Gen II Helmet Sensor

The Gen II Helmet Sensor finally brings a screening capability to potential head and brain injuries.

When a Soldier goes through a concussive event, such as an IED explosion, he or she often does not remember exactly what happened. The event is so sudden, and the jolt so intense, that there are cases where the Soldier has walked away, thinking he was unharmed, only to learn later that he has suffered a traumatic brain injury. 

The new Gen II Helmet Sensor takes away the guesswork by recording the forces that affected the Soldier during the concussive event. The helmet-mounted sensor records, measures and stores linear and rotational accelerations to the helmet. It even measures the overpressure generated by an explosive event. This information will help with regard to early detection of traumatic brain injury, and will help experts compile information that could lead to better detection and improved diagnosis of concussive events. Though the unit is not a medical device, the data it collects will be very useful to the medical community in providing treatment of traumatic brain injuries.

The Gen II sensor has a USB port for charging its battery (good for one year) and for transferring its data to a laptop computer. It weighs approximately 2.14 ounces and can store up to 1 gigabyte of data.

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INVISIBLE WOUNDS

ANGEL THUNDER 2011- Pararescue Exercise

Approximately 1,400 U.S. military, federal and state employees and Coalition Forces participate in the 6th Annual Angel Thunder Exercise, the world's largest military CSAR Combat Search and Rescue Exercise in the world. Airman from the 55th Rescue Squadron transport injured personnel to the local hospital in Tuscon, Arizona on October 11, 2011.

Source

Portable Ultrasound Empowers Special Forces Medics

FORT BRAGG, NC – When Dr. (Maj.) Andrew Morgan came to 3rd Special Forces Group (Airborne), he already knew the value of ultrasound machines from being an emergency physician at Womack Army Medical Center at Fort Bragg.

He brought that knowledge with him to the group in the summer of 2007 when he became the battalion surgeon for 1st Battalion, 3rd SFG, and he quickly pushed to have more ultrasound machines at his unit.

He and his staff realized a deficiency in the arena of medical imaging after they reviewed the medical capabilities of the battalion’s Special Forces operational detachment alpha teams.  So he pushed to acquire more ultrasound machines in order to get them to the Special Forces medics in the field; where they would have the greatest impact.

The machines, which use high-frequency sound waves to look into the body for a variety of medical purposes, such as identifying blood in the abdomen, finding fractures, skin infections and collapsed lungs, already have widespread use in Army medicine but until recently were not storied in the Special Forces arena. 

But with the advent of portable ultrasound machines, which can weigh less than five pounds, Special Forces medics are realizing the power of this technology in their environment. 

Currently, each Special Forces battalion is authorized a single portable ultrasound machine, but when Morgan took his current position he requested more of the machines to put in the hands of the unit’s medics.

He argued there was a “lack of practical imaging” on the battlefield and in his eyes, one portable ultrasound wasn’t sufficient for training or operational employment.

So Morgan proposed an idea to the Command Surgeon at the United States Army Special Forces Command, then Col. Peter Benson, that if his battalion was authorized more portable ultrasound machines, they would be put to good use.  He would give a detailed report to USASFC on how the machines were used by medics in the field.

His proof would come in the form of numbers.

Morgan, Sgt. 1st Class David Hubler, senior medic, 1st Bn., and Capt. William N. Vasios, physician assistant for 1st Bn., spent more than a year training 26 Special Forces medics to use the machines, and in January 2009, the battalion deployed to Afghanistan with nine portable ultrasound machines to put to the test in a combat zone.

“The concept of putting portable ultrasound machines in the hands of our 18Ds [Special Forces medics] is something I’m very excited about,” Morgan said. “Ultrasound has been around for years, but the novelty in our concept is empowering medics, in addition to medical officers.”

Battalion medics collected hundreds of images from exams from their deployment to use for documentation and to characterize how Special Forces medics employed their new skill.

Along with their newly acquired capability to use ultrasound in the field, the battalion also had X-ray at their disposal; however, Morgan said the contrast between the two systems couldn’t be greater when it comes to portability and practicality.

Each Special Forces battalion has one portable X-ray system, but the size of the machine made it impractical to use in remote combat environments.

“It would take one-third of a Chinook helicopter to get an X-ray machine out to a fire base,” Hubler said.

This is in stark contrast with the currently-fielded portable ultrasound machine’s ability to fit inside a standard-size medical aid bag.

Therefore the medics of 1st Bn. took full advantage of portable ultrasound on the battlefield.

