An example I can cite for you is how we do fluid and blood product resuscitation of trauma victims. The things we learned from our experience supporting combat operations in Iraq and Afghanistan fundamentally changed the way trauma patients are now resuscitated in emergency rooms and trauma theaters through the use of fluid and blood products. And it’s made a real difference in terms of improving the outcome for those patients.
Another example would be our management of burn patients. The data that was captured from the combat operations highlighted some excellent opportunities to improve the outcomes for patients with serious burns. Those have become standards in the fluid resuscitation of burn patients now.
What kinds of stresses are placed on Air Force medical personnel due to operating farther forward as well as the change in emphasis toward stabilization and rapid evacuation of wounded rather than treatment in more elaborate field hospitals, as in the past?
The opportunity that presents itself now to improve outcomes for trauma victims, as you stated, requires initial stabilization and then movement within a relatively short time window to a medical center for definitive care. The experience has shown that this improves outcomes. So, in order to be able to do that and to fully leverage the opportunities to provide advanced care in a forward field setting, our teams need to be prepared to provide advanced care in a field hospital and even in a pre-hospital environment.
In support of counterterrorism operations, we’ve found that the surgical teams and the critical-care teams need to be able to operate outside the hospital environment often in a location that was never built or designed to be used for medical care. That’s requiring a lot of innovation and ingenuity and a lot of training and a lot of insight as we equip the teams.
That means we’re deploying teams with more advanced capability than we have ever in our history. And that’s true for Army, Navy, and Air Force as well. That requires that our teams go forward with the techniques, and the technology, and the equipment to be able to provide advanced care – and sustain the readiness to do so. The other thing that imposes demands on our medical teams with current combat operations is that the nature of the counterterrorism combat operations really requires that we have agility and the ability to be somewhat mobile in terms of our surgical stabilization capability.
To apply the advanced intervention techniques and to apply the lessons we’ve learned from the research using the Joint Trauma Registry, our teams need to be able to be agile and to move about, but have equipment that is a small enough equipment package that it can be moved readily and set up in a building of opportunity.
Ediger attended battlefield acupuncture training taught by Dr. Richard Niemtzow, director of the Air Force Acupuncture Center on Joint Base Andrews, on April 1, 2016. Battlefield acupuncture is a rapid technique using tiny acupuncture needles inserted into the ears that directly modify the way the central nervous system processes pain so as to reduce pain significantly in more than 80 percent of patients. The technique was developed by Niemtzow in 2001. U.S. Air Force photo by Matthew Eichie
In support of counterterrorism operations, we’ve found that the surgical teams and the critical-care teams need to be able to operate outside the hospital environment often in a location that was never built or designed to be used for medical care. That’s requiring a lot of innovation and ingenuity and a lot of training and a lot of insight as we equip the teams.
Can you highlight any developments either involving en route care or innovations on the battlefield that bring a special sense of organizational pride?
The establishment of the Critical Care [Air] Transport Teams in the late 1990s has enabled us to move trauma victims much more quickly than we were able to do historically. That’s had a dramatic effect on improvement on the outcomes. But we know that there are further opportunities to enhance our capability in terms of what kind of inventions and what kind of monitoring we can apply in the in-flight environment. So we continuously are performing research in terms of new ways to apply technology in the in-flight environment and aeromedical evacuation and new ways to be able to continue with the stabilization process during movement.
We know the nature of U.S. military operations are such that it is becoming increasingly likely on occasions that we will move patients a significant distance who have yet to be treated in a hospital. We know we need to have as much capability as possible in flight to continue the stabilization. So we have research right now on systems that will help our teams do that.
Examples of these would be systems that use equipment, including microprocessors capable of using computer logic, to help with trend analysis in flight on vital signs, to actually have autonomous adjustment of ventilator settings in flight, and also to apply some diagnostic techniques in flight, such as ultrasounds, that would enable us to detect conditions that may need intervention while in flight.
These are just a few of the innovations that are being researched right now. This is being done in partnerships with trauma centers where we have Air Force trauma specialists embedded and then being prototyped for use in operational settings.