Medics armed with new technology
by Jennifer Whittle
U.S. Special Operations Command Public Affairs
03/10/03 - MACDILL AIR FORCE BASE, Fla. (AFPN) -- When special operations forces medics returned from an Operation Enduring Freedom mission in 2002, they said they needed blood-clotting technology, according to the U.S. Special Operations Command surgeon. Now they have it.
"They needed something to stop hemorrhaging. And they wanted a more accommodating tourniquet. And we sat across from them and listened," said Col. David Hammer.
Today, the medics are armed with a one-handed tourniquet and a hemostatic bandage that can stop severe bleeding within two minutes.
"This bandage will have a direct impact on reducing battlefield death," said Hammer. "It has such a potential that the Food and Drug Administration is allowing SOF medics to use it in accordance with stringent guidelines under an 'investigational new drug' status."
According to Hammer, medics like Col. (Dr.) John Holcomb saw similar wounds during operations in Mogadishu, Somalia, in 1993.
Holcomb, who now commands the Institute for Surgical Research, witnessed battlefield trauma and uncontrollable bleeding. He said he felt the frustration. Back then a bandage to stop uncontainable bleeding was forecasted for 2007. Now, these bandages are available.
There are two types of blood-clotting bandages -- chitosan and fibrin, according to Master Sgt. Michael Brochu, senior enlisted adviser to Hammer.
"The chitosan product is FDA-approved, but the manufacturing process is still being refined," he said. "It is actually a derivative from shrimp shells, so you can imagine factory standards for its production." These bandages will cost about $100 each.
"The fibrin bandage, on the other hand, is impregnated with human blood-clotting factors in the material," Brochu said. "When applied to a wound, it actually becomes part of the blood clot. The FDA approved (new drug) protocols for SOF use because we have a smaller populace, meaning the bandage would be more manageable, more accountable and used with specialized care."
"It is important for folks to understand that we are not interested in using experimental medicine on our troops, Hammer said. The (investigational new drug) label from the FDA has strict guidelines, and all ... medics must use those guidelines in accordance with the FDA. Our medical personnel control this bandage like a narcotic."
When special operators are in a tactical situation, they wear Kevlar body armor, according to Bruchu. But, Kevlar is not foolproof.
"It leaves three areas exposed: the neck, underarm and groin," he said. "If one of our special operators (is) hit in any of these three areas, the bleeding can be so severe that hemorrhaging and even death could result. SOF normally operate in remote areas, where a hospital is hundreds and hundreds of miles away.
Traditional methods to stop bleeding are pressure and gauze battlefield dressings, Brochu said.
"SOF medics are to use these steps first. If the bleeding persists, the wounded troop is informed about the fibrin bandage before its use. Then the bandage is applied to the wound, and after about two minutes with pressure it actually seals the hole and clotting begins. The fibrin bandage takes advantage of one's own ability to clot. The bleeding stops, (and) the troop's chances for survival have greatly increased," he said.
This technology is available because senior military leaders went to Congress after understanding what the medics needed. Congress replied with $8.2 million to accelerate the fielding of the fibrin bandage.
"Humans are more important than hardware," said Hammer.
About $500,000 is invested into training each special operator for war, according to Brochu. The $1,000 fibrin bandage becomes a precious commodity on the battlefield to protect that investment.
For more than a decade the command's biomedical initiative steering committee has listened to special operations medics returning from tactical situations.
"We bring the four component commands' surgeons to the table," said Robert Clayton, biomedical research and development coordinator. "We look at the issues laid out by our SOF soldiers, sailors and airmen who practice medicine. Then we push technology toward real fixes."
The one-armed tourniquet is a real fix. Two hands applying a tourniquet in the middle of a battle is one hand too many, Brochu said.
"Nothing stops for our troops in a tactical situation," he said. "Nothing. Not the mission. Not the weather. Not the defense. Anything that saves time can save a life."
"We're using technology that is better than anything anyone has ever seen before," Hammer said. "Our SOF medics are helping to rewrite trauma care.
"What we're getting to (the) troops ... solves our unique mission requirements because when special operators are out there -- there is not timeout."
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