War and Medical Innovation
Wartime medicine is an incredibly challenging setting for those who practice it. Not only are the injuries frequently serious, but the tools at hand are often more limited than in a traditional hospital. Over time, that has meant that medical personnel have had to innovate. These innovations, in turn, often serve to refine medical practices beyond the military.
During the last decade of the War on Terror (Operations Enduring and Iraqi Freedom), several important medical and surgical innovations created for these conflicts have found their way into everyday civilian trauma, emergency, and critical care practice. These range from the creation of new bandages, devices, and transfusion protocols to control life-threatening hemorrhage, to new operative and surgical care models which improve a trauma victim’s chance of survival. The University of Michigan not only uses these innovations today, but continues to play a significant role in developing these and other technologies that will be used to save lives on the battlefield and at home.
Two critical differences and challenges face the wounded warrior in battle compared to the injured civilian at home. The first is the severity and type of injury incurred. Injuries produced by high velocity munitions and explosions can result in multiple amputations and traumatic brain injuries that are not commonly experienced off the battlefield.
The second is the fact that there is no “Golden Hour” on the battlefield. The Golden Hour concept developed and practiced by the civilian trauma community holds that trauma victims have the best chance of survival if they begin receiving their care at a definitive trauma center within one hour of their injury. However, in battle, rapid care and transport to a definitive surgical facility cannot be guaranteed for many reasons, from terrain, to weather, to active combat conditions. In the Special Operations community, definitive care could be several days away. These unique circumstances make it imperative that sophisticated life-saving care is made available to the injured within an hour, despite the location of the victim.
Turning Challenges into Opportunities
While advances in combat casualty care and training have helped significantly reduce current battlefield mortality and morbidity, many opportunities remain. The challenge is the inability to predict with certainty, the landscape of future conflicts, which could range from moving from the desert and mountainous environments of Iraq and Afghanistan to the tropics of South America or Asia, or advancing small tactical operations at a growing number of locations to conducting combat operations in mega-cities. This unpredictability will require a new generation of adaptive tools and devices that can be deployed in the battlefield, which is why MCIRCC developed its Combat Casualty Care Program.