Sweets against pain and powdered blood: ‘Operation Protective Edge’ was the launch of the “His Brother’s Keeper” project of the Israeli medical corps – a programme which was designed to improve the survival rates of injured soldiers and to make it easier to control pain on the battlefield.
Pictures of hospitals overwhelmed by the injured, helicopters bringing in more and more injured soldiers, the doctors who attended to them, and the struggle to save the lives of the soldiers, burnt into the consciousness of the Israeli public in the summer of 2014 during “Operation Protective Edge”. What these pictures did not tell was what preceded them: the struggle to address the wounds on the battlefield itself during the first critical minutes after the injury.
Operation Protective Edge was the baptism of fire of the project of the medical corps in recent years: “My Brother’s Keeper”, a programme of many years in which 30 million ILS were invested, the aim of which was significant improvement in the survival rates of injured soldiers on the battlefield itself before their removal to hospital, the Israeli TheMarker reveals.
It is still too early to know exactly how many soldiers’ lives were saved as a result of these improvements which were introduced to IDF medical treatment on the battlefield, but it is already clear that in this last operation, where new medical technology which did not exist in previous operations, and are not used anywhere else in the world was used, has been a great success.
“Most people die near the time and place where they were wounded, and we therefore looked for ways to bring forward the exact and relevant medical advances, so as to save as many soldiers’ lives as possible”, said the operational Head of the IDF’s medical team, Lieutenant Colonel Dr Alon Gelzberg to TheMarker. The concept of the key is “Golden Hour” – the time period from the moment of injury till their death of about 90% of those killed in war (it is in fact 43 minutes, not an hour). “That is why it is so important to give quality treatment on the battlefield”, he added.
The biggest enemy of those wounded on the battlefield is bleeding. More than an estimated 80% of deaths from injuries are from loss of blood, according to estimates by the rescue teams. Avi Boskila, CEO of the Association of the Army Medical Corps said “It is impossible to prevent many of the worst instances of bleeding which lead to death by usual methods alone, as they demand more advanced measures and immediate removal so as to achieve this target”.
These are the foremost subjects that the IDF has been focused on during the last few years. “So as to reduce the number of deaths and to improve the initial treatment of the injured, emphasis was placed on a few basic things: increasing the numbers of skilled medical personnel such as paramedics and doctors who provide a high standard of medical care in the field, equipped with the most advanced medical tools possible, quick transfer to hospitals”, said Gelzberg. In his opinion “The transfer during Operation Protective Edge was a real achievement. During the second Lebanon war there were injured soldiers who suffered greatly for hours till they were transferred to hospitals. This time the injured were transferred with a very short delay”.
The highlights of the medical care during Operation Protective Edge were the medical innovations which were introduced to the battlefield. “Treatment of trauma has hardly changed over hundreds of years”, said Gelzberg. “Infusions, for example, came into use in 1831 and have not changed. The first changes occurred in recent years, because the way of thinking changed – first defining the need, and then going to companies and telling them: find the technology which should be as simple as possible, cheap and practical”.
Also in the area of treatment of pain, which in the past was hardly addressed, has began to develop during the latest campaign. “This was one of the legacies of the past” Boskila told TheMarker. At the beginning of the second Lebanon war, for example, injured soldiers lay on the battlefield while the medics did not have the equipment or the ability to treat their pain. During the last few years the approach has changed: first of all, every medic is equipped with an automatic syringe with morphine, and there are additional ways of addressing the pain. More than the importance of preventing unnecessary pain of the injured soldier, research showed that immediate treatment of pain in very important because it increases the chances of stopping the cycle of chronic pain in the future, and the likelihood of suffering from post traumatic disorder.
