Page 10 - Journal of Special Operations Medicine - Spring 2017

by Allison Esposito, Managing Editor

Multi-Domain Battle White Paper normally. . . .” Researchers say these men are at high
risk for suicide.
The 18 January 2017 white paper Multi-Domain Battle:
Combined Arms for the 21st Century “describes a coor- “Doctors at several medical centers hope to offer penis
dinated Army and Marine Corps approach for ground transplants from deceased organ donors to wounded
combat operations against a sophisticated peer enemy veterans . . . In recent years, the military started provid-
threat in the 2025–2040 timeframe. It is intended to ing better gear, essentially Kevlar underpants, to pro-
promote thought and discussion concerning the meth- tect the pelvic area . . . A new finding in the report is
ods and capabilities required to confront sophisticated that blast injuries to the pelvis may have a delayed effect
threats. It offers specific hypotheses to inform further that destroys fertility even if there is no obvious external
concept development, wargaming, experimentation, damage.”
and capability development. This paper encompasses
the views of the Army and Marine Corps regarding an
endeavor that involves the entire joint team. It is there- Oxygen Carries: Alternates to Red Blood Cells
fore published with the expectation that the ideas herein For more than 80 years, researchers have struggled to
will, in concert with the other Services, be refined and find an oxygen carrier to replace red blood cells lost dur-
expanded into appropriate joint concepts.”
ing massive hemorrhage. Nothing highlights this prob-
lem more than the need to transfuse injured Soldiers
The white paper describes how the Army/Marines plan in austere environments. Early observations regarding
to fight in the future and has implications for medical stroma-free hemoglobin raised concerns about crystal-
innovations for the battlefield, including the areas of fo- lization in the proximal renal tubules. This issue was re-
cus of prolonged field care, endovascular hemorrhage inforced in the 1942 book Blood Substitutes and Blood
control, battlefield pain management, unmanned medi- Transfusion by Mudd et al., in which it is reported that
cal platforms, and virtual health.
the use of lyophilized hemoglobin needed further study
because of the renal damage caused.

In the late 1970s, artificial blood made of perfluorocar-
bon emulsions was introduced. Within several years,
due to the failure to demonstrate efficacy, this product
was removed from the market because of safety issues.
Recent work on hemoglobin oxygen carriers has shown
some potential for their use in trauma, but adverse
events remain a problem. A promising new dried blood
Comprehensive Review of powder is under development at Washington University
GU Injuries in Veterans
in St Louis, Missouri. It would require no refrigeration,
The report “Epidemiology of Genitourinary Injuries have a longer-term shelf life than previous similar prod-
among Male U.S. Service Members Deployed to Iraq ucts, and not require cross-matching. Availability of the
and Afghanistan: Early Findings from the Trauma Out- product, though, is still years away.
comes and Urogenital Health (TOUGH) Project” (JC
Janak et al., J Urol. 2017;197(2):414–419) finds that One final comment, in 1984, my colleagues and I at
“1,367 men in the United States military suffered inju- WRAIR developed a mechanism for collecting blood
ries to their genitals or urinary tract in Iraq or Afghan- shed into the chest. With a large-bore needle and a
istan from 2001 to 2013, mostly from bomb blasts,” Heimlich valve, the blood could be collected and rein-
says Denise Grady, New York Times (see https://www.ny fused safely back into the wounded Soldier. Perhaps this
times.com/2017/01/13/health/genital-injuries-among technique should be revisited for use in austere environ-
-us-troops.html?_r=0). ments. Blood is a precious commodity on the battlefield,
and research needs to be focused on many paths to en-
“The number of cases is ‘unprecedented’ and the in- hance survival in Soldiers where tourniquets and he-
juries ‘uniquely devastating’ because they can impair mostatic dressings cannot be used. —Jerome H. Hauer,
a man’s ability to have sex, father children or urinate PhD, MHS, JSOM Associate Editor

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