thedrifter
02-13-07, 07:38 AM
Lessons from treating battlefield woundedbring medical advances
By Kelly Kennedy - Staff writer
Posted : February 19, 2007
For all the recent advances in weapons, body armor and vehicles, the discoveries most beneficial long after a war ends could be coming out of hospitals.
In the Civil War, Army doctors created big, open, clean hospitals that soon became the norm for civilian wards. In World War I, doctors figured out how to surgically remove infected tissue from wounds. In World War II, tetanus shots earned mainstream status. And in Vietnam, medics learned how to prepare severely wounded soldiers for transport when they loaded them onto helicopters. It all transferred to the civilian world.
Advances in the wars in Iraq and Afghanistan, from prosthetics operated by thought to better record-keeping methods, could also change the way civilian hospitals do business.
At the Military Health Systems conference Jan. 29 and 30 in Washington, Charles Scoville, program manager for the military amputee patient care program for the Army Surgeon General, talked about leaps prosthetic design has taken.
“Three years ago, you had to move your elbow, then your wrist, then your hand,” he said. “Now, you can do it simultaneously.”
For the 541 service members who have lost a total of 648 limbs as of Jan. 15, those advances can mean the difference between going back to Iraq or depending on someone to assist them through each day of their lives. So far, 12 amputees have gone back to Iraq or Afghanistan.
“We have one goal: to return these guys to duty,” Scoville said.
In the past, people missing a leg could go down stairs with their prosthetic knees, but going back up was a trick: They had to swing a straight leg out to the side to place it on the next step. Now, a power knee bends and lifts the leg.
New techniques
Amputees are also learning to use existing muscles to make their new limbs work. For example, the biceps muscle that used to bend an elbow still fires after the forearm is gone. But now, when an amputee fires that muscle, it bends the prosthetic elbow up. The muscle doesn’t do the work, but an electrode placed on the muscle lets a computer know it’s time for the elbow to bend.
Scoville showed a Special Forces soldier missing a forearm and hand demonstrating the technology by using his prosthetic device to insert an IV. The soldier wanted to prove he could do one of the tasks required to go back to Iraq.
Scoville also showed a new technique called osseointegration, in which a piece of metal is added to the stump of the missing limb so a prosthetic device can attach with a clip. Risks include infection and weakening of the bone, but for people with no options, a few years of use may be worth it, Scoville said.
“We had a guy who hadn’t walked in 10 years because they couldn’t fit anything to the socket,” Scoville said. “He said that even if he only got to walk for five years, it was worth it.”
In other research, an implant in the brains of monkeys allows them to move their prosthetic arms just by thinking about it.
And doctors have found people can “feel” with missing limbs if corresponding nerve endings in their existing limbs are touched. This means — and has been the case for at least one amputee — that people can sense weight or hot and cold when doctors attach those nerve endings to plungers that move when a prosthetic finger moves.
Learning from mistakes
But past mistakes also have led to recent changes. In the 1991 Persian Gulf War, troops were exposed to everything from depleted uranium to oil-fire smoke to leishmaniasis — a blood-borne disease caused by the bite of a sand fly. But nobody kept track of where the exposed troops were deployed, other than general unit deployments.
“We want to keep track of where people have been so you know what they’ve been exposed to,” said Col. George Johnson, director of force readiness and health assurance for Tricare.
For that reason, he has asked units to record where people sleep every night. Johnson said Tricare is hoping to make the record defensewide, but it’s not up yet beyond the local level.
Tricare is also taking air, water and soil samples. So far, the air in Iraq is considered a moderate threat because of its high dust levels, and treated water in Iraq is also rated moderate because of the risk of diarrhea and vomiting.
In past wars, much of the information about how military physicians do their jobs has been lost — including how to do research. Col. John Holcomb, chief of the trauma division at the U.S. Army Institute of Surgical Research, said someone needs to monitor human research.
Studies to date in Iraq have yielded policy change as doctors learn how to do things better. For example, they figured out that a test for coagulopathy — a blood-clotting defect — can be done quickly and save many lives.
“Now you know who has a chance of dying with a two-minute test within 30 minutes of arrival at the hospital,” Holcomb said. And it’s a fairly easy fix: administer a 1-to-1 ratio of plasma to red blood cells.
But for ethical reasons, research needs to be monitored.
Holcomb created a six-person team in Iraq that monitors research, fills out regulatory paperwork for permission back in the U.S. and makes sure the research is relevant to the military.
