First-aid methods for saving wounded soldiers have evolved considerably over the centuries, from treating burns with hog’s lard during the American Revolutionary War, the use of ether and chloroform as an anaesthetic during the Crimean War, advancements in amputation during the First World War, and the establishment of fully equipped, mobile field hospitals in the Second World War.

Wounded Canadian soldiers in Afghanistan await helicopter evacuation.

PHOTO: CPL. ROBIN MUGRIDGE

Today, control of blood loss is the top priority for military medics and researchers as hemorrhaging continues to be the leading cause of death in war. Soldiers and fully trained medics are now more knowledgeable, and far better equipped, with safer tourniquets and blood-clotting bandages.

But the evolution of medicine hasn’t stopped there.

Household items like sponges, typically used to clean dishes or scrub the bathtub, and polyurethane foam found in bedding, furniture and insulation are now being developed for the battlefield.

Oregon-based company RevMedx Inc. has developed a hemostatic device called XStat, intended to control bleeding from junctional wounds in the groin or armpit, areas that aren’t protected by body armour and cannot be treated with a tourniquet or manual compression.

The syringe-like applicator injects small sponges into the wound that rapidly expand and swell to fill the
cavity within 20 seconds of contact with blood. The sponges provide internal pressure to prevent hemorrhaging and can be used for up to four hours until the wounded soldier can be transported to receive surgical care. The sponges contain an X-ray detectable marker to aid in surgical removal.

The company announced on April 7, 2014, that the U.S. Food and Drug Administration (FDA) had approved XStat. According to the RevMedx website, XStat will be available for use on the battlefield this year.

Another applicator device was developed last fall by undergrad-uates at Johns Hopkins University in Baltimore, Md., for the same purpose of curbing blood loss while a wounded soldier is transported to medical care, but rather than sponge, it uses polyurethane foam.

The prototype device, invented by eight biomedical engineering students for a class project, is the size of a whiteboard marker and holds two liquid chemicals, a polyol and a diisocyanate, that are stored in separate canisters within the device. When injected, the chemicals mix together and create a foam that expands, hardens and applies pressure to the wound cavity to stop bleeding.

The students’ project was supervised by two surgeons at All Children’s Hospital, a Johns Hopkins Medicine facility in St. Petersburg, Fla. Supporting surgeon and veteran Paul D. Danielson said that the device is expected to be “a viable solution to a problem that’s been plaguing us on the battlefield.”

While in development, doctors and engineers are working to ensure there is enough foam to effectively fill a wound and harden quickly, as well as address questions about the ease of removing the foam during surgery and if there would be any residual damage to body tissues.

The “platinum ten” represents a ten-minute window of time that medical personnel have to assess the situation, administer treatment and then transport the injured to ensure there is minimal blood loss—and maximum survival.

“The fate of the wounded lays with those who apply the first dressing,” wrote Colonel Nicholas Senn (1844-1908), surgeon and founder of the Association of Military Surgeons of the United States.

Inspired by those words, today’s researchers keep striving to develop lightweight and quickly administered medical tools, knowing their success will be measured in lives saved on the battlefield.