Calling Dr. G.I. Joe

Today's soldiers practice high-tech medicine on the battlefield


Early in the Iraq war, when the United States unleashed precision smart bombs, surveillance drones and other high-tech gizmos of destruction, for a moment it seemed as if this war would be automated and for coalition forces largely bloodless. Unfortunately, the gee-whiz weaponry has given way to a daily tally of horrific injuries from crude bombs, snipers and other hazards, injuries that haven’t changed since gunpowder exploded on the scene some five centuries ago.

Jeffrey Decoster

In Iraq, however, the number of those killed from such injuries has dropped to about 9 percent, compared with 24 percent in Vietnam, 30 percent in World War II — and worse in earlier wars. Fatalities are down because of dramatic technological and logistical improvements in preventing and treating the greatest killer in Mesopotamia: bleeding from wounds.

Speed has been a major factor in stanching the bleeding before it kills. If evacuation teams can quickly move a soldier to a hospital in Iraq, the soldier has a 97 percent chance of surviving. Medical teams use advanced communication networks and locators to find the wounded, then dispatch Black Hawk helicopters and ambulances to whisk them to a Combat Support Hospital, a CSH, pronounced “cash.” There surgeons stabilize patients in modern operating theaters before they are loaded onto aircraft  (C-17 Air Force cargo planes converted into intensive care units) and flown back to the United States. In Vietnam, it often took several weeks to move a soldier back to the United States; in Iraq, it usually takes about 36 hours.

Soldiers’ kits and training are another factor in a war where G.I. Joes are more than ever becoming Dr. G.I. Joes for certain injuries. For instance, every soldier is equipped with a high-tech tourniquet featuring built-in ratchets that he or she can tighten with one hand. In previous wars, tourniquets were discouraged because delays in getting the wounded to a surgeon to remove a tourniquet often meant the loss of a leg or an arm. In Iraq, surgeons routinely remove them within an hour.

Soldiers are also outfitted with special chemicals to encourage clotting and to stop bleeding. The U.S. Army has issued bandages coated with chitosan, a granular molecule that helps bind the outer shells of shrimp and other crustaceans and that promotes blood clotting. Positively charged chitosan molecules are affixed to bandages that attract negatively charged red blood cells, causing clumping and clotting. Made by HemCon of Portland, Ore., this bandage was named one of the “Top 10 Greatest Inventions this Year” by the Army in 2005. Other bandages used in Iraq are coated with chemicals that occur in humans naturally and help blood clot quickly — fibrinogen and thrombin. And to slow bleeding, Army surgeons use the genetically engineered Factor VII, a clotting treatment developed for hemophiliacs, though some doctors have raised concern that risk of stroke and other complications outweigh the benefits.

HemCon’s bandages are also controversial. The Army has embraced them, but Navy researchers have claimed that they work only slightly better than gauze on bleeding wounds. The Navy, Air Force and Marines prefer a powder applied to wounds to stem bleeding called QuikClot, a hemostatic that seals wounds. Made by Z-Medica of Wallingford, Conn., QuikClot absorbs the moisture in a wound and seals it. The Army is critical of this use because in a few cases Quikclot has caused burns, though the Navy says the risk is minimal, and if burns occur, that’s better than bleeding to death. Cost is a factor. The HemCon costs $120 per bandage; QuikClot is about $20 for a 3.5-ounce bag.

“The hemostatic agents have been great, they are a real advancement,” says Col. Norman Rich, MD, who recently retired as the chair of surgery at the Uniformed Services University of Health Sciences in Bethesda, Md. “It’s still a debate as to what works best, but the end result is that more soldiers are being saved,” says Rich, a Stanford medical alumnus, class of 1960.

HemCon and QuikClot are being used back home, too, by EMTs, police officers and firefighters, though they have been slower to adopt the technology because of the burn problem.

In the pipeline

Battlefield medicine of the future might give soldiers even more doctoring ability. One device the Army is developing to speed up the location and transportation of injured soldiers is a 911-type button that would signal medics their position when wounded. Another more futuristic device is a computerized ultrasound system carried by combat units that could locate and cauterize internal wounds. Colonel Rich is working with a Stanford team headed by Charles Taylor, PhD, associate professor of bioengineering, that’s testing two prototypes developed by competing companies with the support of DARPA, the Pentagon’s Defense Advanced Research Projects Agency.

Engineers are also developing enhanced body armor that would protect a soldier’s entire body. In this war, while Interceptor body armor and Kevlar helmets protect the head and torso (the so-called kill zone), arms and legs are vulnerable. One Army research project is the Future Force Warrior, a system of head-to-toe armor outfitted with a continuous communications net connected to a central command, internal climate-controls to keep fighters cool or warm, external sensors to detect movement and locations, and biomonitors that would keep track of the soldier’s vital systems and report back physiological data and injuries. The armor might also administer basic first aid.

There is talk of outfitting armored suits with a powered exoskeleton that would solve armor’s weight problem: Heavy armor on soldiers’ arms and legs severly curtails mobility. So the Army has funded University of Texas nanotechnologist Ray Baughman, PhD, to develop military-grade nano-fibers charged with electricity that would contract like muscles, but are many times stronger than human tissue. This would reduce the weight-to-strength ratio for tomorrow’s battle armor, which will look more like that of Imperial Storm Troopers on Star Wars than of today’s troops, who look similar to the grunts and G.I.s who have fought in wars since the early 20th century. The armor is years away from being perfected and deployed, putting it in a galaxy far, far away for today’s soldiers.

Back in our galaxy, as the Iraq war rages on, military medicine is making steady progress on the battlefield, hovering somewhere between the bloody wars and injuries of the past and a high-tech future that we can hope never needs to be deployed.


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