Those findings spurred more intensive medical safety training of warfighters prior to deployment and the inclusion of components in the standard kit, such as coagulant bandages designed to stop or at least reduce bleeding, and the CATs. A new Burn Resuscitation Decision Support System helped combat medical personnel determine the ideal amount of IV fluid to give a patient 48 hours after a severe burn. The Army also instituted a TBI management strategy mandating medical attention within 24 hours of a suspect incident (such as an IED causing those in an otherwise protected vehicle to be tossed around inside the hull) and medical clearance before being allowed to return to duty.
Unfortunately, TBI symptoms may not manifest for months or even years after the original injury. Research by Duke University’s School of Medicine and the VA has found soldiers close to explosions in combat may experience brain injuries without showing any symptoms. Despite an increase in research and treatment protocols, brain trauma remains a mystery. It is believed to be a trigger for post-traumatic stress disorder (PTSD), but any exact relationship remains unclear.
Defense Advanced Research Projects Agency Director Dr. Arati Prabhakar speaks with reporters during DARPA Demo Day 2016 at the Pentagon on May 11, 2016, to give the Defense Department community an up-close look at the agency’s portfolio of innovative technologies and military systems. Among DARPA’s current research endeavors are the Pharmacy on Demand and Biologically-derived Medicines on Demand initiatives of its Battlefield Medicine program, which aims to close current capability gaps in combat zones of the future. DOD photo by Marine Corps Sgt. Drew Tech
A 2015 study by Royal Navy surgeons and the University of Birmingham of U.K. soldiers who survived “unsurvivable” injuries in Southwest Asia found the level of injury severity in which half of casualties would be expected to survive had nearly doubled between 2003 and 2013. According to the study, 572 casualties survived injuries the U.K. National Health Service (NHS) classified as “life-threatening” and 38 survived what NHS termed “unsurvivable” wounds.
“This study is the most detailed analysis of combat casualties ever released on either side of the Atlantic and is the first to definitively prove that the huge efforts to advance and improve the care of our wounded have been enormously effective,” Lt. Cmdr. Jowan Penn-Barwell, a Royal Navy surgeon, told the London Telegraph.
Even so, there remain many gaps in the treatment available to wounded warfighters in the field. While a number of government agencies, universities, and private-industry labs are working to address most of those, many are looking to the Defense Advanced Research Projects Agency (DARPA) for major future advances. Known for its pursuit of technologies and capabilities considered on the far edge of science, DARPA has established a Battlefield Medicine program to close current capability gaps in future combat zones.
According to the program’s director, Dr. Tyler McQuade, DARPA is pursuing two integrated research thrusts – the Pharmacy on Demand (PoD) and Biologically-derived Medicines on Demand (Bio-MOD) initiatives. Together, they are seeking to develop miniaturized device platforms and techniques that can produce multiple small-molecule active pharmaceutical ingredients (APIs) and therapeutic proteins on site in response to specific battlefield threats and medical needs as they arise.
Tech. Sgt. Eddie Colon, left, and Lt. Col. Patrick Johannes, both assigned to the 10th Expeditionary Aeromedical Evacuation Flight and both members of a Critical Care Air Transport Team (CCATT), discuss a patient’s care in flight on July 4, 2014. U.S. Air National Guard photo by Staff Sgt. Allan Eason
“The PoD research is aimed at developing and demonstrating the capability to manufacture multiple APIs of varying chemical complexity using shelf-stable precursors, while the Bio-MOD research is focused on developing novel, flexible methodologies for genetic engineering and modification of microbial strains, mammalian cell lines, and cell-free systems to synthesize multiple protein-based therapeutics,” he explained. “As a proof of concept, both PoD and Bio-MOD efforts will seek to develop platforms for manufacturing single-dose levels of FDA-approved APIs and biologics and demonstrate high purity, efficacy, and potency in short timeframes.
“[In so doing], Battlefield Medicine will leverage continuous flow approaches that will, if successful, pave the path forward for enabling distributed, on-demand medicine manufacturing capabilities in battlefield and other austere environments. Additionally, the platform would have built-in flexibility to produce multiple types of therapeutics through its modular reaction design. The ultimate vision for Battlefield Medicine is to enable effective small-batch pharmaceutical production that obviates the need for individual drug stockpiling, cold storage, and complex logistics.”
The treatment of wounded warfighters in the field and at first-level battlefield medical facilities in 2016 is so far advanced over late 20th century capabilities it could be seen as science fiction-cum-fact. But what researchers expect to be fielding in 2026 could make even those advances pale by comparison.
This article first appeared in the Veterans Affairs & Military Medicine publication.