Story Highlights• On-site treatment for severe bleeding has changed little since Roman times
• Iraq, Afghanistan wars spurred urgency, helped HemCon and QuikClot grow
• Citing military reports, HemCon and QuikClot claim to have saved hundreds
• Expert: New treatments not perfect, but generally effective
By Greg Botelho
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WASHINGTON (CNN) -- The solution to curb severe bleeding was the same three years ago as 3,000 years ago -- gauze, applied with pressure.
But the wars in Iraq and Afghanistan have added groundbreaking and fast-working wound dressings to the medic's bag.
Dr. Hasan Alam, a trauma expert and associate professor of surgery at Harvard Medical School, said there have been dramatic improvements in hospital survival rates in the past 20 years, but little movement in pre-hospital survival. "If someone gets blown to bits, that's one thing," he said. "But if you have a fixable injury, that's more of a tragedy."
Historically and in Iraq, half of combat deaths can be traced to uncontrolled bleeding. A science and military partnership in the last four years has helped fine-tune and fast-track products through the FDA approval process that, according to reports, have saved hundreds of lives on the battlefield.
U.S. Army soldiers carry HemCon bandages. Their main ingredient is chitosan, which is derived from shrimp shells and can rapidly clot blood. QuikClot is a similar product, but relies on the mineral zeolite to speed clotting and is used by all branches of the U.S. military, as well as NATO and Iraqi defense forces.
The innovations are also catching on in the civilian world, where some first responders, medical technicians, dentists and surgeons are adopting the products.
Ray Huey, CEO of QuikClot's parent company Z-Medica, awaits the day civilians can apply a QuikClot dressing to their own cuts.
"Wars always cause improvements in trauma care," said Col. John Holcomb, a trauma surgeon and head of the U.S. Army Institute of Surgical Research. "For the first time in combat, there are multiple products better than gauze dressing .... The lessons that we learn in the military are going to apply 10- or 100-fold to the civilian community."
HemCon was co-founded in 2001 by Dr. Kenton Gregory and Dr. William Wiesmann, who had retired in 1997 as head of Combat Casualty Case at the Army's Medical Research and Material Command (MRMC). That year, Army scientists gave the product high marks and subsequently worked with HemCon to refine the bandages and get them on the battlefield.
Meanwhile, Francis Hursey, formerly a scientist with the Apollo space program, patented a QuikClot prototype in 1989. It wasn't until 2002, though, that the product took off after excelling in a competitive U.S. Navy test.
HemCon and QuikClot tout great success rates, but Alam, director of Massachusetts General Hospital's Trauma Research Laboratory, cautions against considering them cure-alls.
When HemCon bandages work, "they work great," he said. "But when they fail, they fail completely." The problem, Alam explained, isn't the bandages' chemical make-up but their physical properties: The squares may not create a sound seal over every wound, especially those in hard-to-reach, uneven places like armpits or groins.
Alam lauded QuikClot's ability to promote clotting. Yet the original product generated heat that sometimes led to burning, and the granular material was messy for surgeons to clean from wounds. Later incarnations fixed the problems, and Alam said the bandages still effectively generate clots, but "not as rapidly."
Whatever the technology, some injuries cannot be overcome.
"It makes a huge difference if bleeding is rapid enough that you're going to die regardless," said Dr. Dick McCarron, chairman of the Department for Trauma and Resuscitative Medicine at the Naval Medical Research Center.
The killed in action rate -- those who died before reaching an aid, surgical or hospital facility -- in the Iraq conflict is 13.5 percent, down from 20 percent in Vietnam, according to a 2006 study in the Journal of Trauma. This drop is despite the highly mobile nature of the Iraq and Afghanistan wars, which lack clear front-lines and leave many troops facing danger isolated from medical facilities, McCarron noted.
Holcomb, a co-author of the Trauma study, credited improved body armor, evacuations, training and equipment, including new one-handed tourniquets and the clotting bandages.
But work on improving the bandages and arming those in battle with new ways to treat serious wounds continues.
"We can't just sit on our duff," said Huey. "We're continuously working to improve."
Roman soldiers used gauze to curb bleeding, as did U.S. troops until a few years ago.
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