Frontline Medicine

[DPM]

Found this show from a British Army forum that I'm on:

Frontline Medicine

It is a BBC documentary on the Role 3 Facility in Helmand Province, Afghanistan. Some of you probably know that I spent a lot of time in that part of the world and I think this show is a great piece on how well the joint ISAF med group works in theatre.

For interest, the thread from the other forum can be found here.

 

[EpiEMS]

It is a BBC documentary on the Role 3 Facility in Helmand Province, Afghanistan. Some of you probably know that I spent a lot of time in that part of the world and I think this show

Wow, this is too cool!

Thanks for the link!

For those interested in medical management of combat casualties from a case-study approach, take a look at http://www.bordeninstitute.army.mil/published_volumes/war_surgery/war_surgery.html

 

[DPM]

I'm glad you liked it. It was great to see Royal Navy, British Army, Royal Airforce, USN, USAF etc all working together like that. Luckily I never really needed their help myself, but it was reassuring to know that these guys and girls were ready and waiting when the balloon went up.

 

[mycrofft]

Excellent, excellent video from battle zone to final hospital stateside

It is part one, no ads, and part two is linked at the end.

It IS for laypersons, but professionals and enthusiasts can still learn from it, as well as read into it, watch all around the picture for stuff (like the ambulance's have their pet names on the port-side front bumper? One's names "Haggis Basher").

And they do a whole body CT scan, read by a very good radiologist, on almost every patient to rule out (or in) hidden trauma, bleeding, etc. Makes sense with so many penetrating and concussive wounds.

They say the #1 cause of death is exsanguination. I think this is affected by ballistic armor shielding the torso and preventing direct trauma to vital organs (I read that in Iraq snipers shifted their points of aim to groins and other non-armored areas).

PS: how come Bastion seems always to be enveloped in dust/haze? Vehicle traffic?

 

[DPM]

I never really noticed that. I'm sure it's a mixture of a few things. There's a lot of traffic between Bastion 1 & 2, Shorabak and Leatherneck, and add to that a pretty busy runway!

The sniper thing in Iraq was reported as true. We found that we were taking casualties from single shots aimed at the side / armpits where there was no ballistic plating. Rumors went around about a sniper / snipers but I'm not really sure what happened to all that.

The exsanguination, as you've guessed, is due to the mechanism of injury. Around 50% of all Casualties that go through Bastion are from IEDs, with IDF, Small Arms, Accidents etc etc making up the rest. We recently issued groin armor, enhanced underpants as well as an outer kevlar 'cod piece' that comes between the legs to try and help with the problem.

Likewse, with the body armor now being able to withstand several AK hits, it's no longer the round in the middle of the chest that you have to worry about, but the shot to the thigh, armpit, neck etc etc

 

[mycrofft]

Accidents...one of the earliest weapon fatalities during DESERT SHIELD (ramp-up to DESERT STORM) was allegedly due to someone messing with a LAW (baseball bat sized anti-tank rocket launcher) which left HIS tent and struck another airman or soldier in another tent.

With EVERYONE carrying slung rifles, etc., I can imagine weapons and related accidents are not inconsiderable, and NOT reported.

 

[DPM]

When going through "RSOI" (Reception, Staging and Onward Integration) a guy was shot at Bastion. Luckily and surprisingly it wasn't serious. An out of date Skill at Arms instructor was running through some General Purpose Machine Gun drills with a few reservists... with a belt of live ammunition. Accidental Discharge followed and some poor B*stard took a few 7.62 to the legs...

 

[mycrofft]

Here we go, let me say it so we stay on track..."there are no accidental discharges, just careless one". OK back to thread.

 

[DPM]

With regards to exsanguination, do / are US troops routinely trained to use Tourniquets and Hemostatic agents? Having found that bleeding is our main problem, UK battle casualty drills are very bleeding focused. It may seem limited but if there's only so much that you can teach the non-medics and in a certain amount of time, then training them to address the most common causes of death is a pretty good way of going about things.

When I was last in Afghan HemCon was on it's way out with Celox Gauze taking it's place. We also had the ubiquitous CAT (tourniquet) that features in the Video and the new pressure / trauma bandage. These pieces of kit essentially 'treated' our bleeding issues. TQ + Bandages for compressible bleeds, hemostatic agents for the non-compressible. Everyone that deploys on the ground carries two tourniquets and two bandages, with one if four being team medics carrying Celox, more bandages and chest seals.