The Navy and Air Force are working on similar teams.
Ellie
By Kelly Kennedy - Staff writer
Posted : February 19, 2007
For all the recent advances in weapons, body armor and vehicles, the discoveries most beneficial long after a war ends could be coming out of hospitals.
In the Civil War, Army doctors created big, open, clean hospitals that soon became the norm for civilian wards. In World War I, doctors figured out how to surgically remove infected tissue from wounds. In World War II, tetanus shots earned mainstream status. And in Vietnam, medics learned how to prepare severely wounded soldiers for transport when they loaded them onto helicopters. It all transferred to the civilian world.
Advances in the wars in Iraq and Afghanistan, from prosthetics operated by thought to better record-keeping methods, could also change the way civilian hospitals do business.
At the Military Health Systems conference Jan. 29 and 30 in Washington, Charles Scoville, program manager for the military amputee patient care program for the Army Surgeon General, talked about leaps prosthetic design has taken.
“Three years ago, you had to move your elbow, then your wrist, then your hand,” he said. “Now, you can do it simultaneously.”
For the 541 service members who have lost a total of 648 limbs as of Jan. 15, those advances can mean the difference between going back to Iraq or depending on someone to assist them through each day of their lives. So far, 12 amputees have gone back to Iraq or Afghanistan.
“We have one goal: to return these guys to duty,” Scoville said.
In the past, people missing a leg could go down stairs with their prosthetic knees, but going back up was a trick: They had to swing a straight leg out to the side to place it on the next step. Now, a power knee bends and lifts the leg.
New techniques
Amputees are also learning to use existing muscles to make their new limbs work. For example, the biceps muscle that used to bend an elbow still fires after the forearm is gone. But now, when an amputee fires that muscle, it bends the prosthetic elbow up. The muscle doesn’t do the work, but an electrode placed on the muscle lets a computer know it’s time for the elbow to bend.
Scoville showed a Special Forces soldier missing a forearm and hand demonstrating the technology by using his prosthetic device to insert an IV. The soldier wanted to prove he could do one of the tasks required to go back to Iraq.
Scoville also showed a new technique called osseointegration, in which a piece of metal is added to the stump of the missing limb so a prosthetic device can attach with a clip. Risks include infection and weakening of the bone, but for people with no options, a few years of use may be worth it, Scoville said.
“We had a guy who hadn’t walked in 10 years because they couldn’t fit anything to the socket,” Scoville said. “He said that even if he only got to walk for five years, it was worth it.”
In other research, an implant in the brains of monkeys allows them to move their prosthetic arms just by thinking about it.
And doctors have found people can “feel” with missing limbs if corresponding nerve endings in their existing limbs are touched. This means — and has been the case for at least one amputee — that people can sense weight or hot and cold when doctors attach those nerve endings to plungers that move when a prosthetic finger moves.
Learning from mistakes
But past mistakes also have led to recent changes. In the 1991 Persian Gulf War, troops were exposed to everything from depleted uranium to oil-fire smoke to leishmaniasis — a blood-borne disease caused by the bite of a sand fly. But nobody kept track of where the exposed troops were deployed, other than general unit deployments.
“We want to keep track of where people have been so you know what they’ve been exposed to,” said Col. George Johnson, director of force readiness and health assurance for Tricare.
For that reason, he has asked units to record where people sleep every night. Johnson said Tricare is hoping to make the record defensewide, but it’s not up yet beyond the local level.
Tricare is also taking air, water and soil samples. So far, the air in Iraq is considered a moderate threat because of its high dust levels, and treated water in Iraq is also rated moderate because of the risk of diarrhea and vomiting.
In past wars, much of the information about how military physicians do their jobs has been lost — including how to do research. Col. John Holcomb, chief of the trauma division at the U.S. Army Institute of Surgical Research, said someone needs to monitor human research.
Studies to date in Iraq have yielded policy change as doctors learn how to do things better. For example, they figured out that a test for coagulopathy — a blood-clotting defect — can be done quickly and save many lives.
“Now you know who has a chance of dying with a two-minute test within 30 minutes of arrival at the hospital,” Holcomb said. And it’s a fairly easy fix: administer a 1-to-1 ratio of plasma to red blood cells.
But for ethical reasons, research needs to be monitored.
Holcomb created a six-person team in Iraq that monitors research, fills out regulatory paperwork for permission back in the U.S. and makes sure the research is relevant to the military.
The Navy and Air Force are working on similar teams.
Ellie