Army Invention Saves Severely Injured Servicemembers' Lives

A new lifesaving standard of care has garnered the U.S. Army Institute of Surgical Research here a prestigious recognition: invention of the year.

The innovation, called Damage Control Resuscitation of Severely Injured Soldiers, was named one of the Army's "Top Ten Greatest Inventions of 2007."

"The American Association for Trauma Surgeons calls this one of the biggest improvements to trauma care in the last 10 years," said Michael Dubick, senior research pharmacologist for the Institute of Surgical Research. The invention is aimed at saving severely injured soldiers with internal injuries that cannot be compressed using a tourniquet or other device, Dubick said.

The institute focused its attention on severely injured soldiers after analyzing data from an autopsy study that showed 79 percent of servicemembers killed in combat died of hemorrhage, and 70 percent had an injury that couldn't be compressed.

"We needed to find a better way to stop bleeding," Dubick said. "In theater, there was no solution for people with noncompressible injuries."

The innovation involves the fluid resuscitation process, in which IV fluids and blood products are used to stabilize a patient's physiology. The standard method is to administer IV salt solutions in an amount that is three times the patient's blood volume. If the patient is still bleeding, blood transfusions are given to restore lost blood.

In most cases, this method is effective for wounded troops, but for some severely injured warriors, the massive volume of fluids and blood can create a negative effect, Dubick said.

"The body has only a finite amount of clotting factors," he explained, "and a large volume of fluids can dilute those clotting factors, which reduces their ability to slow down or stop the bleeding."

Under the new standard of care, fluid resuscitation with salt solutions is limited, which keeps the blood pressure from rising too high and "popping" newly formed blood clots. In addition, blood volume is restored using plasma as the primary resuscitation fluid, along with packed red blood cells.

But rather than using the standard of four times the amount of red blood cells to plasma, "we use a ratio of 1-to-1 of plasma to red blood cells," Dubick said.

Dubick said early use of a clotting factor called "rFVIIa" also has been beneficial. The factor normally is used for hemophiliacs, but it has proven beneficial for severely injured warriors. Other blood products, such as platelets and "cryoprecipitate," are used as needed.

The reduction in fluids not only increases the patient's short-term chances of survival, but also helps long-term treatment, since "there is less fluid built up in organs, and surgeons have a better field of operation," Dubick said.

While the innovation is gaining recognition stateside, it already has had a striking impact in the combat theater, decreasing the mortality rate from 65 to 17 percent.

The impact of this change in the standard of care is so striking, Dubick said, that "some liken this standard of care to the first time someone applied antibiotics."

The military innovation also is gaining civilian attention.

"We've met with over 26 civilian centers and are working with 16 of them," Dubick said.

As word of the lifesaving measure begins to spread, Dubick said, he and his fellow scientists already are looking ahead, working with a company to produce freeze-dried plasma. In its natural state, plasma has a limited shelf life and is subject to temperature requirements.

The scientists also would like to develop a shelf-stable artificial blood with clotting factors that would enable medics to provide early intervention at the site of injury, Dubick said.

"The majority of patients bleed to death in the first five to 10 minutes," Dubick said. "We believe that procedures like this one can save soldiers who survive beyond 10 minutes -- keep them alive long enough to get to the hospital and to surgery. It's a remarkable innovation."

Dubick's team for the project includes Jill Sondeen and Charles Wade, from the Institute of Surgical Research; Philip Spinella, Brooke Army Medical Center; Army Maj. Jeremy Perkins, Walter Reed Army Medical Center, Washington, D.C.; Air Force Maj. Matthew Borgman, Wilford Hall Medical Center; and Army Col. John Holcomb, ISR commander.

The invention was the only medical innovation to make the Army's Top Ten cut, and marks the third year of the last four that the Institute of Surgical Research has made it to the Top Ten list. The winning programs are selected based on their impact on Army capabilities, inventiveness and potential benefit outside the Army.

U.S. Army Institute of Surgical Research http://www.usaisr.amedd.army.mil/

By Elaine Wilson
Special to American Forces Press Service

Elaine Wilson works at the Fort Sam Houston Public Information Office.

