Page 76 - JSOM Spring 2024

similar purification tasks. These commercially available de- Conclusion
vices vary greatly in size, weight, cost, and volume of water
throughput. Six different methods of water purification were Based on the results of this study and the feedback received
evaluated and found to effectively reduce the bacterial burden from experienced military physicians, we conclude that a
in water. However, no single device was perfect, as each device layered approach to water purification is optimal. Notably,
had both perceived strengths and weaknesses. CHLOR-FLOC, the product the U.S. Military has used since
WWII, has many desirable characteristics and effectively re-
duces microbial load in contaminated water. In austere settings
Severe, open, battlefield wounds are inherently prone to in-
fection because of their exposure to the environment, con- where all equipment is manually carried, given its high-volume
tamination with dirt and debris, and blood loss/transfusion. throughput, low cost and cube, and positive effects on pH and
11
Irrigation with fluids is a primary strategy to remove debris water decontamination, the Aquamira drops appear superior
and reduce infection. Accordingly, it is crucial to ensure that to the other small, lightweight products. When weight, cost,
12
no additional bacteria are introduced via contamination with and cube are less important (vehicle availability), the Guardian
dirty water. All the evaluated products significantly decreased purifier appears to be a superior device.
the CFUs of all contaminated water sources (pond and river
water and inoculated saline), but only the Steripen device re- Author Contributions
duced bacteria levels to below detectable limits. NM, DJS, and JCW conceived the study. IBH and SMS co-
ordinated, collected, and analyzed the data. IBH, SMS, JBH,
and JCW wrote the first working drafts of the manuscript. All
It is generally understood that human pathogenic bacteria
thrive in alkaline environments; as such we measured pH in authors read, edited, and approved the final manuscript.
13
the pond, river, and tap waters used in this study. The use
of filtration or boiling decreased the already alkaline pH of Disclaimer
the pond, river, and tap water, whereas chemical purification The views expressed in this article are those of the author(s)
methods raised the acidity of the water. Accordingly, chemical and do not reflect the official policy or position of the U.S.
purification may be preferred to filtration. Army Medical Department, Department of the Army, DoD, or
the U.S. Government.
Turbidity reflects the “cloudiness” or individual particles
in any water source and generally indicates the presence of Disclosures
pathogenic microorganisms. As expected, pre-treatment tur- Dr. Holcomb is a consultant with BARDA, Aspen medical and
14
bidity measurements indicate that only pond and river water DoD, is Co-founder, Co-CEO and a Member of the Board of
sources were more turbid than saline or tap water sources. The Directors of Decisio Health, the Board of Directors of He-
Guardian and CHLOR-FLOC methods decreased the turbid- mostatics, QinFlow, Zibrio, and Oxyband. He is also a Co-
ity of both river and pond water. inventor of the Junctional Emergency Tourniquet Tool.

Given the lack of conclusive data from high-quality clinical tri- References
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