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Two new options to help stem bleeding, save lives of wounded

Uncontrolled bleeding from the chest, neck, groin and abdomen — areas where a tourniquet cannot be cinched — accounts for the vast majority of preventable deaths downrange, doctors and researchers say.

To help stop the bleeding, medics and doctors in Afghanistan will soon have two more options available to them: a lifesaving drug that aids clotting, and a new viselike tourniquet that can be placed over the groin and lower abdomen—areas where a typical tourniquet will not work.

The drug, tranexamic acid, is cheap, widely available and safe, doctors and researchers say. The British military first began injecting troops with the drug after a global study, published in 2010, showed that tranexamic acid reduced deaths by 10 percent when given within eight hours of injury, and even more when administered sooner.

Until now, the U.S. military has been reluctant to use tranexamic acid, or TXA, as it had not been tested in combat settings. The 2010 study had looked mainly at crash victims.

But results from a joint U.S.-U.K. study, which examined 900 troops given tranexamic acid at Camp Bastion, the main British military base in Afghanistan, provided evidence that the drug reduces mortality in combat injuries as well.

“Tranexamic acid is the best agent we have for noncompressible hemorrhage,” said Dr. Frank Butler, a retired Navy captain and chairman of the Committee on Tactical Combat Casualty Care, which is responsible for setting guidelines on how U.S. troops are treated in theater.

During a conference call with reporters, Butler and Dr. (Col.) Lorne Blackbourne, commander of U.S. Army Institute for Surgical Research, said the guidelines would soon, possibly within a few weeks, recommend the use of tranexamic acid downrange.

Tranexamic acid was first found to be useful in controlling bleeding in the early 1960s, and it has since been used to reduce hemorrhaging in surgery and to treat heavy menstrual bleeding. It works by preventing the breakdown of the blood’s natural clotting response, said Ian Roberts, the lead investigator of the much larger British study, which looked at 20,000 patients, most of them traffic accident victims, in 40 emergency rooms worldwide.

Roberts had earlier questioned the U.S. military’s reluctance to use the drug, which was also recently added to the World Health Organization’s list of essential medicines.

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“They have been persuaded by the evidence that tranexamic acid should be included,” he said in a phone interview Tuesday. “I think it’s the right decision, and I think it will save U.S. soldiers’ lives.”

U.S. medics in Afghanistan will also begin fielding a new type of tourniquet, called the Combat Ready Clamp, which can be applied to areas where a typical tourniquet will not work.

The need for such a device arose after more servicemembers were being injured in the pelvic and groin area — the injuries were most likely the result of more foot patrols last year and Afghan insurgents using powerful and sophisticated homemade bombs.

Stemming uncontrolled bleeding in these areas could prevent the deaths of three soldiers a month, said Blackbourne and colleagues in an article published last April in the U.S. Army Medical Department Journal.

“The high (on the leg) amputations, (and) pelvic injuries are the perfect injury for the device,” Blackbourne said in the conference call this week from the Advanced Technology Applications for Combat Casualty Care conference in Fort Lauderdale, Fla., where military and civilian personnel are gathered to address findings and issues in pre-hospital care.

Unlike a typical tourniquet that cinches around a limb, the Combat Ready Clamp attaches like a vise, applying pressure to the arteries as it is screwed tight.

Made by Combat Medical Systems, of Fayetteville, N.C., the device has been approved for use by the U.S. Food and Drug Administration and has already been fielded by a few medics in Afghanistan, Blackbourne said.

“We’ve had one field report where it was used,” he said, “and it worked.”

robbinss@estripes.osd.mil

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