The history of Medical Capability Gap JCM-1-5 - Poor ability to stop life-threatening extremity bleeding (original) (raw)

The significance of hemorrhage was not immediately apparent to the medical community. Medieval surgeons considered blood to be one of the four humors, levels within the human body needed to be managed rather than conserved. Inflammation, or excess accumulation of blood, was considered a bigger risk than blood loss. Conventional wisdom was transformed with William Harvey's (1578-1657) observation that blood circulated within a closed system. Eighteenth -century surgeons began employing crude tourniquets to stop hemorrhage during amputation, dramatically increasing the chances of survival for the patient. Jean Louis Petit (1674-1750) developed a tourniquet that used a screw mechanism to keep the band constricted instead of requiring an assistant for that task and his design was widely used for the next two centuries. As the application of anesthesia became more sophisticated by the turn of the twentieth century, surgeons had more time to perform surgical procedures employing improved techniques to prevent blood loss. Hemorrhage control became a first aid issue. First responders, known as corpsman or combat medics, were trained in basic lifesaving techniques relying on bandages to stem blood loss. The tourniquet had become a first aid technique, whose use was discouraged. When it was possible for a surgeon to save a limb, the risk of damage to the limb by a tourniquet left on too long was considered a greater risk than hemorrhage. However, by the late 1980’s, when it was recognized that up to one-third of all combat deaths resulting from exsanguination could have been prevented with the use of more effective hemorrhage methods, the U.S. Army’s Combat Casualty Care Research Program focused on the development of more effective hemostatic products than gauze. The first prototype of Dried Fibrin Sealant Dressing applicable to trauma surgery was developed at the Letterman Army Institute of Research in early 1993. This innovation led to the development of chitosan and fibrin dressings which have widely been used on the battlefield to arrest hemorrhage. A new generation of tourniquets was developed and has become a standard component in the Individual First Aid Kit. This success changed the approach to trauma care leading to the development of civilian applications of this approach. On Oct. 6, 2016, President Obama unveiled the “Stop the Bleed” campaign to empower bystanders to act as immediate responders. Working with the Departments of Homeland Security and Health and Human Services, FEMA, the private sector, not-for-profit organizations, and the medical community, the “Stop the Bleed” campaign aims to raise awareness of life-saving strategies and provide public access to bleeding control tools already used by first responders and the military. Learning Objectives o Describe how an understanding of the importance of hemorrhage has evolved. o Describe the development of technological interventions to control hemorrhage. o Understand the influence of science on the practice of medicine.