Attrition: Magic Powder Backfires

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April 26, 2009: The U.S. Army has temporarily withdrawn WoundStat, a granular substance that is poured into a wound to stop bleeding when bandages won't work. The FDA approved WoundStat over a year ago, and medical experts from all the services approved it for combat use. Nearly 20,000 packets were ordered and WoundStat was distributed to combat medics late last year. But subsequent testing showed possible damage to the walls of blood vessels. Moreover, there are far fewer of the serious battlefield injuries WoundStat was designed to deal with. So it was withdrawn, for the moment.

WoundStat was but one of many new medical tools for battlefield that has greatly increased the effectiveness of the immediate (within minutes or seconds after getting hit) medical care for troops. This effort consisted of three programs. First, there was the development of new medical tools and treatments that troops could be quickly and safely taught to use. Then came the equipping of medics (about one for every 30 or so combat troops) with more powerful tools, so that troops were less likely to bleed to death or suffocate from certain types of wounds that are not fatal if treated quickly enough. Finally, there was the Combat Lifesaver program, which more than tripled the number of "medics" by putting some soldiers through a 40 hour CLS (Combat Lifesaver) course in the most common medical procedures soldiers can perform to deal with the most dangerous types of wounds usually encountered. These CLS trained soldiers are not medics, of course, but they do make available in combat crucial medical treatments. Thus they are sort of "medics lite," which is close enough if you are badly wounded and in need of some prompt medical treatment.

 The Combat Lifesaver course teaches the troops how to do things like insert breathing tubes, and other emergency surgical procedures to restore breathing. The CLS troops have skills most likely to be needed in lifesaving situations, when a medic is not available. The additional emergency medical training, and new emergency first aid gear (the "CLS bag") has saved hundreds of lives, and reduced the severity of even more wounds. Enough troops have taken CLS training so that there is one for every 10-15 combat troops, and one for every 20 or so support troops on convoy or security duty.

One of the most crucial new medical tools has been the clotting bandage, and later clotting powder (like WoundStat), to stop heavy bleeding. This was a major medical advance to come out of the war effort. But, competition being what it is, there are several clotting products available, all operating a little differently.

Five years ago, the first of the bandages, the Chitosan Hemostatic Dressing (more commonly called HemCon), showed up. It is basically a freeze dried substance, that causes clotting of blood, and incorporated into what otherwise looks like a typical battlefield bandage. But these dressings greatly reduced bleeding (which is the most common cause of death among wounded American troops.) This device was a major breakthrough in bandage technology.

Over 95 percent of the time, the HemCon bandages stop bleeding, especially in areas where a tourniquet could not be applied. Then came two new products, WoundStat and QuikClot (a gauze bandage similar to HemCon, that was actually available in 2003, but had some teething problems). While medics, and troops, prefer the bandage type device, there are situations where the fine granular substance (WoundStat) is a better solution (especially in the hands of a medic).

In the past, troops would often die from loss of blood before a surgeon could get in there to stop the bleeding. In the first two years of use, over 250,000 HemCon bandages were obtained for military needs. This was to make sure everyone in a combat zone had one at all times. While there are not a lot of casualties in base areas, the occasional rocket or mortar shell is likely to cause the kinds of wounds where HemCon can be a lifesaver. So it was a morale boost if everyone could carry a HemCon around (a small first aid kit is a standard part of combat equipment).

Last year, the army standardized on the QuickClot bandage and Woundstat powder. Currently, every soldier is issued one QuickClot bandage. Each combat lifesaver has a "combat lifesaver bag" with medical supplies which now includes three QuickClot bandages. Only the medics get packets (usually two) of Woundstat powder. That's because this is only needed for deep wounds, and has a theoretical risk (it hasn't happened yet) of causing fatal clots if it gets into the bloodstream. The medics will turn in their WoundStat until more tests are completed. Additional instructions were also issued for users of QuickClot, which can cause tissue burns under some conditions.

These clotting devices are also popular with civilian emergency medical services, and the manufacturers are still trying to catch up with worldwide demand.

 


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