Here is an interesting article. Seems that the military is re-thinking some of the new methods of treatment on the battlefield. I don't enough about it to venture an opinion, but I thought many of you would be interested.

http://www.baltimoresun.com/news/health/bal-te.militarymed29mar29,0,2803375.story

Such is the way of progress in America. We made quick progress in military medicine in Vietnam. Then we sat on out hands for thirty years. When we went to war we were shocked to find out we didn't have many doctors who were up to date and that we had lost a lot of the edge.

Going into Desert Storm there was push to catch up for lost time and to leapfrog forward. So the gates were opened to methods and products that hadn't been rigorously researched.

So now the pendulum swings the other way. The rush to push new things has faded and people area asking important questions that got lost. Questions about efficacy, efficiency and costs. As is typical the majority of what came in new and promising has been shown to be no better, or only marginally better, than what we had. There may be a few methods and materials that are shown to be truly useful but they will typically be few and far between.

Actually, that's a very disturbing article. And I wouldn't really characterize it as "lessons learned" but more like "Ooops! Let's not do that anymore..."

Seriously, it sounds like these wounded service members really were just unwitting guinea pigs for many of these "innovative," i.e. experimental, products and procedures. What really galls me is the fact that these experimental procedures were implemented service-wide as standard care with little to no clinical evidence to support it. There is a place for trying out new things, on a small scale, in combat that wouldn't be ethical to experiment with during normal situations, but that care and process seems to have been largely thrown out the window here.

It sounds like a good idea is enough to win service-wide approval in some cases. Reminds me of the same way that many investors have been duped into buying into various companies or financial investments lately by simply having a "good story" behind them. Anyway, there are so many things from that article that disturb me.

And it's a good thing to note, based on this article, that just because the Army uses something for first aid doesn't mean that it's a smart idea for you to carry it, too. Like, I had no idea that they had abandoned the new HemCon bandage until I read this article. Good to know.

Maybe so - let's be grateful for what battlefield medicine has taught us though, its hard experience that doesn't get thrown away. I grew up living next to a vascular surgeon who served in Vietnam, and he came back to the life with new treatments that left several generations of military and civilians walking on two feet or keeping their hands intact. Literally hundreds of thousands of grateful trauma patients. I have never used a HemCon bandage, but the 'revelation' that tourniquets are not a dead-end treatment in every scenario caused me to get the necessary training, rethink when I would apply one, and to actually go out and purchase a decent tourniquet, just in case.

Yep, the problem is that we don't retain that hard earned knowledge very often, and some otherwise innovative solutions get lost in the bureaucracy once again. Same old tune...

My microbilogoy professor once told us of the dean of a medical school getting up at the commencement and adressing the new doctors.....

I must, on behalf of this institution, apologize because HALF of what we have taught you is WRONG! I must further apologize....because nobody knows which half!

I could never confirm if it were true or not...but it does reflect a very important sentiment....

For some strange reason, I thought I was watching/reading about an episode on M*A*S*H where the doctors were experimenting on new techniques, gadgets and hemostats, etc. And the use of whole blood instead of blood components reminded me of an episode where Radar "donated" blood twice in one day courteous of somebody syphoning off while he was on a sleep break.

One of the items no longer in favour seems to be WoundStat which looks kind of like a sanitized bentonite clay that can be moulded around a wound. Another is an injected blood clotting agent (Factor VII) or the $89 bandage called HemCon which was no more effective than gauze!

Doesn't the military have a regular history of testing things out and experimenting with troops lives?? Heck, isn't that were things like Agent Orange came from? I thought one of the first rules of medicine was "do no harm"?

Priorum non nocere. First do no harm. Its not actually part of the Hippocratic oath, though it seems to have replaced it in some sectors.

The Army has tested lots of things on troops (Agent Orange isn't really one of them, since its a herbicide). But it has tested chemical weapons on troops and various diseases (yellow fever for instance) as well as radiation. Sometimes with consent (informed or otherwise), sometimes without. Some of this testing is very clearly wrong, some of it (like this for instance) less so. The army tried out new $90 bandages in the interest of saving lives, instead of continuing to use the same $5 bandage I had in ROTC in the interest of saving money.

A book that relates to this only obliquely is "The Soldier's Load and the Mobility of a Nation". Its all about the logic of logistics and one of the statements it questions is "Nothing is too good for our boys" which it argues leads the army to spend more resources on frivolity and ultimately less on the business of fighting, putting more people into danger and making the Army less effective. I think this is one of those situations. Someone says, "I have a new bandage!" and people respond "We'll buy a million, nothing is too good for our boys!" not "Does it work?"

Change is not the same thing as progress. Progress consists of picking apart old things and new things and taking out the working pieces from both to make the next new thing. Change is just new things. They can be hard to tell apart.

The general themes in this discussion are certainly valid but to equate a HemCon with a 4x4 or old-school pressure dressing reveals a lack of research and appreciation for a key issue: context. Don't dilute a good point with poor presentation of the facts.

Perhaps I am an outlier here with respect to my view on this topic, but I don’t adhere to the apparent negative conclusions reached in this article. There is no way to adequately test medical procedures, medicines and products, utilizing human clinical trials of trauma wounds in the civilian population before use on the battlefield. The types of traumas suffered in non-combat situations would not allow for adequate sample size and proper evaluation of techniques and products of potential use to preclude potential use on the battlefield.

Having never been in combat or having to deal with combat induced traumas, one might discount my point of view as purely academic, but having been in biomedical research for 32 years and EMS for over 20 years, I have seen both my share of research and trauma. Combat medicine is unique in that traditional techniques and products can be “field trial tested” on a population of human victims that would never be obtainable in the civilian world. Many advances in emergency medicine have come directly from combat medicine. The fact that not all of the techniques and products are universally beneficially does not diminish the contributions that have been successfully made and yes, improved over time.

The ethical argument, that the military personal should not be guinea pigs is valid. However, all medical procedures, medicines and products are sooner or later “tested” on the greater population where on occasion the negative attributes are made manifest due to the larger sample size of patients. Just think of how many medicines, medical procedures and products have been recalled, placed on hold and the like. Why would combat medicine be any different?

Just my 2 cents-

(Glock-A-Roo I am not referencing your posting, it just happened to be last)

Pete