Combat Casualty Care Director Discusses Program Research at Medical Museum

By Daniel Daglis
National Museum of Health and Medicine

Since the creation of the Army Medical Museum (the precursor to today's National Museum of Health and Medicine) in 1862 by Surgeon General William Hammond, research has been conducted on and off the battlefield to improve the care of service members. Today, the U.S. Department of Defense (DoD) continues to make the medical care of service members a top priority.

U.S. Air Force Col. Todd Rasmussen, director of the U.S. Army Medical Research and Materiel Command's Combat Casualty Care Research Program (CCCRP), headquartered at Fort Detrick, Maryland, spoke Tuesday, May 24, 2016, at the National Museum of Health and Medicine (NMHM) Medical Museum Science Cafe about some of the advancements and innovations that have been made to continue to decrease casualties of war.

CCCRP is paying particular attention to their recently-launched "Stop the Bleed" campaign, a national public service effort designed to educate American citizens on how to act when cases of massive, life-threatening bleeding occur in everyday life. This is particularly important in light of recent battlefield research, which shows 91 percent of combat wounded die of hemorrhage.

"It is the crucible of the recent wars in Afghanistan and Iraq," said Rasmussen regarding the current bleeding-control effort. "We have tried to become more accurate - driven by science, driven by statistics - to develop better and more accurate ways to control hemorrhage

Rasmussen continued, "The wars in Afghanistan and Iraq were the biggest challenge to military medicine since Vietnam and it is the largest burden of injury with an all-volunteer force in history."

Dr. Basil Pruitt, a Vietnam-era surgeon specializing in burn surgery and mentor to Rasmussen, pioneered a learning health system comprised of a trauma system, trauma research program and the Uniformed Services University of the Health Sciences (USUHS). Rasmussen credited Dr. Pruitt for helping aid the eventual founding of the CCCRP. Research platforms including the CCCRP and service labs such as the Walter Reed Army Institute of Research (WRAIR) have contributed greatly to the advancement in knowledge, materials, devices and technologies that exist in military and civilian medicine today.

Examining the records of a sample size of 4,000 casualties, DoD researchers found that 75 percent were not survivable due to lethal head wound injuries, cardiac injuries, or lethal body disruption. According to Rasmussen, the remaining 25 percent of casualties died of hemorrhage, which were potentially survivable had the soldier made it to a hospital.

Rasmussen said, "The CCCRP is a national investment that is improving the survival and recovery of injured service personnel. The scope of research has widened." While cause of death on the battlefield is determined by the Armed Forces Medical Examiner, it is through research and analysis that CCCRP can help determine how to improve practices that increase the chances of survival for a wounded service member between the site of injury and the next level of care.

On the battlefield, stopping blood loss is vital to a soldier's survival, and Rasmussen pointed out that extremity hemorrhage casualties are rare due to the increased use of tourniquets in most cases. The CCCRP is working to develop ways to stop internal hemorrhage. Rasmussen featured several innovative technologies, including the combat-ready clamp, which stops junctional hemorrhage that takes places between the torso and the body's extremities - where a tourniquet cannot be applied. The XStat is another innovation which aids in treating bleeding tract wounds. The XStat is a modified syringe injected into a wound to release small rapidly-expanding sponges which build pressure and stop the bleeding.

According to Rasmussen, endovascular capabilities were nonexistent at the beginning of the wars in Iraq and Afghanistan back in 2003. Now, however, technologies like the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) tool exist, which aid in the effort to stabilize service members injured on the battlefield. Specifically, the REBOA allows for the placement of a balloon-tipped catheter into the femoral artery, from which point it is then maneuvered into the aorta before the balloon is inflated in an effort to temporarily stop major bleeding. This technique is useful when the patient has either arrested, or is about to arrest, and needs to be transported to an operating room.

Other innovations like the Wound Stasis System can currently be used safely inside a hospital, though Rasmussen noted that such technology may hopefully be translated to out-of-hospital setting in the near future.

NMHM visitors can see several examples of such innovations in the museum's Advance in in Military Medicine exhibit. The exhibit features surgical tools used during the Civil War to medical equipment used in the recent wars in Iraq and Afghanistan.

NMHM's Medical Museum Science Cafés are a regular series of informal talks that connect the mission of the Department of Defense museum with the public. NMHM was founded as the Army Medical Museum in 1862 and moved to its current location in Silver Spring, Maryland, in 2012. NMHM is an element of the Defense Health Agency. For more information on upcoming events, please call 301-319-3303 or visit www.medicalmuseum.mil.

	Caption: U.S. Air Force Col Todd E. Rasmussen, MD FACS, Director, U.S. Combat Casualty Care Research Program (CCCRP), speaks about medical lessons learned from the wars in Iraq and Afghanistan, during the Medical Museum Science Café, held May 24, 2016, at the National Museum of Health and Medicine (NMHM) in Silver Spring, Maryland. NMHM is a Department of Defense museum founded in 1862 and is an element of the Defense Health Agency. The Science Café was titled Advances in Combat Casualty Care: Past, Present, and Future." (National Museum of Health and Medicine photo by Matthew Breitbart / Released)
	Caption: U.S. Air Force Col Todd E. Rasmussen, MD, FACS, Director, U.S. Combat Casualty Care Research Program (CCCRP), speaks to an audience during the Medical Museum Science Café, held May 24, 2016, at the National Museum of Health and Medicine (NMHM) in Silver Spring, Maryland. NMHM is a Department of Defense museum founded in 1862 and is an element of the Defense Health Agency. The Science Café was titled Advances in Combat Casualty Care: Past, Present, and Future." (National Museum of Health and Medicine photo by Matthew Breitbart / Released)
	Caption: U.S. Air Force Col Todd E. Rasmussen, MD FACS, Director, U.S. Combat Casualty Care Research Program (CCCRP), demonstrates the use of a truncal tourniquet, known as the Combat Ready Clamp (CRoC), during the Medical Museum Science Café, held May 24, 2016, at the National Museum of Health and Medicine (NMHM) in Silver Spring, Maryland. NMHM is a Department of Defense museum founded in 1862 and is an element of the Defense Health Agency. The Science Café was titled Advances in Combat Casualty Care: Past, Present, and Future." The truncal tourniquet is a device placed over the groin and lower abdomen to stop severe blood loss due to a traumatic battlefield injury. The new tourniquet was developed with support from CCCRP and the U.S. Army Institute of Surgical Research. (National Museum of Health and Medicine photo by Matthew Breitbart / Released)