conformable bandage. “Gauze, even if it is impregnated with a hemostatic agent, you may not be able to shove it into the hole that you need to. With something like this, it is a spray-on dressing, but it comes in a couple of different formats—a spray and in a syringe kind of format. Both of those would be applicable in a situation where you need a bandage that conforms itself to the wound. ”

Hack said that one reason this product could be particularly helpful on the battlefield is that rocks and debris that are thrown in the air from a roadside bomb “become like missiles on their own,” and so servicemembers may end up with hundreds of wounds from the flying debris. “How do you put a role of gauze in each one of those holes? That is one of the main places where this [product] could be used. The other place that it would have a good use is in large surface wounds that are maybe not that deep.”

Fielding the Right Products

Many companies have stepped forward with ideas and products in response to the military seeking out better wound dressings in the early days of the current conflicts. As a result, Hack said that they have set up a testing facility to vet the products. “We have set up a program not only to coordinate with those who are trying to collaborate with us, but we have set up essentially a testing facility with a standard model to test these kinds of products.”

In determining what products will work in the field, Hack said additional considerations are cost, whether the product is environmentally stable, and whether the product is a practical size.

Military leaders are aided by the Joint Theater Trauma Registry (JTTR) in determining whether the products they deploy are effective in stopping bleeding and addressing other problems on the battlefield.

The JTTR was established in 2005 and is a data repository that collects and hosts all DoD trauma-related data. This allows medical leaders to make decisions about what is needed based on data, rather than just on anecdotal evidence. “We can continually go back to that database to find out answers to questions or what the scope of the problem is. That has been one of the main ways that we can determine what is happening.”

In addition, Hack said the office of the Armed Forces Medical Examiner is an important source because that office does autopsies to analyze what troops are dying from.

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