About 5 percent of admissions to hospital trauma centers involve life-threatening bleeding.
However, these injuries are responsible for a disproportionate number of deaths.
Despite advances in healthcare over the past half century, the mortality rate for bleeding in the torso, chest, or pelvis has hovered stubbornly at about 50 percent, says Col. Todd Rasmussen, associate dean of research at the Uniformed Services University of the Health Sciences in Maryland.
Such injuries are familiar to the military and to Rasmussen himself, a vascular surgeon who was deployed five times to Iraq and Afghanistan over the past 13 years.
His experiences led Rasmussen to help develop an innovative medical device called the ER-REBOA, an “internal tourniquet” that doctors can use to cut blood flow from the aorta for up to a half hour.
That’s long enough to stop bleeding in the torso, set up an IV, and get the patient to the operating room.
“It’s a bad problem that took the military to really dig into and invest in a solution,” Rasmussen told Healthline.
Advancing medicine from war
Part of the ER-REBOA name includes the first letters of the last names of Rasmussen and his co-inventor, Dr. Jonathan L. Eliason, who also served a tour of duty in Iraq in the mid 2000s.
The latter part of the name is short for “resuscitative endovascular balloon occlusion of the aorta.”
The ER-REBOA is just one example of the innovative healthcare devices and procedures that have sprung from the longest period of combat operations in U.S. history, dating back to 2001.
“There’s an old adage that the only thing that benefits from war is medicine,” said Rasmussen.
In the past century of armed conflict, the U.S. military has pioneered the widespread administration of penicillin to treat infection, the use of blood products like plasma and platelets to replace lost blood, emergency vascular repair as an alternative to amputation of damaged limbs, and medical evacuation of casualties.
“When medics got out of the service they had experience that they brought back to civilian medicine and applied those lessons,” noted Rasmussen.
New devices from the battlefield
In the case of the ER-REBOA, being marketed nationally by Prytime Medical, Rasmussen and Eliason used their combat medicine experiences to develop a device that allows doctors to stop bleeding earlier in the course of treatment.
“There were existing devices that one could use to perform this procedure, but they’re not really for use in a trauma or emergency room setting. It required X-rays and other expensive and larger equipment designed to be used in the operating room,” said Rasmussen. “We saw the promise of the approach, and we changed the technology significantly so it could be used much more easily in emergency situations in ERs and by EMTs.”
Over the past two years, Prytime Medical has sold more than 1,500 of the ER-REBOA devices, which have been used to treat about 1,000 patients.
A study on effectiveness and best practices is currently underway, but so far the ER- REBOA is “very much performing as expected,” said Rasmussen.
The interaction between military and civilian medicine “really is a dynamic two-way partnership,” added Rasmussen.
For example, over the course of the past decade, the military’s Joint Trauma System was developed based on protocols at hospital-based trauma centers in the United States. The military “gave back” by demonstrating the patient benefits of putting surgeons and anesthesiologists on medivac helicopters in addition to EMTs.
The military also led the way in developing what’s known as the Massive Transfusion Protocol, which calls for early delivery of saline and blood products to injury victims, and has been rapidly adopted by civilian trauma centers, said Rasmussen.
ResQFoam, a self-expanding substance that can be injected into patients’ bodies to stop severe internal bleeding, is a collaboration between Dr. David King, a trauma surgeon at Massachusetts General Hospital and a lieutenant general in the U.S. Army, and life-sciences company Arsenal Medicine.
A recently announced clinical study of ResQFoam is being funded by the Army’s Medical Research and Material Command.
“Many patients and military personnel with massive abdominal bleeding will die before they reach surgical care,” King said in a press release. “Quickly stabilizing these patients can increase their chances of survival.”
However, the ability of physicians to reattach limbs severed by roadside bombs or other weapons remains limited.
Prosthetics are perhaps the most visible sign of the carnage inflicted on U.S. troops.
Here, too, wartime experience is helping to improve patient care.
Earlier this year, Dr. Ronald Hugate of Colorado successfully implanted permanent artificial legs on a pair of patients.
The surgery involved a device he designed based in part on his military background that included working with amputees at combat hospitals in Iraq and Afghanistan.
A life-saving vest
Much like the space program, military technology can also have unforeseen benefits in healthcare.
The SensiVest, a wearable device designed to measure fluid levels in the lungs of patients with congestive heart failure, utilizes radar originally developed by the defense industry to allow the military to see through walls and search for victims in collapsed buildings.
The vest is part of the growing digital health industry that the government and private sector are investing billions of dollars in every year.
Currently, monitoring thoracic fluids requires catheterization via the carotid or femoral artery — an invasive procedure that takes place in a hospital setting and carries the risk of bleeding and infection.
The SensiVest can be worn for just 90 seconds a day and transmits its data wirelessly so “physicians can look and see if the trend is moving toward the danger zone,” said Dr. Rami Kahwash, a researcher at Ohio State University who is leading a randomized study of the device designed by Sensible Medical Innovations.
“Fluid starts to build two weeks before the patient feels it,” Kahwash told Healthline. “Once you have symptoms, it’s really too late.”
Hospital readmission rates for heart failure patients are staggering — 25 percent for one month, 50 percent for six months — and expensive.
SensiVest’s military-developed technology can not only prevent the need for catheterization, but also cut readmission rates with early intervention that “makes it easier for patients to breathe, exercise, and feel better” — and, as Kahwash’s study may show, extend life span, as well.