- The Washington Times - Wednesday, November 19, 2003

A mineral powder that stops wounds from hemorrhaging. A bandage made of shrimp shells that seals cuts. Miniaturized ultrasound machines for instant diagnosis.

These and other medical inventions being used on battlefields in Iraq and Afghanistan no doubt will be available in coming years in an ambulance or emergency room near you. They will join innovations from previous wars, such as anti-malarial drugs and various antibiotics, that we have come to take for granted.

If combat is the mother of invention, however, hard scientific research is the father. War merely pushes developments along faster, according to historian Dale Smith, professor and chairman of the department of medical history at the Uniformed Services University of Health Sciences in Bethesda, who says that between 3 percent and 5 percent of mainstream medicine is derived directly or indirectly from warfare.

“The things we think of as coming out of the battlefield [from past engagements] like blood transfusions and penicillin all have their origins before war and have their first testing in an academic setting,” he cautions. “War pushes it because you have a need greater than the civilian experience and you have a lot of doctors being quickly educated on new ideas who might otherwise find out about them more slowly.

“You have system advances such as telemedicine and helicopter evacuation coming directly out of war, but the medical technology typically comes out of research. Laws exist to allow the military to use things ahead, but emergency utilization is not [the same as] a clinical trial.”

He cites the example of the drug Cipro, which was first used in the 1991 Gulf war for the potential threat of anthrax, even though it had not previously been studied as an anthrax treatment.

“It was an approved drug, but not for anthrax, but there was no reason to think it wouldn’t work,” Mr. Smith says. “The military sat down with the Food and Drug Administration to get emergency clearance. They looked at the data and said, ‘Yes, it’s better not to have a bunch of people die while we wring our hands.’”

The full effect of the innovations being used in Iraq isn’t yet known, Mr. Smith says. “We may have cut down on deaths from hemorrhaging, but nobody has tested this apart from the heat of battle.”

The inventions to treat wounds — emergency measures used on the front lines — did not exist in 1991’s Desert Storm or in Somalia in 1993, but they are vital aids for helping save lives. Frequently cited statistics show that nearly 80 percent of soldiers who are severely wounded in battle die in the first 10 minutes, prior to hospitalization, with blood loss a major cause of death. Hence the need for a way to treat excessive bleeding and for a bandage that would seal a wound.

The first of these inventions, a granulated mineral substance sold under the trade name QuikClot, has been cleared by the FDA for general use in an over-the-counter version to treat minor wounds, such as cuts and scratches. Z-Medica, a Connecticut company, first produced QuikClot in 1992. A much stronger dose was approved for use by Marine and Navy ground troops. When poured directly into the wound, the substance absorbs water out of the blood, and what remains clots very quickly, stopping the bleeding.

QuikClot is on display along with other artifacts from 20th- and 21st-century military conflicts in an exhibit open to the public at the National Museum of Health and Medicine at Walter Reed Army Medical Center, 6900 Georgia Ave. at Elder Street NW.

The second invention has similar absorbent qualities, but it is made of an entirely different material. Known as the chitosan bandage, it was derived from chitin, the main component in shrimp shells. Like many other emergency aids of this kind, chitosan was developed by a commercial manufacturer working in tandem with the military to meet a specific need. HemCon (short for hemorrhage control), a company in Oregon, makes the 4-inch-square bandage, which works primarily because the chitin, when treated, attracts red blood cells like a magnet and causes them to form clots. It was approved by the FDA last year for use in limited circumstances.

“The good thing about this dressing is that it is completely nontoxic and biodegradable,” notes Dr. Troy Johnson, a Marine Corps major who has written about battlefield medicine for the American College of Emergency Physicians.

Dr. Johnson describes another product currently in use. It is a synthetic opiate 100 times more potent than morphine and instantly effective for pain control. Marketed as Actiq by Anesta Corp. of Utah, the product already has been approved for treating cancer patients.

Used in combat, he says, the opiate — delivered by mouth — is a stopgap measure to alleviate pain when medical technicians are too busy attending other casualties to put in an IV.

“It gets absorbed through the mouth to the cheek and to the rest of the body,” he says.

As reported by Dr. Lynn Welling, a captain in the U.S. Navy Medical Corps and a specialist in emergency medicine, a miniaturized ultrasound machine smaller than a laptop computer is employed by some units on front lines today.

“Without it, we wouldn’t know except by clinical examination whether there is blood in the abdomen of injured soldiers,” he says. The instrument helps a medical team in a triage situation determine who are the most critical patients.

Portable digital X-ray units also are in use for diagnosis, according to Chuck Dasey of the Army Medical Research Office at Fort Detrick, Md.

Still another emergency aid available is a liquid decontamination lotion cleared this spring by the FDA for use by the U.S. military. Called Reactive Skin Decontamination Lotion or RSDL, the lotion can be applied to skin exposed to a chemical agent to remove or neutralize adverse affects of a toxic agent. To date, it has not been needed in Iraq.


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