Report Examines Lower Body Blast Injuries|
On September 21, 2011, the Army Surgeon General's Office released its report on dismounted complex blast injuries (DCBI), which more than twice as many service members have suffered annually since the 2009 troop surge in Afghanistan.
Army Brig. Gen. (Dr.) Joseph Caravalho Jr., Commander of the Army's Northern Regional Medical Command, detailed the report's findings. The injury pattern known as DCBI, Caravalho said, is typically caused by a mine or roadside-bomb explosion, affects troops on foot patrol, and involves traumatic amputation of one leg, at least a severe injury to the other leg, and wounds to any or all of the pelvis, abdomen and genitals.
Army Surgeon General Lt. Gen. Eric Schoomaker charted a task force in 2011 to study the injury pattern, Caravalho said. The group, which Caravalho chaired, included experts from the Army, Marine Corps and Veterans Affairs Department, who examined the causes, prevention, protection, treatment and long-term care options for service members suffering these severe injuries, he added.
The report details the number of surviving service member amputees from January 2010 to March 2011. Of 194 amputations, 78 resulted from DCBI and 116 from other causes. By service, 53 Marines, 23 soldiers and two sailors suffered dismounted complex blast injuries resulting in amputation.
Caravalho said while severe injuries nearly doubled from 2009 to 2010, military medicine is saving more lives than ever before.
More combat troops are surviving, he said, because personal protective equipment and armored combat vehicles have decreased the number of head, torso and serious burn injuries; battlefield medics focus first on controlling bleeding with tourniquets; helicopter evacuation times are shorter; there are highly trained medical professionals aboard those helicopters; and medical surgeons have improved surgical resuscitation.
The task force identified 92 recommendations to improve quality of care to service members suffering lower body blast injuries and their families, Caravalho said.
Some best practices have already been implemented, he added: paramedic training for flight medics, to improve the level of care available during medevac; and early use of blood products, possibly even on the battlefield.
Other recommendations focus on point-of-injury and long-term pain management, and on a multidisciplinary approach to long-term care, he said.
Army Col. (Dr.) James Ficke, chairman of the orthopedic surgery and rehabilitation department at Brooke Army Medical Center near San Antonio, has worked with many service members who have suffered complex blast injuries. Service members who suffer these injuries can still live fruitful and productive lives, but need help to deal with fear of the unknown, he said.
Army Col. (Dr.) Jonathan Jaffin, chief of staff for the Army Surgeon General Office's Complex Battle Injury Work Group, said the military medical research community also is researching how to compress blood vessels "that otherwise you couldn't get a tourniquet on."
Military medical teams use a multidisciplinary approach to complex blast injuries, incorporating surgeons, therapists, prosthetists and behavioral medicine experts to give patients the best possible long-term outcome, Ficke said.
Caravalho said military medical professionals want service members to know there always is hope, even after complex traumatic injuries.
"Military medicine and the VA will be with them for the long term," he said. "They are entitled to the absolute best care we can provide -- not because of their injuries, but because of their service."
Abstracted from a report by Karen Parrish, American Forces Press Service
October 28, 2011
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