thedrifter
02-26-08, 05:32 AM
New Technology Improves Care for Wounded Troops
Drawing on new technologies as well as lessons learned in Iraq, the U.S. military is using both new technology and improved methods to treat wounded soldiers, leading to higher survival rates overall. Tom Bearden reports on these advances.
JIM LEHRER: Now, a health unit report on advances in the treatment of wounded soldiers. NewsHour correspondent Tom Bearden has the story. The Health Unit is a partnership with the Robert Wood Johnson Foundation.
TOM BEARDEN, NewsHour Correspondent: The 28th Combat Support Hospital in Iraq's Green Zone is rarely quiet. Medical staff here at the world's busiest military trauma facility work day and night to aid soldiers, airmen and Marines who are injured in the field.
Thanks to new technologies and procedures used here and throughout the military medical system, the approximately 30,000 soldiers who've been wounded during the Iraq war have had a far better chance of surviving than in the past.
During the American Revolution, 42 percent of the injured died; in World War II, it was 30 percent; Vietnam, 25 percent. Today, 90 percent recover.
Colonel John Holcomb is the commander of the Institute of Surgical Research at Brooke Army Medical Center in San Antonio.
COL. JOHN HOLCOMB, Commander, U.S. Army Institute of Surgical Research: I think there's been a number of advances on this battlefield compared to ones even 5 to 10 years ago, and they are not one single area. It's training, medical equipment, deployment of forces on the battlefield, all combined, body armor, so protection both in vehicles and on personal protection, that have come together to allow us to have the highest survival rate in any war we've ever been in.
Many factors led to improvement
TOM BEARDEN: One of the biggest changes is in the speed of transporting the wounded to the level of care they need.
It begins on the battlefield. Helicopters take the wounded directly to nearby combat support hospitals, like the 28th. But if a soldier needs more sophisticated care, they don't stay near the front lines very long.
Once stabilized, the wounded are loaded onto medical transport aircraft to take them to Landstuhl Regional Medical Center in Germany. These flying intensive care units carry up to 200 seriously injured soldiers.
DOCTOR: Welcome to Germany. We're going to take good care of you here.
TOM BEARDEN: If the person needs more care than even Landstuhl can deliver, patients are then flown directly to major military hospitals in the United States.
COL. JOHN HOLCOMB: The rapid evacuation we speak of now is from the hospital back to the United States. It's not unusual for soldiers who are severely injured to be back in the United States in two-and-a-half to three-and-a-half days.
DOCTOR: Lay back. Lay there. I'll be back.
TOM BEARDEN: Holcomb says survival rates have also improved because of a technological revolution that reaches down even to the front lines.
COL. JOHN HOLCOMB: There's ultrasounds on the battlefield for diagnostics, small, portable ultrasounds. There's oxygen generators on the battlefield. There are I.V. pumps in the battlefield, small, portable anesthesia machines, small, portable monitors on the battlefield.
We have CAT scans on the battlefield now at every combat support hospital. So you can approach in many respects the type of care we get back here to a level-one trauma center.
TOM BEARDEN: But some of the improvements have been far less high-tech. In the 1990s, studies showed that most battlefield fatalities were the result of uncontrolled bleeding, so doctors took a fresh look at tourniquets.
COL. JOHN HOLCOMB: The end result is there's been six million tourniquets sent to the battlefield. Every soldier, sailor and airman carries a tourniquet on their body, and medics carry multiple tourniquets on their body, and that really springs from better training.
TOM BEARDEN: Doctors also started treating bleeding from inside of the body, injecting a clotting agent called recombinant factor VIIa. It was first approved by the FDA to treat hemophilia.
Early on, some researchers and politicians questioned using it on injured soldiers, concerned about negative side effects. But after clinical trials began, the controversy subsided.
COL. JOHN HOLCOMB: It's an FDA-approved drug used in off-label fashion. If you step back from the controversy that's been generated largely in the media and look at an FDA-approved drug used in off-label fashion, 60 percent to 80 percent of the drugs we use everyday are used in exactly that fashion.
TOM BEARDEN: Factor VII is now routinely used in U.S. emergency rooms for people who have suffered massive blood loss.
Researchers at the Surgical Research Institute are trying to develop ways to increase survival rates even further. Jose Salinas says managing fluid intake for burn patients in transport aircraft is particularly challenging and particularly critical.
JOSE SALINAS, U.S. Army Institute of Surgical Research: It is a life-or-death issue. If you give the patient too much fluid, you're going to end up with complications that are life-threatening and possibly can lead to patient death. If you give the patient too little fluid, you'll end up with complications again that could lead to life-threatening situations.
TOM BEARDEN: So Salinas and his colleagues are conducting tests aiming to build a computer-controlled fluid monitoring system that will automatically adjust I.V. pumps as the patients' needs change.