“We were interested to find that they [Special Forces medics] found it practical not only for trauma, but also routine medical care of their teammates and host nationals,” Morgan said.

One ODA medic returning from this recent deployment said he was initially apprehensive to use portable ultrasound. 

Sgt. 1st Class Robert Lopez envisioned a lengthy learning curve and thought portable ultrasound’s use was more for pregnancy than for battlefield injuries.  However, learning to use the machine took less time than he thought and his feelings of apprehension quickly subsided after he used it for the first time.

As a Special Forces medic with 1st Bn., Lopez was a beneficiary of the training organized by Morgan and his staff, and on their recent deployment he ran a remote firebase clinic where his machine saw prolific use.

He described several stories of his practical use of portable ultrasound to a large crowd of physicians and medics during the Special Operations Medical Association’s annual conference in Tampa, Fla.

But it was the story of the first time he put his training to the test downrange that had the audience captivated.

Early in 2009, Lopez thought he was going to have an easy day at his remote clinic when a local national came in with a pain in his hand.

Lopez didn’t notice anything out of the ordinary with the patient’s hand, so he said he gave the man some pain medicine and told him that if it still hurt to come back later.

Four hours later the local national was back.

“It was then that I looked behind me and saw the ultrasound machine,” Lopez said.

He decided to put his training to work.

Lopez conducted an evaluation of the patient’s hand using the portable ultrasound machine and found a foreign body: a piece of shrapnel from a blast at a trash pit some time back.

Lopez was able to consult with one of his doctors several hours away by describing what he saw on the ultrasound.  The doctor confirmed the patient did indeed have a foreign body in his hand.

In a matter of five to ten minutes Lopez was able to remove the shrapnel. 

“My ability to find the foreign body and remove it gave the patient a lot of confidence in my abilities,” Lopez said. “And it gave me a lot of confidence in using the ultrasound machine.”

Up to a 100 patients a day came through Lopez’s clinic, and by the end of the rotation, he said “if patients came in and I didn’t use the ultrasound, they thought I didn’t care about them.” 

But it took some time for an ultrasound machine to find its way to Lopez’s hands.

Portable ultrasound in Special Forces actually had its beginnings in 2003 when the group’s received their initial fielding. Upgraded machines were added 18 months ago, and only recently did demand mount for more widespread fielding, said Lt. Col. Andrew Landers, current command surgeon at USASFC.

“I have always been a big proponent of ultrasound, but we needed some data to support the use, and to look at training issues,” Landers said.

Morgan provided that data, as well as a model training program.

He and several other medical practitioners devised a program they dubbed Special Operator-Level Clinical Ultrasound, or SOLCUS, which they loosely based off guidelines given for training emergency physicians by the American College of Emergency Physicians. 

Morgan said he intends for the training program to spread and bring ultrasound capability to all types of special operations units.

Those intentions moved forward Dec. 13 when he briefed his two-year experience with training and applying ultrasound in the Special Forces environment at the SOMA conference. 

He, along with Lopez and Hubler, also briefed their personal accounts of success with ultrasound and demonstrated the value of the equipment to physicians and medics from across the world. 

In attendance were special operations medical professionals from allied nations, civilian government agencies such as NASA, physicians and physician assistants from various specialties, and special operations medics from every branch of the U.S. Armed Forces.

They were immersed in eight hours of lessons learned and practical training on the portable machines.

The audience also heard some of the technical aspects of why Morgan had such a passion about ultrasound.

Portable ultrasound machines offer capabilities such as being able to save images as .jpg files as well as recording live video of procedures in which they are used.  These can then be downloaded through USB ports on the machines.

The machines can see nerve bundles to help in local anesthesia as well as showing clear pictures of veins to guide medics when drawing blood or giving fluids intravenously.

They operate off a standard operators’ radio battery or can be plugged into a 110-volt power source with a continuous run-time of two hours.

They are roughly $40,000, a third of the cost of a portable X-ray machine and have a much greater diversity of functions than X-ray. This makes portable ultrasound a more viable financial option and a more powerful clinical tool for the groups, Morgan said.

“Using portable ultrasound in theater is a kind of like the guy who first decided to put a lid on a coffee cup – it just made sense,” Vasios said.  “So we used it, and we proved it.” 

With these factors in mind, the medical staff of 1st Bn. and Landers continue to work to get more portable ultrasound machines in the hands of those they feel need them most: the Special Forces medic.

 “The plan is to increase the program to all the groups in a phased approach,” Landers said. “The key is training and maintaining the skills required to operate and use the machines.”

