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Development of Hemostatic Dressings for Use in Military Operations

Abstract : On the battlefield, hemorrhage from wounds remains the leading cause of mortality, accounting for 50% of all deaths [1]. Hemorrhage is also the second leading cause of mortality among injured civilians, accounting for 39% of civilian trauma deaths [2-4]. The primary field-ready methods for control of hemorrhage tourniquets, direct pressure, bandages, and clamping have not changed greatly in several centuries [5]. These interventions, even in the hands of experts, are not always effective [6]. In Vietnam, 50% of combat deaths resulted from wounds with uncontrollable bleeding. Of these wounds, about 11% were inflicted in sites accessible for first aid treatment without need for surgical intervention [1,7]. More effective hemostatic methods could have been prevented tip to one third of the deaths from exsanguination during the Vietnam War [1, 8]. This background information strongly illustrates the need to develop a better hemostatic method to improve the immediate care and survival of casualties in the field. For the past nine years, the United States Army has worked closely with the American Red Cross (ARC) to develop a field-ready hemostatic dressing that can effectively stop arterial bleeding from major wounds. The ARC has an active program to develop fibrin sealant hemostatic agents, the focus of one of our research projects. The organization also controls 50% of collected human plasma, the current source of fibrinogen and thrombin proteins, which are the main components of fibrin sealant dressing. This article briefly reviews the history and development of fibrin sealant dressing as well as other hemostatic products (e.g., chitosan dressing) and the important role that the US Army Institute of Surgical Research (ISK) has played in developing these products.