AND i forgot to add - there's a clip of a contact at 8 seconds in and I was there! Didn't get on Camera though

 

[Hemostatic]

With regards to exsanguination, do / are US troops routinely trained to use Tourniquets and Hemostatic agents?

I can't speak for all units across the US Army/military service, but I have generally found that most soldiers I came across were familiar with the CAT's and pressure dressings. We are also issued a hemostatic gauze (Link Here), for inguinal, axillary, and neck wounds. I would say that the average joe knows that they are carrying the gauze, but not very familiar with the appropriate techniques for using it.

As for me, I drilled it into my guy's heads every morning before mission on how to treat the more common types of exsanguinating wounds. I'm not going to claim that they were all experts at it, but they could certainly do a decent job at slowing the blood flow down until I got up to the point of injury.

 

[mycrofft]

In the video I also saw extensive use of the Israeli Battle Dressing (green striped elastic wrap, has a plastic anchor on one end?).

A professor and former Army nurse at Pleiku said many if not most of the TK's that came in from Vietnam battles were inappropriate. Maybe they were good as an expedient measure under fire? The packaged TK's then were an inch wide, cotton or nylon webbing about 1/16th inch thick, with a simple spring buckle on the end, I THINK they came with a three inch , 1/4 inch did dowel as the windlass.

 

[mycrofft]

Anyone seen part 2 yet?

 

[Veneficus]

I never really noticed that. I'm sure it's a mixture of a few things. There's a lot of traffic between Bastion 1 & 2, Shorabak and Leatherneck, and add to that a pretty busy runway!

The sniper thing in Iraq was reported as true. We found that we were taking casualties from single shots aimed at the side / armpits where there was no ballistic plating. Rumors went around about a sniper / snipers but I'm not really sure what happened to all that.

The exsanguination, as you've guessed, is due to the mechanism of injury. Around 50% of all Casualties that go through Bastion are from IEDs, with IDF, Small Arms, Accidents etc etc making up the rest. We recently issued groin armor, enhanced underpants as well as an outer kevlar 'cod piece' that comes between the legs to try and help with the problem.

Likewse, with the body armor now being able to withstand several AK hits, it's no longer the round in the middle of the chest that you have to worry about, but the shot to the thigh, armpit, neck etc etc

I think body armor is an interesting topic, there is a promotional video here about armored cav being dismounted and retasked for light infantry duty, but when you compare modern body armor with that of ancient Europe and Japan, it really is starting to look the same.

Maybe those old guys knew something?

 

[RocketMedic]

Veneficus, the big issues with armor (especially in the last century or so) are cost and relative effectiveness.

A knight in 13th Century Europe might have a sweet, hand-crafted masterpiece of steel armor, molded to his body by a craftsman and tended to by a dedicated technician- but that armor is going to cost him a literal fortune and was invalidated by the advent of gunpowder firearms. That suit offered good protection against hand-held weapons and decent protection against hand-powered projectiles, and covered more area of the wearer's body with more money invested.

The rapid development of firearms and the scalability and deployability of functional weapons to massive numbers of newly-trained men were the death knell for knights as a whole, with emphasis on their armor specifically. A good bowman was still an asset on the battlefield well into the 1700s, and could rapidly become a rifleman or a scout, whereas the suit of armor was near-useless against the most realistic threats at best, a liability at worst. With the advent of massive, continent-spanning wars, armies gave up armor for the most part, as the technology required to make effective anti-bullet suits was prohibitively expensive, people were cheap, and makeshift armor was of dubious effectiveness. With the introduction of true industrial warfare and massive armies, tactics and technologies that enabled individuals with unprecedented levels of firepower, and the demands of war, armor fell by the wayside nearly entirely, with the exception of the helmet (see WW1).

WW2 and the Korean War saw the reintroduction of body armor as defensive technology finally became realistically competitive again. Initially used to bolster morale, armies rapidly discovered that training men was more expensive than protecting the ones they had, and with the new defensive technologies (synthetic fabrics, ceramics, steel plates that could stop a bullet), coupled with the politics of being seen to attempt to protect the soldiers, body armor became a viable possibility again, and then expected.

Today, it's a signature piece of kit in every Western and most armies, to the point where we focus nearly exclusively on it. Modern armor does a reasonable job of stopping bullets and shrapnel without the expense of custom-fitted suits, at the expense of a few casualties. Eventually, weaponry will advance to the point where armor is obsolete for a time, and the cycle will begin again (we're already starting to see this with the Army's slow push towards a more powerful service round).

