New Tech for Wounded Warriors

I have a buddy who lost an arm to a mine in Vietnam and now heads the VA's prosthetics programs. While hunting deer a couple of years ago in West Virginia he explained to me that although the new body armor has saved many lives in Iraq and Afghanistan it has also caused a greater percentage of amputations across the population of wounded than previous conflicts because of the way the shock of an explosion is transferred to the extremities.

Resultantly there is a great demand for prostheses, and from demand comes innovation. Modern technology has afforded wounded warriors devices that are increasingly capable of replicating the performance of human limbs - a huge quality of life issue for these heroes.

Otto Bock HealthCare, a company that started out providing devices for German World War I veterans in 1919, has developed a prosthetic knee system that is an upgrade to its already popular C-Leg. According to an Armed Forces Press Service release "the prosthesis is for above-the-knee amputees and uses a microprocessor to control the knee's hydraulic functions and anticipate the wearer's actions and make changes in real time."

The new system has more sensors, a faster hard drive, and more memory. Engineers are also looking to improve battery life to 50 hours per charge. The release states the leg will "improve transitions between movements like level-ground walking, climbing stairs, and running."

Barring any technical problems, the new prosthesis should be available to servicemembers in 2009.

-- Ward

Iraq's Deadly Germs

As anyone who's ever read Guns, Germs, and Steel will tell you, bacteria and viruses have long been a part of combat -- some times, the nastiest part. During the waning days of World War I, the flu sent 70,000 American troops to the hospital; one-third never recovered. In the Civil War, twice as many troops died from disease as from gunshots.

Today's problems aren't nearly so severe, in comparison. Since th invasion of Iraq, "more than 700 US soldiers have been infected or colonized with [the bacteria] Acinetobacter baumannii," Steve Silberman reports in the current Wired magazine. "The Armed Forces Institute of Pathology has recorded seven deaths caused by the bacteria in US hospitals along the evacuation chain."

But it's the way that the American military officials have dealt with the bug's release that's particularly disturbing. "For a long time, the DoD claimed that the bacteria... was a naturally occurring organism in the Iraqi soil that infected soldiers when they were wounded by IEDs," Silberman tels Defense Tech. "As you'll see, this is not the case, and the DoD has known the true source of the infections -- the combat support hospitals in Iraq themselves -- for over a year and a half."

One marine's mom was told her son died of "injuries as a result of enemy action." Turned out, it was Acinetobacter, instead.

Now, this isn't the first time the military has mislead families about how their kin were killed. Pat Tillman is probably the most famous example of this in recent years. First, the Tillmans were told he died from enemy fire; then, from friendly; now, murder isn't being ruled out. But there are many, many others. The question is: Why lie?

(Big ups: XJ)

60 Minutes Covers the "Golden Hour"

It's no secret that the military's trauma units have saved the lives of thousands of injured service members and Iraqi civilians whose wounds would likely have killed them in earlier conflicts.

But last night, 60 Minutes ran a powerful 13 minute piece on the doctors, nurses and medics who operate in theater and on the field helicopters. The Hueys UH-60 Blackhawks are stationed around Iraq so that no casualty is more than 25 minutes from a helicopter, helping to ensure that injured soldiers are treated in a hospital within 60 minutes, known as the "Golden Hour."

The piece focuses on two American soliders, Kenny Lyon and Brad Fulks. Lyon was hit by a mortar while fixing his vehicle, and lost half his blood through three severed arteries before arriving the Air Force theater hospital on the Balad Air Base north of Baghdad.

Fulks was hit by a roadside bomb, which burned the skin over half his body and destroyed one of his lungs.

The Balad Air Base trauma center sees 300 trauma cases a month, but sends many via C-17s transformed into airborne medical centers to Germany. In the Vietnam war, it took an average of 40 days to get wounded soldiers back to the States; in the Iraq war, it now averages three days.

You can read a transcript of the piece here, but I highly recommend watching the video, even if you already know the extraordinary efforts of the military's trauma teams.

- Ryan Singel

Insta-Blood for Israeli Troops

"In about two years' time, Israel Defense Forces soldiers may carry with them to the battlefield packets with their own powdered blood," says Ha'Aretz.

"The idea is to take a soldier's blood, freeze it in laboratory conditions, take out the ice crystals leaving only the blood components. It will look like freeze-dried coffee in a little bag," said Lieutenant colonel Amir Blumenfeld, head of the IDF medical corps' trauma unit.