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Technology Adds Realism to Khaan Quest

ULAANBATAR, Mongolia – This scene was experienced by Korean special operations service members with the Republic of Korea’s 21st Battalion, International Peacekeeping Force, during the the combat lifesaver course, the first of seven training phases they participated in during the field-training exercise portion of Exercise Khaan Quest 2011, at Five Hills Training Area near Ulaanbatar, Mongolia, Aug. 3.

The squad worked with U.S. Navy medical personnel with the Tactical Medical Simulation Center, III Marine Expeditionary Force, Okinawa, to develop muscle memory when performing life-saving measures in a combat zone, said Lt. Cmdr. Trey Hollis, a chief medical officer and planner of Khaan Quest.

The primary purpose of the center is to prepare Marines and sailors who are deploying to combat areas with combat-lifesaving skills, but this time the center’s personnel will be teaching service members from six different countries.

“This is the first time the center has been employed in a military-to-military interoperability setting,” said Hollis. “The staff provides training that is followed by a technologically-enhanced practicum, which provides muscle memory needed to ensure lessons learned today can be recalled when needed most.”

Although many of the Korean soldiers are proficient at combat first aid, they agreed the combat-lifesaver training taught them things they had never encountered before.

“In Korea, we practice each injury separately, one at a time, so it was good to be able to combine all of these treatments into one training scenario,” said Capt. Yoon Hen, platoon leader, 21st Bn., IPKF. “When I get back to Korea, I will try to improve our medical training to something similar to this.”

All the service members who participated in this training experienced a unique piece of technology. The sailors deployed the center’s 3rd generation simulation mannequin, a talking, moving dummy that reacts to medical treatment almost like a real person.

“The ability to employ such a unique asset during a field training exercise to train multinational forces in lifesaving techniques shows III MEF’s commitment to support U.S. Pacific Command’s mission of enhancing partner nations’ capabilities during peacekeeping operations,” said Hollis.

The “sim man” provides service members an invaluable aspect of training, said Mark Kane, program manager, TMSC, III MEF.

“The best part about the dummy is that the student doesn’t have to look for an instructor to get feedback, the sim man provides feedback and will tell a person whether they’re doing it right or wrong. It will even tell you to go away,” said Kane. “The [mannequin] isn’t the end-all to training though. You need to have a realistic environment to train in. The combat environment added to the training is what makes people better.”

Creating realistic environments seemed as natural to the instructors as the medical training itself. They used controlled explosives, smoke, fake blood and office furniture as props to create a simulated catastrophe.

“My brigade deploys to many different types of operations, including combative and peacekeeping operations, so it was nice to be able to train on this level of reality,” said Capt. Seong Hyun Yeon, platoon leader, 21st Bn., IPKF.

This training allowed the countries to work more cohesively in multinational peacekeeping settings, said Hollis.

The week-long training will go a long way toward improving medical theater-security cooperation within the U.S. PACOM area of responsibility, and allowing non-medical service members involved in peacekeeping operations to feel more self-confident in the event of a mass-casualty situation, according to Hollis.

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One Standard for SOF Medics: TCCC

ADAR, Croatia – With more and more European partner nation Special Operation Forces (SOF) participating in ISAF operations, having medical personnel available to save the lives of wounded personnel in austere and sometimes dangerous environments is of critical importance.

Medical personnel, regardless of nation, must be trained in and armed with the appropriate medical equipment and procedures corresponding to each level of care and perform to the same standards.

As a result, the U.S. Special Operations Command Europe (SOCEUR) developed and conducted a Tactical Combat Casualty Care (TCCC) Train-the-Trainer course to enhance the SOF capability and interoperability of the participating nations, but most importantly, incorporate one recognize standard for managing trauma on the battlefield.

Over a two-week period in May at Zemunik Air Base at Zadar, Croatia, 17 medics from Croatia, Germany, Hungary, Latvia, Lithuania, Romania and Ukraine received expanded medical and trauma care training from U.S. medical personnel from 1st Battalion, 10th Special Forces Group (Airborne) and 352nd Special Operations Group (SOG).

According to Lt. Col. Mark Ervin, SOCEUR Surgeon, after feedback from several multinational events and deployments that SOCEUR components participated in, it was clear that while all the participants were familiar with the principles taught as part of TCCC, there were differences in how those principles were applied.

“These differing standards led to less effective care when the injured combatant most needed rapid medical treatment,” Ervin said. “

SOCEUR’s goal in organizing the TCCC Train-the-Trainer course was to provide its partner nation SOF medics with the knowledge and skills required to instruct others in providing medical care in a combat environment following the guidelines and protocols of TCCC.

