Perhaps the most significant lifesaving advancement in combat medicine in Afghanistan and Iraq was refinement of tourniquets and training to keep wounded troops with shattered or missing limbs from bleeding out.
Another notable gain was faster medical evacuations of the wounded to reach increasingly higher levels of care, thanks to enhanced communication and transport capabilities, said Navy Rear Adm. Bruce Doll, director of research, development and acquisition for the Defense Health Agency.
Those advances in theater medicine, as with most gains involving military medical research, relied on collaboration — between branches of service, between allied forces and between military and industry, Doll said.
To reinforce the need to share lifesaving and health-inducing ideas, the Defense Health Agency last month hosted a four-day symposium in Fort Lauderdale, Florida. Government and private-sector experts discussed continuing progress against signature wounds of recent wars, infectious diseases and operational hazards.
“It’s all about our discovery, development and delivery” of products to better care for service members, to make them more resilient in whatever environment they operate and, for the severely wounded, to restore quality of life as best as possible through timely care and rehabilitation, Doll said.
At this year’s symposium, Dr. Jonathan Woodson, assistant secretary of defense for health affairs, noted that 19 percent of battlefield deaths in recent wars were potentially survivable, having involved no mortal head or cardiac wounds or complex body disruption. The top cause of death in three-quarters of these preventable fatalities was hemorrhaging, he said.
So despite gains, more research is needed in combat casualty care, Woodson said, to be able to field even better products and improve training.
For Doll, the 19 percent represents “a mandate to improve our delivery of care.” Though increasing “survivability in the face of severe wounds is a challenge,” he said, for researchers it must remain “a very high priority.”
Spending on military medical research, including combat casualty care and traumatic brain injury treatment, has leveled off. The Defense Department’s annual medical research budget, to include spending on medical information technology, has averaged $1.37 billion over the last five years.
Given tighter budgets, it’s increasingly important that Army, Navy, Air Force and outside partners not move separately down the same research paths, unaware of progress made elsewhere. Doll’s goal is to prevent such overlaps as a “shared services” directorate under the 2-year-old Defense Health Agency. It exists to coordinate research that benefits any military member while acknowledging that expertise resides in each service.
The goal “is all about support to the services” in advancing collaborative, innovative research, he said. But to do so better, “we agree among the services there are certain practices we can consolidate.”
His agency is developing a database of research across defense components “to make sure that everybody knows what everybody is doing,” Doll said. He compared it to a catalog of expenditures and results that National Institutes of Health publishes for all NIH-funded projects.
“The economies of scale that come from this constant awareness of products being developed — and where the experts are — is something we are committed to enhancing” to improve care delivery to ill or injured and to assist (a) wounded service member in achieving optimal performance in any mission environment.
“We understand that every service has certain unique areas” of expertise such as undersea medicine for Navy. In those areas “we’re not looking to do anything but assist,” Doll said. “They do it well.”
But every service member bleeds, he said. So his directorate is coordinating research to address those deaths from hemorrhaging.
“To the extent we have those types of projects, beneficial to all the services, we look to fund those and to do so consistent with the priorities that we review every year,” Doll said.
The U.S. military estimates that more than 300,000 service members have suffered some traumatic brain injury since 2001. About 82 percent of those cases are categorized as mild. But researchers are committed to finding better ways to diagnose and treat a traumatic brain injury, from using protein markers to detect these types of injuries to more closely tracking any long-term effects.
Other priority research is focused on improving trauma care, advancing operational medicine, fighting infectious diseases and regenerating skin and organs. The research is almost always collaborative with other agencies or outside experts. But for the Pentagon the purpose is always the service member.
“That’s the broad focus on all these topics: How does this map back to individuals on the front line who are performing the mission,” Doll said.
The U.S. military “does not lay claim to the best in its own environment of research and development. But what it does do very well, through organizations like NATO or individual nation relationships …is to look for collaboration, look for areas of expertise resident in countries that we can partner with,” Doll said.
For example, the efforts of Scandinavian countries to optimize performance in cold-weather environments “become something we can learn from them and, together, move forward.”
Given the number and severity of injuries in Iraq and Afghanistan, however, the U.S. military has led in developing tourniquets, medical evacuation techniques and critical refinements to trauma care.
As the wounded “are moved back from the site of injury,” Doll said, “their care is improving in terms of technology and expertise brought to bear” at every stage. “As wounded are flown at relatively high altitudes in pressurized cabins, delivery of oxygen has to be tweaked.”
Because transport aircraft are noisy, however, medical evacuation teams have learned to adjust oxygen using visual rather than audible alarms.
Other advancements have involved precision medicine, such as the monitoring of protein levels to detect if a patient is still fighting infection or has entered a reparative state appropriate for closing a wound, Doll said.
Many young researchers at last month’s symposium learned how their work might help wounded service members. Doll said he hopes another lesson learned is that, in conducting research “you can go fast by yourself, but if you go together you can go a lot farther.”
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