Report Examines Lower Body Blast Injuries

WASHINGTON, Sept. 21, 2011 — The Army Sur­geon General’s Office released its report yes­ter­day on dis­mount­ed com­plex blast injuries, which more than twice as many ser­vice mem­bers have suf­fered annu­al­ly since the 2009 troop surge in Afghanistan.

Army Brig. Gen. (Dr.) Joseph Car­aval­ho Jr., com­man­der of the Army’s North­ern Region­al Med­ical Com­mand, detailed the report’s find­ings to reporters here.

The injury pat­tern known as DCBI, Car­aval­ho said, is typ­i­cal­ly caused by a mine or road­side-bomb explo­sion, affects troops on foot patrol, and involves trau­mat­ic ampu­ta­tion of one leg, at least a severe injury to the oth­er leg, and wounds to any or all of the pelvis, abdomen and gen­i­tals.

Army Sur­geon Gen­er­al Lt. Gen. Eric Schoomak­er chart­ed a task force in 2011 to study the injury pat­tern, Car­aval­ho said. The group, which Car­aval­ho chaired, includ­ed experts from the Army, Marine Corps and Vet­er­ans Affairs Depart­ment, who exam­ined the caus­es, pre­ven­tion, pro­tec­tion, treat­ment and long-term care options for ser­vice mem­bers suf­fer­ing these severe injuries, he added.

“These are life-defin­ing injuries for these war­riors and their fam­i­lies, but it is not des­per­ate,” Car­aval­ho said. “All of us in uni­form under­stand it’s not just about sav­ing lives; it’s about doing every­thing mil­i­tary med­i­cine can do to help them lead full and pro­duc­tive lives.”

The report details the num­ber of sur­viv­ing ser­vice mem­ber amputees from Jan­u­ary 2010 to March 2011. Of 194 ampu­ta­tions, 78 result­ed from DCBI and 116 from oth­er caus­es. By ser­vice, 53 Marines, 23 sol­diers and two sailors suf­fered dis­mount­ed com­plex blast injuries result­ing in ampu­ta­tion.

Car­aval­ho said while severe injuries near­ly dou­bled from 2009 to 2010, mil­i­tary med­i­cine is sav­ing more lives than ever before.

More com­bat troops are sur­viv­ing, he said, because per­son­al pro­tec­tive equip­ment and armored com­bat vehi­cles have decreased the num­ber of head, tor­so and seri­ous burn injuries; bat­tle­field medics focus first on con­trol­ling bleed­ing with tourni­quets; heli­copter evac­u­a­tion times are short­er; there are high­ly trained med­ical pro­fes­sion­als aboard those heli­copters; and med­ical sur­geons have improved sur­gi­cal resus­ci­ta­tion.

The task force iden­ti­fied 92 rec­om­men­da­tions to improve qual­i­ty of care to ser­vice mem­bers suf­fer­ing low­er body blast injuries and their fam­i­lies, Car­aval­ho said.

Some best prac­tices have already been imple­ment­ed, he added: para­medic train­ing for flight medics, to improve the lev­el of care avail­able dur­ing mede­vac; and ear­ly use of blood prod­ucts, pos­si­bly even on the bat­tle­field.

Oth­er rec­om­men­da­tions focus on point-of-injury and long-term pain man­age­ment, and on a mul­ti­dis­ci­pli­nary approach to long-term care, he said.

Army Col. (Dr.) James Ficke, chair­man of the ortho­pe­dic surgery and reha­bil­i­ta­tion depart­ment at Brooke Army Med­ical Cen­ter near San Anto­nio, told reporters he has worked with many ser­vice mem­bers who have suf­fered com­plex blast injuries.

One, a West Point grad­u­ate of less than a year, lost three limbs, Ficke said.

“He’s mar­ried; he has a brand-new baby,” Ficke said. “He went through a griev­ing process, as we can only imag­ine — it would be hubris to say we under­stand what they’ve gone through. But for him to go through that griev­ing process, and then recov­er, and be in a wheel­chair the rest of his life, but see that child grow up — he has said, ‘I’m glad I’m alive.’ ”

Ser­vice mem­bers who suf­fer these injuries can still live fruit­ful and pro­duc­tive lives, but need help to deal with fear of the unknown, he said.

“We have men­tor­ing, we have indi­vid­u­als that have gone through some­thing like this and are able to coach, and tell some­one who’s just start­ing that process: ‘This is what it’s like. I’ve been there; I know,’ ” Ficke said.

Car­aval­ho said research con­tin­ues into “blast box­ers,” armored under­wear that may help pre­vent some gen­i­tal and femoral artery injuries.

Army Col. (Dr.) Jonathan Jaf­fin, chief of staff for the Army Sur­geon Gen­er­al Office’s Com­plex Bat­tle Injury Work Group, said the mil­i­tary med­ical research com­mu­ni­ty also is research­ing how to com­press blood ves­sels “that oth­er­wise you couldn’t get a tourni­quet on.”

Ficke added, “If we can stop bleed­ing, we can keep peo­ple alive. That’s why we’ve seen such suc­cess in sur­vival in this war, with severe injuries.”

The next chal­lenge is to achieve sim­i­lar suc­cess with gen­i­tal injuries, he added.

“We have recon­struc­tive urol­o­gists in the com­bat sup­port hos­pi­tals, deployed, so that if there is a tes­tic­u­lar or gen­i­tal injury that is sal­vage­able, that sur­geon can do some­thing far for­ward,” Ficke said.

The long-term prog­no­sis for peo­ple who have had a leg ampu­tat­ed is best if doc­tors can pre­serve the oth­er leg, even if it’s dam­aged, Ficke said.

“If we have tech­nol­o­gy … that can improve that abil­i­ty to walk, it, long-term, gives them a bet­ter health out­come for heart dis­ease, dia­betes, all of those things,” he said. “We are now work­ing with an excit­ing device that enables some­one to use a limb that has had a dev­as­tat­ing injury … and can still run.”

Mil­i­tary med­ical teams use a mul­ti­dis­ci­pli­nary approach to com­plex blast injuries, incor­po­rat­ing sur­geons, ther­a­pists, pros­thetists and behav­ioral med­i­cine experts to give patients the best pos­si­ble long-term out­come, Ficke said.

Car­aval­ho said mil­i­tary med­ical pro­fes­sion­als want ser­vice mem­bers to know there always is hope, even after com­plex trau­mat­ic injuries.

“Mil­i­tary med­i­cine and the VA will be with them for the long term,” he said. “They are enti­tled to the absolute best care we can pro­vide — not because of their injuries, but because of their ser­vice.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)