Although TCCC started as an initiative by U.S. Special Operations Command, it is now used by all services in the U.S. military, conventional as well as SOF community. It is also now used by most allied countries and has been credited as a major factor in U.S. forces having the highest casualty survival rate in our history according to United States Army Institute of Surgical Research.

“This event gave a multinational group of experienced combat trauma care instructors a common course of instruction approved by the official internationally recognized Committee on TCCC,” Ervin said. “This regularly updated and reviewed program can now be used to bring all SOF operators and medics into compliance with an internationally recognized standard.”

The initial proposal to conduct the course took place in October 2010 where members of the SOCEUR Medical Directorate briefed the Croatian Ministry of Defense on the concept of the TCCC and presented a formal request to conduct the event there. Over a five-month period, several planning conferences took place to gather input from the partner nations and to establish a common framework for the event.

“When we first starting discussing TCCC training with our partner nations, it became clear that certification from an internationally recognized body was critically important,” Ervin said. “We entered discussions with the committee on Tactical Combat Casualty Care (CoTCCC) which resulted in defined criteria for approval of international TCCC courses to be certified by the CoTCCC and the naming of two experience TCCC instructors based in Europe to serve as validating officials.”

The CoTCCC’s mission is to advise the Assistant Secretary of Defense for Health Affairs and the Service Surgeons General about battlefield trauma care for wounded warriors. The committee is responsible for making changes and updates to the TCCC program. The training objectives of the SOCEUR-sponsored event centered on the three definitive phases of TCCC:

Care under Fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic; 

Tactical Field Care: Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours; and

Tactical Evacuation Care (TACEVAC): Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.

Training objectives included tourniquet application/hemorrhage control, needle decompression, patient movement/splinting, nasopharyngeal (NPA) airway insertion, MEDEVAC request/9-Line and rotary wing/loading procedures. Also, the participants had to be able to evaluate each other, design their own scenarios and perform other instructor skills so that they would be able to return their own units able to teach on their own.

Ervin specifically highlighted the importance of having interoperable protocols for tactical field medical care as wounded personnel may likely be treated by medical personnel from a different nation.

“With the diverse coalition contributing to ISAF, it is possible that a casualty will be seen by a combat first responder, medic, CASEVAC crew and physician that all come from different countries,” Ervin said. “A standardized protocol of field trauma care, such as TCCC, insures the injured combatant that despite the differences in language, everyone caring for him will be able to perform the most appropriate procedures and communicate using the ‘language’ of TCCC.”

As a lead instructor of the event, MSgt. Will A. Ward, noncommissioned officer in charge of Medical Operations, 352nd SOG, used his prior TCCC training to bring an air of realism to the participants, especially including “stress inoculation” during the field training exercise (FTX). The concept of "stress inoculation" is derived from a common principle in TCCC which is, care on the battlefield is almost never under good conditions. 

During the FTX the participants were exposed to stressful factors that could influence battlefield casualty care such as enemy fire (the number one factor that determines when and how much care can be provided), darkness, terrain, environmental factors, limited medical equipment, evacuation times and platforms (aerial) based primarily on the tactical situation at the time of the evacuation. They underwent several training lanes in which they were evaluated for their ability to make timely life care decisions under duress.

“Exposing students to a ‘stressful’ environment while making them follow the guidelines and theories of TCCC is the only real way to see if they can follow those guidelines while dealing with what could be a very difficult tactical situation,” Ward said.

During the FTX, Ward’s lane focused on rapid patient stabilization while breaking contact, hot landing zone selection, nine-line procedures, and loading and unloading patients from a helicopter. Ward highlighted that most battlefield casualty scenarios involve making both medical and tactical decisions very rapidly, so placing the medics in situations where their decisions would be the difference between life and death added to their stress level.

“I really wanted to focus on giving the partner nations the same quality and level of training that we get for our initial training,” Ward said. “This includes the same intensity in the exercises. I remember the first time that I had to perform TCCC guidelines in the dark, in a room simulating aircraft sound, temperature controlled at 105 degrees, and with an instructor who was more than happy to ‘hurry me along’ if I was going too slow. Those lessons helped when I had to perform in theater, so I want to embark that on them.”

As the host of the TCCC course, Maj. Mladen Gavrich, Chief of Medical Department, Croatian Special Operations Forces Battalion, was very impressed with the degree of training the medics underwent. Recognizing that regardless of the subject matter expertise and experience of his own nation’s medics had prior to attending the course, Gavrich mentioned the TCCC brought a new dimension to causalty care training that the Croatians had never experienced.

