The Combat Casualty Care Program brings together world-class scientists, clinicians, and engineers from the University of Michigan, and pairs them with industry partners and entrepreneurs to develop and deploy cutting-edge solutions that elevate the care, outcomes, and quality of life of critically injured warriors.
Hemorrhage is the leading cause of preventable death for both battlefield and civilian trauma. Due to increased use of IEDs on the battlefield, many victims sustain multiple injuries, causing catastrophic bleeding. Of particular challenge is controlling hemorrhage in areas of the body that are difficult to compress such as the abdomen, chest, neck, axilla, and groin.
MCIRCC researchers have played a significant role in developing and testing hemostatic strategies that have been deployed in the battlefield as well as those that are envisioned to become next generation products.
- New Tourniquets and External Compression Devices
- Hemostatic Materials and Bandages
- Endovascular Hemorrhage Control Devices
Physiologic Monitoring and Clinical Decision Support Systems
The scope and severity of battlefield injuries, as well as the rapid movement of casualties by ground and air in austere environments pose significant challenges for monitoring patients.
The use of traditional vital signs such as blood pressure, heart rate, respiratory rate, and temperature have very limited value in helping health care providers determine the severity of injury and guiding therapy. An additional challenge is aggregating health care data (physiologic, laboratory, etc.) and optimally using it to improve diagnostic and therapeutic accuracy or to monitor the patient’s physiological status.
Our teams of clinicians, physiologists, engineers, and data scientists are creating the next generation of deep physiological vital signs and monitors, as well as big data clinical decision support algorithms that will allow for precision diagnoses and care for the severely wounded.
- Noninvasive cardiovascular monitoring
- Noninvasive tissue oxygenation monitoring
- Point-of-care coagulation-inflammation-redox monitoring
- Multiparametric clinical decision support systems
Resuscitation and Tissue Salvage
Resuscitation is a complex process of providing the body with certain essential elements, such as oxygen and fluids, to prevent cardiovascular collapse and organ failure. It is also usually necessary during and after surgery, to optimize organ function and survival. Most severely wounded warriors require resuscitation in order to survive long enough to reach definitive surgical care, however the ability to provide resuscitation to multiple severely wounded individuals on the battlefield poses overwhelming logistical challenges.
Our researchers have been instrumental in testing new resuscitation strategies and are developing low volume (weight) resuscitation and other modalities, which enhance tissue survival and healing, reduce bleeding, prevent infection, and reduce pain.
Acute Life Support
Despite having definitive surgical repair and resuscitation of initial combat injuries, casualties on the battlefield continue to occur for a number of reasons. From associated injuries that cannot be surgically repaired (e.g. severe lung damage), to developing states of overwhelming inflammation as a consequence of resuscitation, or from injuries such as burns, survival is only possible by supporting vital organ function until tissues heal and inflammation resides.
Our researchers are developing innovative technologies that support vital organs such as the respiratory, cardiovascular, and renal systems. Several of these technologies incorporate advanced control approaches, which attempt to develop closed-loop systems. These systems take multiple physiologic inputs, and use them to provide precision acute life support to the individual.
Traumatic Brain Injury
As a signature injury of the war over the last decade, severe traumatic brain injury (TBI) represents one of the most challenging injuries to treat. Little progress has been made in the treatment of TBI over the last 30 years, whether at home or on the battlefield. While there are many reasons for this, ranging from the lack of monitoring capabilities to the innate inability of the brain to repair itself like other organs, the challenges of caring for TBI patients are only compounded by the austere conditions of the battlefield.
Our researchers are re-examining how severe TBI is diagnosed, monitored, and treated by leveraging new models, therapeutics, devices, and diagnostics in parallel, rather than using the prevalent “silver-bullet” approach.
Acute Rehabilitation Engineering
Many seriously wounded warriors require weeks to months of intensive care to immobilize their bodies. This type of immobilization can result in long-term muscle loss and weakness, and may even cause immune system dysregulation, making victims more prone to future infection. Prolonged immobilization can also result in complications such as deep venous thrombosis, pulmonary embolisms, bedsores, and pneumonia.
While early mobilization has been demonstrated to counteract many of these complications, such an approach is not scalable and cannot be carried out in the most severely injured, especially as they rapidly move across echelons of care.
Our researchers are developing new approaches to automated and precision rehabilitation, and other countermeasures that will leave patients stronger, and reduce complications from prolonged immobilization.