JOSE SALINAS: The software basically looks at the EKG.
TOM BEARDEN: And Salinas is taking a fresh look at one of medicine's most traditional diagnostic tools: vital signs.
JOSE SALINAS: The classic example is blood pressure. Whenever you're in an accident on the highway or you get shot in Baghdad, the first thing they come to you and they do is they take your blood pressure. Unfortunately, blood pressure is not a very good indicator of what your actual status is after you get injured.
What we're trying to do is we're trying to develop technology that will look at those standard vital signs together with new and improved vital signs that will let us make much better predictions that are much more accurate and much more effective when it comes to treating trauma patients.
TOM BEARDEN: The military is also working on body-monitoring systems that soldiers can actually wear. Lieutenant Colonel Jeffrey Cain is a research physician at the Institute of Surgical Research.
LT. COL. JEFFREY CAIN, U.S. Army Institute of Surgical Research: Number one, it could identify the casualty on the battlefield who needs some type of medical intervention immediately. And that way we can come -- you know, the unit can then initiate some type of a rescue plan to get to that casualty.
On the other side of that, it can prevent unnecessary dedication of assets during a firefight. If somebody is hit and they are injured catastrophically or killed outright, you know, it doesn't make any sense to divert assets at that particular time in the operation to go to somebody who we cannot save or who is already dead. And that's a very critical piece of information to those tactical commanders.
War advances help out back home
TOM BEARDEN: Dr. Ernest Moore is the director of surgery and trauma services at Denver's public hospital.
DR. ERNEST MOORE, Denver Health Medical Center: All right, what's the good news for today?
TOM BEARDEN: He recently participated in the military's senior visiting surgeon program at Landstuhl where he helped treat wounded soldiers. He thinks procedures developed as a result of the Iraq conflict can be applied in civilian hospitals, too, particularly in the event of a terrorist attack.
DR. ERNEST MOORE: If, in fact, we encounter mass casualties in the United States, this type of transport and echelon of care can be directly applied.
And, of course, this also may have applicability to natural disasters, which we're all too familiar with in our country in the last several years. So I think the military can teach us a lot in triage and transport.
TOM BEARDEN: Advancements in treatment for the severely injured have historically occurred during wars. What's different this time is that there is a much more organized collaboration between the military and civilian establishments.
The goal is to push lessons learned on foreign battlefields into the larger medical profession as quickly as possible, saving the lives of both solders and their fellow citizens.
Ellie
Drawing on new technologies as well as lessons learned in Iraq, the U.S. military is using both new technology and improved methods to treat wounded soldiers, leading to higher survival rates overall. Tom Bearden reports on these advances.
JIM LEHRER: Now, a health unit report on advances in the treatment of wounded soldiers. NewsHour correspondent Tom Bearden has the story. The Health Unit is a partnership with the Robert Wood Johnson Foundation.
TOM BEARDEN, NewsHour Correspondent: The 28th Combat Support Hospital in Iraq's Green Zone is rarely quiet. Medical staff here at the world's busiest military trauma facility work day and night to aid soldiers, airmen and Marines who are injured in the field.
Thanks to new technologies and procedures used here and throughout the military medical system, the approximately 30,000 soldiers who've been wounded during the Iraq war have had a far better chance of surviving than in the past.
During the American Revolution, 42 percent of the injured died; in World War II, it was 30 percent; Vietnam, 25 percent. Today, 90 percent recover.
Colonel John Holcomb is the commander of the Institute of Surgical Research at Brooke Army Medical Center in San Antonio.
COL. JOHN HOLCOMB, Commander, U.S. Army Institute of Surgical Research: I think there's been a number of advances on this battlefield compared to ones even 5 to 10 years ago, and they are not one single area. It's training, medical equipment, deployment of forces on the battlefield, all combined, body armor, so protection both in vehicles and on personal protection, that have come together to allow us to have the highest survival rate in any war we've ever been in.
Many factors led to improvement
TOM BEARDEN: One of the biggest changes is in the speed of transporting the wounded to the level of care they need.
It begins on the battlefield. Helicopters take the wounded directly to nearby combat support hospitals, like the 28th. But if a soldier needs more sophisticated care, they don't stay near the front lines very long.
Once stabilized, the wounded are loaded onto medical transport aircraft to take them to Landstuhl Regional Medical Center in Germany. These flying intensive care units carry up to 200 seriously injured soldiers.
DOCTOR: Welcome to Germany. We're going to take good care of you here.
TOM BEARDEN: If the person needs more care than even Landstuhl can deliver, patients are then flown directly to major military hospitals in the United States.
COL. JOHN HOLCOMB: The rapid evacuation we speak of now is from the hospital back to the United States. It's not unusual for soldiers who are severely injured to be back in the United States in two-and-a-half to three-and-a-half days.
