Soldiers today have the best survival rates in the history of warfare, but, of those who don’t make it, 90% die on the battlefield before reaching hospital. Dr Gareth Evans finds out about the technological advances making the crucial difference en route to hospital.

Wounded soldiers today have the best survival rates in the history of warfare, according to Lt. Gen. Nadja Y. West, Surgeon general of the US Army and head of the Medical Command, with around 92% of those injured in combat in Iraq and Afghanistan returning alive. In Vietnam, it was just 75% and in other conflicts the statistics have been lower still, but, while the chances of an injured warrior making it home have undoubtedly improved, one thing has remained much the same. Of those wounded who do not ultimately survive, 90% die on the battlefield, before the casualty gets anywhere near a medical treatment facility (MTF).

Two factors hold the key to changing that: what happens in the first few minutes post-injury, and the level of care en route to hospital. If fellow soldiers and medics have had appropriate training and the right equipment is on hand, the chances of saving the injured’s life can be hugely improved.

Tactical Combat Casualty Care

First introduced in the mid-1990s for the US Special-Ops medical community, Tactical Combat Casualty Care (TCCC or TC3) has subsequently become the gold standard for pre-hospital battlefield care across most of the NATO members and allied countries. A highly effective operational doctrine designed to optimise the interventions and availability of devices required to minimise preventable combat deaths, TCCC has driven a fundamental re-think in both where and how critical life-saving equipment is deployed, and in the broader medical skill-set of soldiers in general.

It has also revolutionised the kind of medical technology that is now routinely being taken into battle.

As Kevin Wheeler, Medical Director at safety solution provider Survitec, puts it, it is all about equipping military personnel with the tools they need to care for their comrades, and giving them the training required to execute the necessary support and care efficiently and quickly. In September, the company launched its Pre-Hospital Care System (PCS), which includes state-of-the-art, pre-hospital medical equipment, sourced from over 44 leading health-care companies, packaged and ready for field use and optimised across the different TCCC phases of Care Under Fire, Tactical Field Care and Tactical Evacuation.

“The system is an end-to-end solution offering a fully integrated approach,” says Wheeler, himself a clinically current, registered Paramedic who has served several tours as a medic in Iraq and Afghanistan.

Modular and scalable

Survitec have taken a modular, scalable approach, with each module in the system designed by a specialist team of experienced military medics and rescue professionals to optimise ease of use, speed of care and equipment mobility.

“We have standardised the modules across the system for several reasons,” Wheeler explains. “Firstly, this eases the training burden by having a commonality and consistency across the modules. So, for example, an IV kit will contain the same items required to gain IV access whether it’s in a Field Care kit or a module used higher up the chain. This also assists resupply, so the end-user knows that when they need to order 1000 IV kits, they’re all the same and have the same NSN [NATO Stock Number]. The kits can be distributed accordingly without each one being unique in some way. This is just an example, but we have utilised this approach where possible.”

The PCS covers an entire range of different trauma scenarios including tactical field care, field mobility, extraction and tactical evacuation care, casualty sustainment care and mass casualty care, far forward environments, naval operations and chemical, biological, radiological and nuclear (CBRN) environments. Each comes with its own particular set of challenges and according to the company literature, the modules devised to meet them are intended to give “the combat medic a full life saving capability from patient access in field to hand off at hospital level.”

The Field Care module provides the portable capability to administer immediate first aid to combatants at the point of injury, on the battlefield and potentially under fire, while the Field Mobility kit enables patients to be carried over rough terrain and for extended distances. The casualty and mass casualty sustainment kits contain the medical materials required necessary to sustain multiple patients for up to 72 hours. For those operating in far forward positions, a Far Forward Blood kit has been specially designed to provide a safe method for transporting blood, which enables pre-hospital whole blood transfusions to be undertaken if necessary, helping avoid post injury blood-loss, which is one of the main causes of on-battlefield mortality.

The PCS is rounded off with an Extraction kit to aid casualty rescue and recovery, and a CBRN kit to allow an affected patient to be extracted without the risk of contaminating the care team or the aircraft or vehicle used for the rescued. A number of the modules are also made in waterproof versions for naval use.

Essential training

The best equipment in the world is, of course, of little use without properly trained hands to operate it. To meet that need, training covers everything from module familiarisation and courses designed to teach non-medical personnel to administer life-saving treatment to casualties in a tactical or remote situation, right up to advanced tactical surgical skills.

“The training is generally done at the customer’s location for ease of cost and logistics,” explains Wheeler. “It’s cheaper and easier to send a handful of our trainers than for them to send 40 troops to us. The training is generally high-level training on the kit and equipment in a ‘train-the-trainer’ manner.”

He says that this approach enables users to develop their own organic expertise and then subsequently disseminate it through the chain of command, via internal courses and the like.

Survitec only officially unveiled the system at September’s DSEI exhibition in London in September, but it seems it has already stirred up a considerable amount of interest. The Norwegian Defence Material Agency had signed up ahead of the official launch to a deal with Swedish company Promoteq AB, with Survitec as subcontractor, acting as the System Integrator, valued at $18m for three years, with an option to extend further. Wheeler says other Scandinavian countries are also showing an interest and, beyond that, he says the Survitec Group has a global footprint and fully intends to leverage their world-wide supply chain to develop the capability even further.

“We are by default an innovative and thought-leading company and we are constantly looking to improve our products and services. The medical team is manned by clinically current personnel who have battlefield combat medical experience, allowing us to design bespoke solutions and give the customer relevant and credible solutions and support,” he explains. “We therefore like to think our solutions are devised in concert with the end-users’ needs, but also from exceptional knowledge and experience.”