“We’ve never trained like this before, especially placing our medics in stressful conditions,” Gavrich said. “The training gave our medics a realistic picture of what could go right or wrong when treating a casualty on the battlefield – especially when taking fire with someone’s life is depending on them to keep them alive.”

He added that with future deployments of the Croatian SOF in support of ISAF, the TCCC course provides a valuable resource and important skills for medics to be successful while conducting this type of medical care to wounded troops on the ground when needed.

But most importantly, Gavrich stressed the course lays a foundation for future medical training as the Croatians will implement their own TCCC course later this year, “taught with common standards and guidelines of the NATO community.”

“The knowledge of what they gained here will allow us to develop better and quality training for our soldiers,” Gavrich said. “I look forward to see how our instructors will train our medics with the skills that they take back from this training and I can say that the TCCC brings our combat medical care to a higher level.”

Ervin agreed with Gavrich’s conclusion on the importance of the TCCC in developing more qualified medics and added linking the event to the CoTCCC provides a continuity of updated training requirements that all the nations can maintain. 

“This committee (CoTCCC) regularly updates the curriculum based on battlefield evidence from trauma casualties,” Ervin said. “The NATO SOF Headquarters (NSHQ) Medical Advisors Office, who coordinated CoTCCC support for this event, is the link between these newly minted NATO TCCC trainers and the CoTCCC.”

For one of the training participants, the TCCC course proved very beneficial. A Lithuanian Special Forces (SF) medic, with three combat tours in Afghanistan, mentioned that although his medical standards were similar to the Americans, it was very important to have one standard for all NATO countries serving together in a coalition capacity.

“If we start to train repetitiously according to the TCCC model, we will be able to better save lives,” the Lithuanian SF medic said. “This course brings legitimacy to the direction we (Lithuania) want to go when developing our Special Forces operators and medics to perform the TCCC protocols to the international standard. We will also take those same standards to better develop our conventional forces.”

He specifically stressed the importance of knowing what actions to take when taking fire.

“This course allowed me to think what my actions are when in combat and treating a casualty,” the Lithuanian SF medic said. “All of my medics understand first aid, but they must be able to think quickly on when to engage the enemy on the battlefield and also be able to provide care while under fire. The TCCC qualification is something that we are going to look at for ensuring medics who deploy in the future have as part of their skill set.”

Having met SOCEUR’s short-term goal of providing an internal mechanism for partner nation SOF to train their own forces in the life saving battlefield skills to the level of the international standard, Ervin mentioned the way ahead for SOCEUR to maintain the momentum of the TCCC event. 

“Long term, this is the first step in the development of an international cadre of TCCC instructors that will provide NATO SOF greater interoperablity in field trauma care,” Ervin said. “Ultimately, we expect that the employment of the TCCC standard within NATO (and NATO partner countries) will drive the introduction of the best European combat trauma scientific research into the proceedings of the CoTCCC.”

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BLOCS Quick Eject Tourniquet Carrier (BQETC)

Seconds count on the battlefield. In an emergency situation, soldiers need to get to their tourniquets quickly and effectively.

The Need:

• Blood loss one of the main causes of death on the battlefield.

• Soldiers not being able to access their tourniquets quickly.

• Soldiers removing their tourniquets from the plastic wrapping and tying them to their uniforms with rubber bands or aircraft ties, exposing tourniquets to the elements. Metal pieces of tourniquet are rusting and other pieces are getting contaminated by mud, dust, rain, and moisture, rendering the tourniquets ineffective.

The Answer:

BLOCS Quick Eject Tourniquet Carrier (BQETC)

(3) main features that other products do not offer:

1. Quick Access

2. Protection from the elements (mud, rain, oil, dust)

3. Versatile Velcro® mounting

More details:

• One-handed release for quick and easy access.

• Protective, water resistant, Pack Cloth covering, keeps tourniquet in the plastic as designed and safe from the elements (dust, mud, blood, oil, rain, etc.), for maximum sterility and effectiveness.

• Versatile velcro mounting system, can be mounted almost anywhere on the uniform for operator preference (including MOLLE straps, belt, shoulder straps, arm bands, etc.)

• Extremely lightweight yet sturdy, uses all MIL SPEC materials

• Moves the tourniquet out of the IFAK/cargo pocket/medical pouch to the front of the uniform where it can be accessed quickly and easily.