August 1, 2008: Technology, and the war in Iraq, have combined to create some major advances in emergency medicine. In the past, troops would often die from loss of blood before a surgeon could get in there to stop the bleeding. Two new technologies have been developed, and used heavily, that have sharply reduced the number of troops bleeding to death from combat wounds (which are often multiple and massive).

Over the last five years, the U.S. military has received clotting bandages (to stop heavy bleeding) and granular substances that have the same effect. This was a major medical advance to come out of the war effort. But, competition being what it is, there were three clotting products, each operating a little differently.

Over 95 percent of the time, these clotting devices stop bleeding, especially in areas where a tourniquet could not be applied. While medics, and troops, prefer the bandage type device, there are situations where the fine granular substance is a better solution (especially in the hands of a medic).

In the first two years of use, over 250,000 of these 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 these bandages can be a lifesaver. So it was a morale boost if everyone could carry one around (a small first aid kit is a standard part of combat equipment).

Following the introduction of the clotting devices, there were more cases of wounded troops getting to a hospital alive, but in need of massive transfusions to replace lost blood. This led to the development of new, and much improved, techniques for getting a lot of blood into a patient who needed that done, and done as quickly as possible without inducing shock or death from blood loss. The new procedures involved some use of the new clotting agents, but was mainly about adjusting the amount of saline solution used along with the blood, and tweaking the overall procedure. This was possible because there were so many such cases encountered in Iraq to try new techniques on. These were often situations where you had no choice but to try something new. The new techniques have reduced bleeding fatalities by over 75 percent, and are one of the reasons why combat deaths are less than a third of what they were in Vietnam and previous wars.