Cancer-Survivor Soldier Joins Unit in Iraq

By Pfc. Monika K. Smith, USA
Special to American Forces Press Service

CAMP STRIKER, Iraq, Jan. 10, 2008 - They call him "Tiny," and as with many nicknames, the moniker inaccurately describes Sgt. Jared Squires' stature. At 6 feet, 5 inches tall, the crew chief with Company A, 2nd Battalion, 3rd Aviation Regiment, more than snugly fits into the space allocated for crew chiefs in the Black Hawk helicopters he flies in.

Army Sgt. Jared Squires reviews his pre-flight checklist Jan. 4, 2008. After conquering cancer, Squires joined his unit deployed to Iraq.

Squires, from Los Lunas, N.M., doesn't mind his nickname. He's just happy to be flying again.

In July 2006, Squires learned he had skin cancer. An Army surgeon estimated he had just six years to live.

"When I first found out, I went to the doctor's office and my wife went with me," Squires said. "The doctor came and said, 'I'm sorry to let you know you have malignant melanoma.' I thought, 'I've got two kids. I've got my wife.' ... I wanted to do everything I could right away, because in six years, I might not be there for my boys."

Squires began a series of surgeries and positron emission tomography, or PET, scans, used to detect cancer and the effects of cancer therapy. The cancer spread to the lymph nodes in his left arm. Surgeons removed the lymph nodes, but his body couldn't produce the skin needed to heal his wounds. The fourth surgery was a skin graft to help close the wound, which Squires said was "by far the most painful thing I've ever been through in my life."

Squires said his inability to fly was one of the worst facets of his illness. "I was grounded and couldn't fly after my first surgery," Squires said.

Once Squires completely healed from his surgeries, he began taking interferon to stimulate his body's immune system to fight off cancer. He began 30 days of daily four-hour intravenous treatments.

"The first day of treatment, I could barely walk out on my own strength," Squires said. "I almost had to be carried out."

For 11 months, Squires self-injected interferon three times a week. Though he didn't lose his hair, it did begin to thin out. His days consisted of treatments and sleeping, because his treatments left him exhausted. But he got great support from his unit.

"My company's (family readiness group) stepped up big-time," Squires said. "For two weeks they came to my house and dropped off meals, because my wife was busy taking care of me. It was a lifesaver. It really helped."

Army Sgt. Thomas Lacroix was one of those who stepped up to help the Squires family. A member of Company A, 2-3rd Aviation Regiment, Lacroix has known Squires for seven years. The two met in advanced individual training, served a tour in Korea and then again with the combat aviation brigade.

"(I) felt pretty bad for him," Lacroix said. "I knew his family, his wife, two kids. I tried to do everything I could to help his family out; there wasn't much anyone could really do for him."

As the brigade prepared to deploy to Iraq, Squires was sent to the rear detachment because his illness made him ineligible to deploy. He worked with incoming soldiers who were deploying while continuing with his treatments. He finished his treatments at the end of October and was cleared to fly. But he wasn't content with that. He wanted to deploy.

"I had the opportunity to stay in rear detachment, and I chose not to," Squires said. "I told them 'No, I want to go.' It took a lot of me, from my side, to get them to say, 'Hey, yeah, you're good to go.' They tried to med-board me, and I had to get my oncologist to say, 'He's fine.' They thought I was crazy. My wife knew I wanted to go and that I missed the guys. I missed my friends. We've been together so long, they're my family."

After Squires obtained all the letters he needed from dermatologists and from his oncologist stating he was rid of cancer and capable of deploying, he was on the first plane to Iraq.

"I know it was a big morale boost to have him come out and join the team again," Lacroix said. "It was pretty rough deploying without him. There was a big void in the company."

For the rest of his life, Squires must have routine PET scans and visit a dermatologist every six to nine months, and he must take active measures to prevent cancer from reoccurring.

"I have a 75 percent chance of it coming back," Squires said. "But skin cancer is preventable. It's not like breast cancer. It's not passed down for generations. There's a chance it will come back, but if I take the preventive steps, it shouldn't be a problem."

Lacroix said the company is glad to have Squires back and that his returning was expected.

"That's what he wanted, and he showed he could do it," Lacroix said. "He got better and beat it. He's a true leader. He had the option of staying home and dodging a deployment, but he chose to come out here. The younger guys look up to that."

(Army Pfc. Monika K. Smith serves with 3rd Combat Aviation Brigade.)