 

[DPM]

I think body armor is an interesting topic, there is a promotional video here about armored cav being dismounted and retasked for light infantry duty, but when you compare modern body armor with that of ancient Europe and Japan, it really is starting to look the same.

Maybe those old guys knew something?

It's the age old question of Armor Vs Mobility. We could give everyone those fancy bomb disposal suits, with extra ballistic plates and all that... but you'd be moving at about 100 meters a day. Where as if you were in shorts and flip flops you'd be much fast etc but more vulnerable.

From what I can see, in the UK we leaned more towards the mobility side of things (take a look at Scimitar and Jackal) where as the US went towards the armor side. There's no right and wrong answer, except that as I was in the British Army I naturally think our way was best

 

[mycrofft]

Are there instances where body armor exacerbates injuries (other than overconfidence)?

 

[DPM]

Are there instances where body armor exacerbates injuries (other than overconfidence)?

We made some serious changes when we came out with our new body armor. With the older style the ballistic plate slid into an external pocket on the armor via a zipper opening at the top. We found that this zipper failed in IED blasts and troops were being struck in the face / chin with the plate. Even in 'smaller' detonations we were seeing serious facial injuries from this. The next version opened at the bottom with a re-enforced top to prevent this, however face injuries were still a problem. The MOLLE loops on the front were still giving way in the blasts and magazines, mag lights etc were still hitting the guys in the face (just not the plate anymore). At first this was stopped with a 'nothing on the front' policy, until our newest body armor came out.

In the new stuff (the name escapes me) the plate is now 'inside' the armor, and not just in an external pocket. It also comes with a 'cummerbund' that your pouches attach to. This is designed to break away while remaining anchored around the sides and back, preventing all this stuff (hopefully!) from smashing you in the chin.

 

[Hemostatic]

Are there instances where body armor exacerbates injuries (other than overconfidence)?

Not directly related to enemy contact, but musculoskeletal injuries (primarily neck and back) have always been problem relating to armor. Obviously there are plenty of other way to injure your neck and back while not wearing armor, but I'm not counting those at the moment.

With more and more pouches and more and more MOLLE attachments available, it is easy for guys to just keep adding weight onto their kit. I know I was certainly guilty of this. This starts to circle back to DPM's mobility vs. preparedness argument with having everything within arm's reach strapped to your body somewhere, and then throw an assault pack, or an aid bag, on your back. All of a sudden, you're gaining 120 pounds of gear before you go out on a little hike, or getting bounced around in a vehicle. It can really start to wear on your body.

Some units are starting to strip down their kit as much as possible and go with only the absolutely most essential gear strapped to them (bullets and a radio). While I agree with the principle of this idea, as mentioned above, I like having a lot of gear with me. It's not always practical to run back to your vehicle in the middle of a fire fight for that thing that you thought wasn't essential.....

Physical conditioning and strength training help to mitigate some of these injuries, but it can't really prevent the wear and tear on the body. Eventually, you're just a vehicle that has too many miles on it.


Side note: Thank you, DPM, for posting that video. I finally got a chance to watch it last night, and I thought it was a great piece of work.

 

[bigbaldguy]

I think body armor is an interesting topic, there is a promotional video here about armored cav being dismounted and retasked for light infantry duty, but when you compare modern body armor with that of ancient Europe and Japan, it really is starting to look the same.

Maybe those old guys knew something?

Good catch, I noticed that the other day as well while flipping between some history channel show and CNN.

 

[DPM]

I didn't even think of non-battle injuries earlier. As well as changing the position / style of our armour the fit was also changed. Origginaly it sat on the shoulders mainly and could get quite painful, but the powers that be made some changed, and our newer armor sets have a built in waistband, so the load can be split between the shoulders and the hips.

In the picture, the 'half' on the left shows the wasitbands undone. They're attached to the back piece of the armor and then velcro together in front of you, before the front and sides are secured. The external ballistic plate pouches can be seen, and if you look carefully the old zipper fasteners and the back up 'push-stud' closure devices can be seen on both halves.

This picture is our latest set, called Osprey Assault. The ballistic plate is now internal, and the external cummerbund is pretty obvious. It's in our fancy new style of camouflage (Multi Terrain Pattern) and is a lot more comfortable, provides a higher level of protection and it's lighter.

The concurrent evolution of MERT (the RAF's Medical Emergency Response Team) and Body Armor has doubtless saved lives, and combined with the world class medical facilities in theater, has meant that more and more young men and woman are surviving injuries, and recovering from injuries, that would have been fatal back in 2004 / 2005.