The advances made in military medicine since Sept. 11 – from point-of-injury treatment to lifelong rehabilitation and care – are unequaled in the history of warfare, which has always been a major driver in medicine and technology.
Major advances in both personal and vehicular armor, combined with significantly advanced battlefield care from advanced Warrior Medics and far forward surgical teams, have led to the lowest killed in action numbers of any war since the beginning of human conflict.
At the same time, those surviving warfighters who would have died on any previous battlefield are returning from combat with far more extensive injuries to hands and arms, feet and legs, vision and hearing. Burns, especially to the face, also have been more prevalent, as has damage to the teeth. While advanced helmets have prevented many once-common head wounds, concussive force damage has become a signature injury in Southwest Asia.
It is the job of the Military Health System to treat all of those, from point of injury in combat to often extensive repair, recovery, and rehabilitation back in the United States. Eventually, all surviving wounded warriors will leave active duty, at which point the Department of Veterans Affairs (VA) takes over their health care and, as needed, continued rehabilitation for the rest of their lives.
More so than any other conflict, this war has forged closer and more extensive ties between the Department of Defense (DoD) and VA health care, from research and development to clinical trials to providing the best possible “reset” of even the most severely wounded to the most functionality medically possible. That is a commitment that never ends, so each new advance will be made available to further improve the lives and abilities of the nation’s now greatly expanded veteran population. That population includes, also in record numbers, members of the Reserves and National Guard, as well as all military family members.
Those leading the way in advancing the technologies and procedures at the cutting edge of medical technology include the U.S. Army Medical Research and Materiel Command (MRMC), Army Medical Department (AMEDD), Army Institute of Surgical Research(ISR), Army Dental and Trauma Research Detachment (DTRD), National Alliance for Eye and Vision Research (NAEVR), MRMC’s Clinical & Rehabilitative Medicine Research Program (CRMRP) and Telemedicine and Advanced Technology Research Center (TATRC), DoD/VA Vision Center of Excellence (CoE), Armed Forces Institute of Regenerative Medicine (AFIRM), Center for the Intrepid, Orthopaedic Trauma Research Program (OTRP), Uniformed Services University, Veterans Health Administration (VHA), Defense Advanced Research Projects Agency (DARPA), Office of Naval Research (ONR), Navy Bureau of Medicine & Surgery (BUMED), National Institutes of Health (NIH), and the Army Wounded Warrior Transition Command.
While the Army, with the most warfighters likely to be wounded in direct combat, has the lead in most on that partial list, it pursues them as joint efforts with its sister services. The other services do have medical research and treatment programs of their own, largely reflecting areas of special interest to their personnel, but also worked jointly. The Navy, for example, has oversight for the DoD/VA Vision CoE and is the lead agency on hearing issues.
One of the most prominent words across the spectrum of 21st century military medicine is regeneration, where various areas of research have application to a wide range of wounds and injuries. A leader in that arena is ISR, created in the 1970s with a primary focus on advances in burn care at Brooke Army Medical Center, now the San Antonio Military Medical Center following a September 2011 merger with the Air Force’s Wilford Hall Medical Center.
“ISR does both clinical and research work in support of caring for combat wounded. It has a long and illustrious history with regard to burn care and is the preeminent DoD center for burn care,” according to Lt. Col. Michael R. Davis (USAF), the institute’s chief of Reconstructive Surgery & Regenerative Medicine.
“In addition, there is a very large research capacity, mostly geared toward reconstruction and regenerative medicine, with very strong support within DoD. For the military, it is basically the mecca for care of combat wounded, research and rehabilitation, working with the adjacent Center for the Intrepid, which is not technically part of ISR but is very closely related and co-located within the Air Force/Army San Antonio Military Medical Center.”
While many people may associate regeneration with the ability of some species to regrow lost limbs (which is, in fact, an area of long-term human research), its primary application now relates to reconstructive techniques, such as composite tissue transplantation, which includes hand and face transplants. Other studies involve skin regeneration, artificial skin, and the use of adult stem cells to facilitate healing and regenerate functional, rather than scarred, tissue.
“A major limiting factor with burn care is getting adequate coverage of the wound, so that has become a major research focus within DoD and ISR. Collaboration with civilian facilities and internal research have really advanced that field, especially as related to upper extremity transplantations – soldiers who have lost their hands,” Davis said.
While that research may lead to improvements in the use of prosthetics, Davis believes it also is the key to enabling wounded warfighters – and others – to retain and regain the use of their own limbs as well as other biological solutions.
“We have a major responsibility here to bring the best outcome to our injured soldiers, so we – and I am personally heading this line of research – are evaluating composite tissue reconstruction for battlefield upper limb injuries,” he said. “There is no question now that the ability to transplant a hand gives better function than the best prosthesis, both with regard to motor capability and sensory feedback, which are difficult to achieve in a prosthetic.