From the classroom to the fight: Preparing for surgical care on the battlefieldBringing expeditionary resuscitation and surgical teams directly to the battlefield reduces time and distance, increasing chances for survival. Made up of experienced surgeons, physicians, and nurses with specialties ranging from general surgery to emergency room care, the teams are equipped to provide crucial surgery procedures out in the field. (U.S. Air Force Photo by Staff Sgt. Kyle Brasier)
For surgical care on the battlefield, the difference between life and death comes down to time, resources, and training. Preparing for the unique circumstances of an austere setting can pose a challenge for the most experienced health care professionals used to working in hospital settings. But thanks to research advancements in surgical care training, realistic preparation for surgery in a war zone has improved.
Downrange surgical care has improved the survival of combatants as the specialty has grown over the last 15 years of war, said Army Reserve Maj. Matthew D’Angelo, assistant professor and interim associate dean for faculty affairs at the Uniformed Services University of Health Sciences’ Graduate School of Nursing
“We know surgical care saves lives, but unfortunately there’s a barrier of getting those injured folks into the clinical setting,” said D’Angelo, speaking at the Military Health System Research Symposium Aug. 27.
Bringing expeditionary resuscitation and surgical teams directly to the battlefield reduces time and distance, increasing chances for survival. Made up of experienced surgeons, physicians, and nurses with specialties ranging from general surgery to emergency room care, the teams are equipped to provide crucial surgery procedures out in the field.
Since competency of skills can be context-related, being successful in a modern hospital setting may not translate into the same success in an austere environment, said D’Angelo. The curriculum is designed to educate and help health care providers adapt to a tactical setting. The team is trained to perform resuscitation, damage control surgery, triage and emergency room care, critical care transport, and prolonged field care.
“They work in a brick-and-mortar facility, so there are some challenges to these types of teams,” said D’Angelo. “How do we take someone who is from a military treatment facility and orient them to the austere locations?”
To help teams learn to work together quickly and adjust to the special operations forces mission, MEDCOM reached out to the U.S. Army Medical Department Center and School. Its division of predeployment medicine came up with a 21-day training platform. The program is broken down into eight days of pre-requisite ERST training and 13 days of ERST training. The first seven days of ERST training focuses on equipment and team development. The last six days are primarily field exercises, which allow teams to work hands-on with equipment in a tactical setting.
Calling the curriculum “developmental,” D’Angelo described the scenario- and problem-based training experienced by students at Joint Base San Antonio, Texas. As the course’s difficulty gradually builds each day, teams face more challenges and must work together.
From the clinical side of surgical care, experts provided updates on current research to address various aspects of surgical procedures. Navy Lt. Luke Johnson, a general surgery resident at Walter Reed National Military Medical Center, said the goal of his project was to look at the use of tranexamic acid, or TXA, for traumatic combat injuries.
By the end of the study, all massive transfusion patients were given the solution. The data show TXA was successful, but overusing it can increase risk for complications. Researchers continue their search for solutions to curb excessive bleeding in traumatic combat injuries and to reduce the risk of complications.
The Military Health System Research Symposium brings together medical providers, researchers, and senior leaders to share research and health care advancements. The symposium highlights research for combat casualty care, operational medicine, clinical and rehabilitative medicine, and infectious diseases.
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Training, Technological Synergy Likely the Key to Future Battlefield Care ScenariosSoldiers from the 15th Brigade Support Battalion out of Fort Hood, Texas, provide treatment to the "wounded" during a mass casualty exercise, March 2, 2015. The training, taking place on Fort Irwin, California, is part of a National Training Center rotation scenario testing their ability to perform under a simulated combat environment. (Photo Credit: G. A. Volb)The first slide on the screen during Maj. Doug Powell's panel presentation on prolonged field care at the 2017 Military Health System Research Symposium in Kissimmee, Florida, features a blank, colorless slate without any pictures, graphics or images. Instead, there's just a single quote.
"It's not about the technology," the slide reads, "It's about the people."
For Powell and the rest of the investigators diving head first into the Army's newly-retooled commitment to prolonged field care–the number one capability gap according to a recent Army Capabilities Needs Analysis–the quote doubles as both a mantra and a mission statement.
"We carry around one of the greatest and most powerful computers of all time in our pockets every day," said Powell, holding up his cell phone to the audience, "and we use it to play 'Candy Crush.'"
He added, "We can do better."
Given that desire for a more complete, more mature fusion of technology and Warfighter, Powell's presentation focused chiefly on the burgeoning telemedicine requirements for prolonged field care in future battlefield scenarios. Products that are flexible, scalable, reliable and convenient are specifically targeted for deployment in the dense, urban settings that experts say will likely dominate combat environments in the coming years.
The presentation highlighted advanced development efforts such as an Air Force Pararescue-Jumper project called BATDOK (Battlefield Airmen Trauma Distributed Observation Kit), which is a cell phone application intended for use on Android platforms. Wireless sensors placed on the patient send aggregated vitals to the computer screen, providing PJs the ability to make emergency medical decisions. Like a cell phone, the device can be set for three kinds of alerts: Auditory, tactical or visual. The alerts notify the PJ not only to which patient is in danger, but also his or her vitals.
