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Marine Corps brings emergency medicine to the battlefield



As the Marine Corps reorients toward crisis response missions in Africa and the Asia-Pacific region, the service's Futures Directorate is developing technology that will ensure serious casualties receive life-saving care within an hour of catastrophic injury — no matter how remote the battlefield.

U.S. troops drastically improved the evacuation of major casualties in Iraq and Afghanistan during nearly 14 years of continuous conflict, saving many who would have certainly perished during past wars.

But getting Marines timely care in a theater with established medical pipelines and hundreds of rotary wing air assets zipping over the battlefield was one thing. Doing that during long-range expeditionary operations launched from the sea over hundreds of nautical miles poses new challenges, said Lt. Cmdr. David Gribben, the expeditionary medicine officer at the Futures Directorate aboard Marine Corps Base Quantico, Virginia.

"We want to be able to keep the same capability with a lighter footprint than Afghanistan and Iraq," he said

If Marines can't be quickly transported to ship-board emergency room-level facilities due to scarce air assets or distance and topography, Gribben and his team are working to bring the ER to them.

They have already proven the concept during the Rim of the Pacific Exercise 2014 last summer using a small vehicle that can provide shock trauma care at the company level. They also demonstrated the use of telemedicine, which uses sensors to carefully monitor and transmit a patient's vital signs so a remotely located doctor can lend his or her expertise to a corpsman.

By summer 2016, they plan to incorporate unmanned aerial vehicle resupply and a robust surgical capability into future exercises.

It is all part of the directorate's movement to adapt to the service's latest concept of operations — Expeditionary Force 21, which emphasizes sea basing and lightning-fast dispersed operations. That makes the Marine Corps more agile, but presents significant challenges for medical personnel.

"The ability to push shock trauma capability forward is what we are all about," said Gribben who deployed with Marines to Afghanistan several times. "EF-21 is really our starting point. It has really given us our North Star to plan around."

Shock Trauma Section

The Shock Trauma Section is at the heart of future battlefield care. It is a mobile ER built on an existing Internally Transported Vehicle and is manned by an emergency medicine doctor, nurse, corpsman and physician's assistant.

By basing the platform on an ITV, the same vehicle used to tow the service's 120mm mortar Expeditionary Fire Support System, the service will be able to transport STSs across the battlefield in the belly of an MV-22B Osprey.

The STS is a self-contained package that provides a medical team with everything they need to stabilize a severely wounded Marine, including blood storage and the ability to warm patients in shock.

Forward surgery

Futures Directorate is also working to bring a robust surgical capability ashore since casualties on remote battlefields could face significant delays after emergency treatment at an STS, before air evacuation back to a ship.

"With one or two [Marine expeditionary units] out at sea, you still have a good amount of combat power, but far less air support than you had in Afghanistan and Iraq," Gribben said. "So you are going to have to hold patients on the ground longer after initial intervention by an ER team. They might be on the ground for two to three hours."

If STS fulfills the role of shock trauma platoon, the military version of an emergency room, then establishing a forward surgical capability will be the equivalent of a hospital's upstairs operating room where patients go once they are breathing, major hemorrhaging is controlled, and they are stabilized for follow on treatment.

One day Marine casualties could be stabilized, have gone under the knife, and be sutured before ever leaving the battlefield.

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