DOCTOR: Lay back. Lay there. I'll be back.
TOM BEARDEN: Holcomb says survival rates have also improved because of a technological revolution that reaches down even to the front lines.
COL. JOHN HOLCOMB: There's ultrasounds on the battlefield for diagnostics, small, portable ultrasounds. There's oxygen generators on the battlefield. There are I.V. pumps in the battlefield, small, portable anesthesia machines, small, portable monitors on the battlefield.
We have CAT scans on the battlefield now at every combat support hospital. So you can approach in many respects the type of care we get back here to a level-one trauma center.
TOM BEARDEN: But some of the improvements have been far less high-tech. In the 1990s, studies showed that most battlefield fatalities were the result of uncontrolled bleeding, so doctors took a fresh look at tourniquets.
COL. JOHN HOLCOMB: The end result is there's been six million tourniquets sent to the battlefield. Every soldier, sailor and airman carries a tourniquet on their body, and medics carry multiple tourniquets on their body, and that really springs from better training.
TOM BEARDEN: Doctors also started treating bleeding from inside of the body, injecting a clotting agent called recombinant factor VIIa. It was first approved by the FDA to treat hemophilia.
Early on, some researchers and politicians questioned using it on injured soldiers, concerned about negative side effects. But after clinical trials began, the controversy subsided.
COL. JOHN HOLCOMB: It's an FDA-approved drug used in off-label fashion. If you step back from the controversy that's been generated largely in the media and look at an FDA-approved drug used in off-label fashion, 60 percent to 80 percent of the drugs we use everyday are used in exactly that fashion.
TOM BEARDEN: Factor VII is now routinely used in U.S. emergency rooms for people who have suffered massive blood loss.
Researchers at the Surgical Research Institute are trying to develop ways to increase survival rates even further. Jose Salinas says managing fluid intake for burn patients in transport aircraft is particularly challenging and particularly critical.
JOSE SALINAS, U.S. Army Institute of Surgical Research: It is a life-or-death issue. If you give the patient too much fluid, you're going to end up with complications that are life-threatening and possibly can lead to patient death. If you give the patient too little fluid, you'll end up with complications again that could lead to life-threatening situations.
TOM BEARDEN: So Salinas and his colleagues are conducting tests aiming to build a computer-controlled fluid monitoring system that will automatically adjust I.V. pumps as the patients' needs change.
JOSE SALINAS: The software basically looks at the EKG.
TOM BEARDEN: And Salinas is taking a fresh look at one of medicine's most traditional diagnostic tools: vital signs.
JOSE SALINAS: The classic example is blood pressure. Whenever you're in an accident on the highway or you get shot in Baghdad, the first thing they come to you and they do is they take your blood pressure. Unfortunately, blood pressure is not a very good indicator of what your actual status is after you get injured.
What we're trying to do is we're trying to develop technology that will look at those standard vital signs together with new and improved vital signs that will let us make much better predictions that are much more accurate and much more effective when it comes to treating trauma patients.
TOM BEARDEN: The military is also working on body-monitoring systems that soldiers can actually wear. Lieutenant Colonel Jeffrey Cain is a research physician at the Institute of Surgical Research.
LT. COL. JEFFREY CAIN, U.S. Army Institute of Surgical Research: Number one, it could identify the casualty on the battlefield who needs some type of medical intervention immediately. And that way we can come -- you know, the unit can then initiate some type of a rescue plan to get to that casualty.
On the other side of that, it can prevent unnecessary dedication of assets during a firefight. If somebody is hit and they are injured catastrophically or killed outright, you know, it doesn't make any sense to divert assets at that particular time in the operation to go to somebody who we cannot save or who is already dead. And that's a very critical piece of information to those tactical commanders.
War advances help out back home
TOM BEARDEN: Dr. Ernest Moore is the director of surgery and trauma services at Denver's public hospital.
DR. ERNEST MOORE, Denver Health Medical Center: All right, what's the good news for today?
TOM BEARDEN: He recently participated in the military's senior visiting surgeon program at Landstuhl where he helped treat wounded soldiers. He thinks procedures developed as a result of the Iraq conflict can be applied in civilian hospitals, too, particularly in the event of a terrorist attack.
DR. ERNEST MOORE: If, in fact, we encounter mass casualties in the United States, this type of transport and echelon of care can be directly applied.
And, of course, this also may have applicability to natural disasters, which we're all too familiar with in our country in the last several years. So I think the military can teach us a lot in triage and transport.
TOM BEARDEN: Advancements in treatment for the severely injured have historically occurred during wars. What's different this time is that there is a much more organized collaboration between the military and civilian establishments.
The goal is to push lessons learned on foreign battlefields into the larger medical profession as quickly as possible, saving the lives of both solders and their fellow citizens.
Ellie