Below are some of the medical aids which have been introduced during Operation Protective Edge:
1 Artery blockers for self-use.
“Artery blockers have been in use since the Peloponnese Wars (Sparta against Athens 431 BCE), and since then the technology has not changed”, said Gelzberg. In the last two years every soldier in the IDF is equipped with an innovative American artery stauncher called CAT, each one costing about 24 dollars, the technology of which is thought to be top of the range. The CAT began to come into use during Operation Cast Lead in 2009, but by Operation Protective Edge every IDF soldier was equipped with one. We are talking here about a very simple idea: the blocking of ‘destroyed’ arteries that reinforces the blockage with the use of a stick, but the CAT-stick is part of the blocking mechanism, which is made up of Skoch and clamps, and soldiers can put on themselves with one hand.
“We teach the soldiers how to use it while they are still in basic training, and in Operation Protective Edge there were soldiers who put it on themselves and on their friends”, said Gelzberg. “It’s big advantage, apart from its simplicity of use, is that it creates more pressure on the blood vessels – more than efficiently. There is a lot of science behind this piece of plastic. It is planned in such a way that there will be optimum balance between pressure that can harm the nerve and pressure than stems the bleeding.
2. Bandage which speeds up blood clotting.
For those injuries where blocking the artery is not appropriate, there is in use today a haemostatic bandage – a bandage that not only absorbs the blood like an ordinary bandage, but feeds special material that speeds up the clotting. The bandage is suitable, for example, for incidents of bleeding from areas where blocking of arteries is not possible, like a blockage high up or an injury in the stomach. “For hundreds of years they used bandages in order to stop the flow of blood, but here we have a bandage that creates around itself the chemical ability to clot the blood. This saves lives”, said Gelzberg.
Every medic in the IDF today has a bandage like this in his or her kit, which is used also in the USA (cost about 40 dollars each). During Operation Cast Lead it was only used with permission from a doctor. However, during Operation Protective Edge, it was used also by paramedics with an injection of Hexakapron (cost about 8 dollars each) and is, according to Gelzberg “safe, cheap and heat-resistant and, the sooner it is administered, the more lives are saved”. The medication works in such a way that the active ingredient preserves the body’s natural clotting, and prevents the breakdown of the blood clots. “The world has known about this medication for many years, but we are among the first in the world to bring it to the battlefield”, said Gelzberg.
3. Instant Dose of Blood
“Plasma powder” maybe sounds like science fiction, but it turns out that what is being referred to is old technology which has been upgraded in recent years: dried plasma, or powdered plasma is in fact a “blood product” that is dried with a method similar to that of dried Nescafe, which when mixed with liquid becomes a kind of blood dose and saves lives.
The big advantage of this technology is that in contrast to units of blood which need cooling or freezing, in the case of plasma, it is possible to take the powder onto the battlefield. “Every doctor and paramedic caries this on his back”, said Gelzberg. There is a bag of plasma and a bottle of fluid – they mix them, and within three minutes they have the appropriate type of plasma. This was invented in the 1940s, but its use was stopped because some soldiers were attacked by infections from material in the blood. In the 1990s the Germans addressed the problem, and today they produce plasma using special technology which destroys viruses and germs in the packet. Slowly information was amassed from trials with 234 thousand people who received the plasma, which proved that it is even safer that blood in blood banks. It withstands heat, is simple, cheap, and saves lives. Today the IDF is the only army which employs this product apart from Germany and France.
4. Lollipop against pain.
"The Aktik", a kind of sweet on a stick, is designed to treat pain when it arises, based on the active ingredient Pantanol (which is 100 times stronger than morpheme). It works in a different way from morphene, but deals with pain in a far better way: Aktik under the tongue – and the pain is taken care of in less than an hour. Pain was the area that we accepted for years, we allowed the wounded to suffer with the attitude “‘it’s not so terrible, you’ll get through it’”, said Gelzberg, “pain was not related to with sufficient significance”. “The aktik helped the injured so that that they did not suffer pain and it was possible to treat them. Additionally this did not lead to a reduction in blood pressure – one of the problems of morpheme and its derivatives.