War lessons saving lives at home in trauma cases

San Diego Union-Tribune:

On the battlefields of Iraq and Afghanistan, doctors and nurses are wasting little time coming up with new ways to treat troops mangled by gunfire and roadside bombs.

Almost as quickly, those innovations are making their way to emergency rooms in San Diego County and across the United States, where they're helping save victims of violent crimes, car crashes and other accidents.

The advances range from the sophisticated – including high-tech prosthetics to replace amputated limbs – to the simple, such as old-fashioned tourniquets applied immediately after injury to stop potentially fatal bleeding.

Some of the war-zone techniques are forcing trauma specialists to rethink practices that have been standard for years.

“We are learning at warp speed,” said Dr. Michael Sise, a clinical professor of surgery and chief of the trauma unit at Scripps Mercy Hospital in Hillcrest. “This is the fastest transfer of wartime learning in history.”

...

The rapid assimilation of battlefield lessons largely is being driven by health providers who also are military reservists. Upon returning from deployments in Iraq or Afghanistan, they apply newly learned techniques to their civilian jobs, Sise said. The information spreads quickly among hospitals through the nation's highly networked trauma-care system.

...

At yesterday's conference, organizers held courses on topics such as how to quickly stabilize a trauma patient, controlling severe blood loss, state-of-the-art rehabilitation for amputees and preparing for a tour of duty as a combat physician or nurse.

For centuries, wars indirectly have served as laboratories for developing important medical advances. Nearly 2,400 years ago, the Greek physician Hippocrates gave this advice to his followers: “He who would become a surgeon should join an army and follow it.”

Statistics suggest that trauma care in Iraq and Afghanistan has far exceeded efforts of previous conflicts. About 10 percent of U.S. troops wounded in the current wars have died, according to the Department of Defense. That compares with a 25 percent death rate in the Korean and Vietnam wars and a 30 percent death rate during World War II.

Among the most important lessons to emerge from Iraq and Afghanistan is an understanding that more service members survive serious wounds if they are transported rapidly from war-zone field hospitals to specialized medical centers in Germany and the United States.

The technique even has a name: damage-control surgery.

Here's how it works. Instead of performing major surgery at a field hospital, doctors stabilize the patients enough to move them to a major medical center. They focus on stopping blood loss, sterilizing injuries and packing wounds with absorbent gauze.

For a soldier or Marine whose leg is shredded by a roadside bomb, damage-control surgery might mean cleaning the wound in the field and holding off on removing the limb for three or four days – until the patient arrives at an amputation center in the United States, Sise said.

“It's doing as little as you have to do,” he said. “That significantly increases survival.”

The method challenges a long-held notion among emergency-room physicians that they must do everything possible for patients before passing them on to the next stage of care, said Dr. Michael Rotondo, chairman of surgery at East Carolina University's Brody School of Medicine in Greenville, N.C.

...

Battlefield medics are widely using tourniquets to stop hemorrhaging, which is a leading cause of death among severe trauma victims.

The device fell out of favor in the United States decades ago after doctors became fearful that it damaged healthy tissue in an injured limb and contributed to a higher rate of amputations.

Experience in the current wars suggests that the lifesaving benefits of tourniquets outweigh those risks, said Dr. Jay Johannigman, chief of trauma and critical care at the University of Cincinnati.

...

During a course at the conference, she learned about a novel treatment for military personnel who suffered concussions after being near bomb blasts. Norton compared their injuries to those of a young soccer player who falls during a game and hits his head on the ground.

...

Most folks don't compare the trauma from playing soccer to that of war, but apparently there is benefit to soccer players who receive the same treatment as combat survivors. As for the other trauma care it can be important in this country where more Americans are being killed in south Chicago than in Iraq over the last three months.