Technology, compact tools put physicians in dust of battle

Changes in front-line medicine improve the urgent care given soldiers hurt in the Iraqi conflict.

By Victoria Stagg Elliott, amednews staff. April 14, 2003.

Modern war moves fast, but military medicine is determined to keep up.

Physicians and medical personnel are now relying on new tools and technology, even updated models of care, to improve battlefield treatment. Innovations have changed emergency medical approaches in this conflict, from first response at the moment a soldier is injured, through continued care at a field hospital and during transport to a European or North American medical center, as soon as 16 hours later.

Front-line treatment
Links
See related content

"The MASH kind of idea seen on television was really the beginning, and now we've advanced far beyond that," said Col. Jonathan Woodson, MD, a reservist who served in the first Gulf War and is based in Kuwait as the deputy commander of clinical services for the Army. "The improvements have been along several lines. The first has to do with training of personnel. The second has to do with the organization of care. The third has to do with the equipment, procedures, medications and operations that can be performed."

Soldiers are trained in basic first aid, and military medics are certified emergency medical technicians. In previous conflicts, medics had only combat first aid training. All medical personnel have received expanded training to include information about chemical and biological weapons and have access to protective gear and antitoxins. They also have new high-tech tools and medications that can stop bleeding faster than ever before.

On the macro level, the military has changed the system by which care is delivered. Front-line surgical teams, initially used on a small scale by the Army during the first Gulf War, are now an important part of every branch of the U.S. military.

"In the modern era where the battlefield is moving quite quickly, these forward surgical teams can move rapidly with the combat troops," said Dr. Woodson. "One of the major problems with medical facilities in prior wars and engagements like Desert Storm is that the hospitals were just too large to move with the fast pace of the battle."

90% of soldiers who died in previous wars did so before reaching medical facilities.

In comparison, these teams are nimble, with the ability to set up an operating theater in just about any structure. "It's a backpack surgical team, and they can be deployed to wherever they are needed," said Maj. Jeffrey A. Bailey, MD, an Air Force trauma surgeon and assistant professor of surgery at Missouri's Saint Louis University. "It may not be a hospital. It may be a house or whatever, but they have the equipment they need to perform a limited number of surgical interventions."

And when the injured get to the field hospitals, there are more specialists at the ready, including psychiatrists to respond to mental health needs and gynecologists to deal with the increasing number of women soldiers. These hospitals, temporary installations farther back from the front, are modularized so they can be easily expanded when surge capacity is necessary or reduced when the need is not so great.

"The goal is to deliver the same kind of state-of-the-art and technologically advanced medical care, just closer to the combat zone," said Lt. Cmdr. Joel Hardin, MD, a Naval reservist and director of the cardiac intensive care program at Illinois' University of Chicago Children's Hospital.

At each stage of combat-zone medical care, patients receive enough treatment to stop the bleeding and be stabilized. The major reparative surgery waits until patients are transferred to a hospital in Europe or North America. The transport is made possible by planes and helicopters outfitted as mobile intensive care units. In the past, injured soldiers would have remained in medical care facilities close to the front.

"It used to be really impossible to evacuate sick people out of theater and care for them in the process without having their condition deteriorate," Dr. Woodson said.

The restructuring, new tools and advanced training were implemented to improve soldier survival rates. Historically, up to 90% of those who died did so before reaching a MASH unit or other medical facility for emergency care. This number has remained unchanged for nearly a century. That's why medical response is now focusing on providing immediate and more specialized treatment to improve survival odds.

Forward surgical backpack teams can set up operating theaters quickly.

Although the most common images of wartime wounds are those caused by bullets or shrapnel, military physicians are quick to note that they have to deal with a variety of injuries.

The most common traumas, for instance, come from motor vehicle crashes. Other dangers include dehydration, particularly in Iraq's hot sun and desert conditions, diarrhea caused by unclean water, fungal or bacterial infections caused by living conditions that may not be hygienically ideal, and, because of the presence of women, pregnancy.

"What soldiers and sailors do, particularly in time of war, is inherently dangerous and results in accidents," Dr. Woodson said. "We see regularly appendicitis, respiratory illnesses, pneumonias, and noncombat trauma, you name it."

Besides caring for soldiers, most of whom are young and healthy, medical teams are also responsible for civilian contractors who provide services to the military. These people are sometimes older and may have chronic medical conditions such as diabetes or hypertension.

"We've had to make sure we can respond to a whole range of medical problems that might present at any stateside hospital as well as the unique features of a battlefield," said Dr. Woodson.

And, although significant changes -- hopefully improvements -- have been made, experts concede that cutting mortality among soldiers is not necessarily a medical solution.

"Get it over with," Dr. Hardin said. "Decisive action and a rapid conclusion is the easiest way to keep the casualties down."

ADDITIONAL INFORMATION:

Front-line treatment

The factors making military medicine more agile:

Soldiers have more first aid training; medics are certified as emergency medical technicians.
Medical teams including physicians are close to the front; can respond within minutes.
Medical teams are mobile and carry most equipment in backpacks or on easily moved palettes.
Technology such as improved bandages, new chemical substances and a one-handed tourniquet may reduce traumatic injury mortality.
Medical personnel are prepared for biological or chemical attacks.
Field hospitals are modularized; size can be expanded or reduced depending on need.
Transport helicopters and planes can be mobile intensive care units.