Situational awareness for receiving field hospitals is also important to provide medical staff on the ground with information that can help them prepare to receive and immediately treat patients. This need is being addressed by an advanced development effort at the U.S. Army Medical Research and Materiel Command called the Medical Hands-free Ultra-wideband Broadcast system. The MEDHUB's distinction is its patient care focus and operational situational awareness capability. The goal is to keep the medic or flight paramedic focused for performing life-saving tasks for multiple patients, unencumbered from documentation. The MEDHUB is designed to automatically capture, store and forward data to the receiving field hospital -- without adding any burden to the medic. Key components are individual wearable vital sign monitors that record vitals and provide littered or ambulatory status through accelerometers; peripherals to capture patient weight; and an end-user device, such as a tablet or phone, that captures and stores the data.
"Prolonged field care is not a skillset. It's a situation you find yourself in," said Lt. Col. Andre Cap, Chief of Blood Research at the U.S. Army Institute of Surgical Research in San Antonio, Texas.
For Cap, the synergy of man and machine in future far-forward environments isn't complete without first addressing the existing training gaps in the prolonged field care discipline. To that end, concepts such as a dedicated emphasis on critical care techniques and prolonged resuscitation efforts are incorporated into current medical training regimens. Additionally, leadership has instituted a pilot program focused around those concepts at Fort Bragg, North Carolina.
"We are still fighting the new war with the tools from the old war," said Cap, "and that has to change."
Both Cap and Powell say that moving forward current capabilities gaps in prolonged field care will include a dedication to the concept of universal interoperability among technological devices, as well as the development of an on-demand, on-call marketplace for continuous communication regardless of location.
Still, the immediate focus remains on strengthening current training, development and execution processes, all while paying special attention to the integration needed to succeed on the future battlefield.
Said Powell, "Whatever we eventually give to the people in the field, I want to make sure it works with what they already have."
The MHSRS is the DoD's premier scientific annual meeting, which combines three previous conferences, including the former Advanced Technology Applications for Combat Casualty Care Conference; the Air Force Medical Service Medical Research Symposium; and the Navy Medicine Research Conference. By combining these conferences into one event, the meeting serves as a critical strategy session for leaders to set future milestones for the Department of Defense's deployment-related medical research programs, centered on the needs of the Warfighter.
Disclaimer: Re-published content may have been edited for length and clarity. Read original post.
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The Development of a Nanofibrous Scaffold for the Recruitment of Fibroblast During Wound HealingPhoto By Katherine Berland | Dr. Tony Yuan from Naval Medical Research Unit - San Antonio presented a poster on the development of a nanofibrous fibrinogen-chitosan scaffold for the recruitment of fibroblasts during wound healing at the Military Health Systems Research Symposium, Kissimmee, Florida, August 29. (U.S. Navy Photo/Released/Katie Berland)KISSIMMEE, Florida – A researcher from the Naval Medical Research Unit – San Antonio (NAMRU-SA) shared findings on the fabrication and characterization of a novel nanofibrous scaffold that could potentially improve wound healing by enhancing wound closure, promoting hemostasis, and acting as a temporary physical barrier against debris and microbial pathogens during the Military Health System Research Symposium (MHSRS), August 27 – 30.
“Combat wounds are a unique challenge to the military health system,” said Capt. Jonathan Stahl, Principal Investigator, Craniofacial Health and Restorative Medicine, Biomaterials and Epidemiology Department. “Extended evacuation times, unique infections, and the complexity of wound injuries can greatly complicate the wound healing process and significantly worsen patient prognosis.”
Stahl and a team of researchers developed a polymer nanofiber scaffold produced from naturally available polymers by using a high-voltage fabrication technique called electrospinning. In addition to the nanofibrous scaffold, a biological functional growth factor was incorporated as a method to improve cellular recruitment during wound healing. Through the results of the research, it was demonstrated that it was possible to significantly improve cell function and recruitment by using the scaffold.
“Overall, electrospun scaffolds such as this one are promising candidates for the development of advanced, specialized wound dressings for clinical use. This has the potential to reduce hospital stays and increase the rate of warfighters returned to service after injury,” said Stahl.
The research findings suggested a higher cellular migration can be promoted through the release of a (blood) platelet-derived growth factor (PDGF) from a nanofibrous scaffold. According to Stahl, PDGF is an important first step in the development of a wound dressing capable of improving cellular recruitment at the site of healing, which could potentially lead to faster wound closure and better patient outcomes in terms of aesthetics and function.
MHSRS is the Department of Defense's (DoD) premier scientific meeting; a unique collaborative opportunity for military medical care providers, DoD scientists, academia and industry to exchange information on research advancements and health care developments in the areas of combat casualty care, military operational medicine, clinical and rehabilitative medicine and military infectious disease research program.
The Naval Medical Research Center’s eight laboratories, including NAMRU-SA, are engaged in a broad spectrum of activity from basic science in the laboratory to field studies at sites in austere and remote areas of the world to operational environments.
In support of the Navy, Marine Corps, and joint U.S. warfighters, researchers study infectious diseases; biological warfare detection and defense; combat casualty care; environmental health concerns; aerospace and undersea medicine; medical modeling, simulation and operational mission support; and epidemiology and behavioral sciences.
NAMRU-SA’s mission is to conduct medical, dental, and biomedical research, which focuses on ways to enhance the health, safety, performance, and operational readiness of Navy and Marine Corps personnel and addresses their emergent medical and dental problems in routine and combat operations.
Disclaimer: Re-published content may have been edited for length and clarity. Read original post.
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