BETWEEN YESTERDAY AND TOMORROW
blood products to the point of injury—a requirement on future battlefields.
Beyond that, more immediate and off-the-shelf medical solutions like advanced topical hemostatic agents (items like coagulant- impregnated dressing and granulated powders that aid blood clotting) as well as acellular regenerative vascular grafts—which are grafting procedures that combine a patient’s own cells with a three-dimensional collagen matrix to create an actual function- ing vessel—further display an advancement of military medical capabilities over those employed in recent conflicts.
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IMPROVING BATTLEFIELD OUTCOMES Critical skills operators with U.S. Marine Corps Forces Special Opera- tions Command simulate administering FDP to a role-playing casualty during an exercise at Camp Shelby Joint Force Training Center, Missis- sippi, in May 2017. All U.S. special operations forces now deploy to war zones with FDP, a crucial addition to first-aid kits that can prevent badly wounded troops from bleeding to death on the battlefield. U.S. forces used FDP in World War II, but concerns about hepatitis transmission led to its abandonment in the U.S. (U.S. Marine Corps photo by Sgt. Salva- dor R. Moreno, Marine Corps Forces Special Operations Command)
BURNS: A RISING THREAT As the U.S. military community—and the world, too, it seems—adapts to the condensed cityscapes characteristic of the future battlefield, we will probably also be forced to con- tend with injuries that are far different than those witnessed in OIF and OEF. Indeed, combat operations in more densely populated metropolitan areas no doubt will come with a greater burn potential than anything we saw in OIF and OEF. Elec- trical hazards, uncontrolled urban fires and flame propagation in confined spaces—along with the possible use of thermobaric weapons, which by design produce more heat and pressure than traditional weapons by igniting explosive vapor in the blast zone—develop into major threats to the warfighter.
As such, the ability to quickly debride—remove dead, dam- aged or infected tissue—burn wounds will be key in these environments. While CCCRP-affiliated researchers
already
to up to three days with full functionality (as opposed to the previous standard of up to five days at room temperature, with gradually degrading functionality), have given way to current efforts focused on extending shelf life to more than two weeks, an impossibility just a few years ago. Coupled with research into cryopreserved platelets—a process in which platelets are stored, indefinitely, at negative 80 degrees Celsius—these advances potentially make the logistical nightmare of transporting blood to far-forward areas significantly less challenging.
We have long known the benefits of basic refrigeration for food storage and biologics. CCCRP efforts effectively harness those same principles to allow transport of these vital resuscitative
94 Army AL&T Magazine April - June 2018
have received FDA approval of a laser-based imaging process developed to determine post-burn tissue viability, work contin- ues in other areas, including the development of a “painted-on” debridement tool, which contains enzymes that can debride non- viable tissue automatically. Further, researchers are now using skin grafts from select animal species to cover burn wounds and provide temporary stability. So-called xenografting efforts use pig and fish skin samples and are an extension of long-used allo- grafting efforts, which use stored human skin to cover wounds.
But perhaps one of the greatest threats on the future battle- field comes from possible chemical, biological, radiological or nuclear (CBRN) agents. In 2015, for example, the Pentagon acknowledged that insurgents in Iraq used chlorine as a weapon at least two dozen times, and had included parts of old Iraqi chemical munitions in homemade roadside bombs, according to an investigation by Te New York Times. While the U.S. has made significant investments in CBRN countermeasures, treating trauma under these conditions remains difficult. Given
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