Battlefield Medical Advances
May Save Wounded Soldiers

Ten years ago, 18 U.S. Army Rangers and Special Operations soldiers died in a vicious firefight on the streets of Mogadishu, Somalia -- several from blood loss incurred while pinned down and unreachable by medical-evacuation teams.

In the intervening decade, military doctors and tacticians have taken a fresh look at battlefield medicine, hoping to apply new technologies and updated trauma procedures to save the lives of wounded U.S. troopers. Years of such research may be on the verge of paying off.

Thanks to improvements ranging from high-tech, fast-clotting bandages to low-tech tourniquets, the capabilities of field medics "have really undergone a revolution in the last few years," says Col. John Holcomb, head of the Army's Institute of Surgical Research in San Antonio. That bodes well for U.S. troops that might be wounded in Iraq, particularly if urban combat breaks out in Baghdad, Basra or other cities.

Hemorrhage is the largest preventable cause of death among U.S. soldiers in combat, historically accounting for roughly half of all such fatalities. Until recently, techniques for controlling bleeding hadn't improved substantially since the Civil War. Typically, a medic or a fellow soldier would slap on a cotton gauze bandage while elevating and compressing a wound -- a chancy procedure in the best of circumstances, and particularly trying in the face of enemy fire.

During the past several years, however, the U.S. military has funded substantial research into bleeding-control techniques, leading to two types of quick-clotting bandages. Both are available to U.S. forces in the Persian Gulf, although in limited quantities.

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The first, developed jointly by Army researchers led by Col. Holcomb and the American Red Cross, involves a bandage coated with fibrinogen and thrombin, two clotting factors found naturally in human blood. When the bandage is applied to a wound, the factors combine to form fibrin, the major component of a blood clot.

Scientists at the Oregon Medical Laser Center in Portland, Ore., have devised a similar bandage that works in a completely different way. Working under a military research grant, scientists at the laser center found that chitosan, a sugary molecule that helps bind the outer shells of shrimp and other crustaceans, also seemed to promote the formation of blood clots.

Kenton Gregory, the head of the laser center, says that when positively charged chitosan molecules are fixed to a bandage, they attract negatively charged red blood cells, helping them clump together into a solid clot. Army researchers believe the chitosan simply may stick to wounds and seal them shut.

Both bandages "work very well" at quickly stopping serious hemorrhages, Col. Holcomb says. Neither, however, is widely available. Only 1,200 or so of the Army-Red Cross bandages have reached U.S. forces in the Gulf. And HemCon Inc., an Oregon start-up that produces the chitosan bandage, so far has shipped fewer than 1,000 bandages to the military's Special Operations Command at Fort Bragg, N.C., and probably will take several months to fill an Army order for 20,000 bandages, HemCon Chief Executive James Hensel says.

The new bandages aren't cheap. Individuals familiar with the fibrin bandages say they cost $1,000 apiece; Red Cross and Army officials declined to comment. HemCon's bandages cost $99 apiece, Mr. Hensel says.

FIRST AIDS How some new battlefield-medicine techniques for wounded soldiers work: • Fast-clotting bandages: Human blood-clotting factors or chitosan molecules impregnated in bandages speed clotting.   • Clotting powder: A porous mineral absorbs water from blood and concentrates blood-clotting factors.   • One-handed tourniquet: Nested loops of fabric with a pull-cord can be self-applied.   • Intraosseus infusion device: A needle plunged into the sternum's bone marrow infuses fluids.

The U.S. Marine Corps, meanwhile, has embraced another fast-clotting product altogether, a powder called QuikClot produced by closely held Z-Medica LLC of Newington, Conn. Composed of tiny, porous zeolite particles that resemble pumice, QuikClot is designed to suck the water molecules out of blood, thus concentrating natural clotting factors at the site of a wound to control bleeding.

At less than $20 for a 3½-ounce packet, QuikClot is relatively cheap, although it has one major drawback: It can sometimes absorb water molecules so quickly that it generates a noticeable amount of heat. Navy Lt. Cmdr. Joseph DaCorta of the Marine Corps Warfighting Laboratory in Quantico, Va., says he takes reports of that problem seriously, although his lab hasn't been able to duplicate it. Bart Gullong, vice president of Z-Medica, says the company warns users to avoid the heating problem by keeping the product dry.

While the Marines have deployed QuikClot in roughly 15,000 first-aid kits in the Persian Gulf, individual Marines are instructed to use the powder only if traditional bandages and tourniquets have failed to control bleeding, Cmdr. DaCorta says. Z-Medica also has sold 30,000 units of QuikClot to the Army, Mr. Gullong says.

Other battlefield innovations aren't quite so high tech. Tourniquets, for instance, can prevent soldiers with wounded or severed limbs from bleeding to death, but generally require the assistance of another soldier or a medic to apply. So military researchers recently designed a one-handed tourniquet -- two nested loops of webbing with a handle that can cinch them around a limb -- that has since been deployed to almost 20,000 U.S. soldiers.

Field medics also have new tools for treating dangerously low blood pressure brought on by blood loss. One such device is an injector produced by Pyng Medical Corp. of Canada that punches a hole in the sternum so saline and other fluids can be rapidly infused into the bloodstream via the bone marrow. This method, known as intraosseous infusion, is useful when blood loss makes it difficult for medics to pump fluids intravenously.

Researchers continue to look for more advanced techniques to prevent battlefield deaths, although many are years away from regular use.

Army surgeons, for instance, are studying genetically engineered Factor VII, a clotting factor used to treat hemophiliacs, as a drug to slow wound bleeding. Factor VII has been deployed in military field hospitals in Afghanistan and the Persian Gulf, although it hasn't been approved for this use by the Food and Drug Administration. Like their civilian counterparts, military doctors are free to use Factor VII for such "off-label" purposes.

On a more futuristic level, soldiers may one day have a "911 button" that would signal medics with their position when wounded. Other future gadgets could include medical foams or gels that can be injected to stop abdominal bleeding or computerized ultrasound devices that can locate and sonically cauterize internal wounds.

Write to David P. Hamilton at david.hamilton@wsj.com

Updated March 20, 2003

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