Every soldier going to battle will receive a packet with his own freeze-dried blood as part of his mandatory personal kit, much like the staple personal bandage.

When necessary, if the soldier is wounded in battle and needs blood, a medic or doctor could take out the dried blood bag, mix it with physiological water and inject the soldier with a transfusion of his own blood.

Hey doctors: is this even possible? Weigh in here...

PTSD Treatment: Fear Drug, Virtual Reality

Could some time in a computer-generated world while on a fear-fighting drug help troops deal with post-traumatic stress disorder? Emory's Dr. Barbara Rothbaum University of California's Dr. Charles Marmar think so.

A tuberculosis drug called D-cycloserine, or DCS, could be the key, notes Army Times.

DCS affects what are called NMDA receptors, key parts of the brain mechanism that controls memory and learning...

The intention is to allow DCS to inhibit fear receptors in the brain so patients can deal with painful memories in a constructive way and essentially "unlearn the fear response" when it comes to their war memories...

Veterans participating in both experimental treatments will be given 50-milligram doses of DCS about half an hour before therapy, as well as exposure therapy...

At Emory, patients will undergo virtual-reality exposure therapy, in which a helmet display with sound effects will put them back in Iraq in one of three scenarios: a solo Humvee ride, a convoy or urban warfare...

Each Emory patient will go through five total sessions — four with the DCS and virtual reality and one preliminary therapy session, she said. The study is expected to take five years and include about 150 patients, although the number could expand, she said...

Rothbaum has already used the combination of DCS and virtual-reality therapy on patients who have a fear of heights. She said patients in that study were "significantly better" even three months later, when they were exposed to heights without DCS.

"That gave us a lot of hope," she said. "So now we’re trying something more complicated."

Training is Gross!

A patrol from the 1st Cavalry Division is held up at an intersection blocked by a wrecked car when a roadside bomb goes off, throwing civilians to the ground. Medics rush to treat the wounded while gunners engage insurgents. One injured civilian squirts blood from a severed limb. Another clutches his intestines spilling from a belly wound.

It's just another day at the Joint Readiness Training Center at Fort Polk in Louisiana. The blood and bombs are Hollywood special effects, the civilians are actors and the insurgents are contractors. But the stress and horror in the medics' eyes are real.

"The battlefield effects give you the look, feel and smell of combat," says JRTC Col. Wayne Detwiler. "Though [the medics] are very well trained, they might have never seen trauma. You've got to get them over that."

One male medic applies a tourniquet to the simulated severed limb (the actor is a Vietnam vet amputee) then moves on to the gut wound. Female Spec. Marin Van Camp follows up behind him with a team, lifting the injured onto stretchers then loading them into a Humvee ambulance. She yells at her team to work faster. Her eyes are wide and her skin flush.

With the casualties all secured, the patrol moves out, speeding to a nearby landing zone. Two UH-60 Blackhawk helicopters flare in to evacuate the wounded.

Van Camp takes a breather. "As long as you know you're going to see casualties ... as long as you're prepared, it's easy."

She's lying. And soon after the choppers have disappeared over the horizon, the soldiers mount up and continue their patrol. Van Camp's work isn't finished.

JRTC Command Sgt. Maj. Matthew Pelletera explains all the blood and guts. "You can replicate an amputee by having a guy hold his leg up, but the effect lasts only so long," he says. "As a medic, you do so much practice, it feels like it's not real."

Not so at JRTC. "Here we replicate live battlefield trauma."

Read more on the front page of today's The Washington Times. Go to Flickr for pics. And check out my graphic novel WAR FIX for scenes of real battlefield gore.

--David Axe

Squishy Sacks of Goo ...

... is really all we are. And on the battlefield, there are lots of hot pokey objects that can puncture our squishy sacks, letting out all the goo. To put this problem in more clinical terms: blood loss is the first and most immediate danger to injured troops. Therefore, finding ways of staunching the flow of blood from battered bodies is one of the military medical community's major priorities.

There's been a lot of advancements on this front in the past couple years, much of it motivated by the high proportion of bleeding limb injuries in Iraq and Afghanistan. Several advancements have been mentioned on this site before. Here's a comprehensive survey:

* One-handed tourniquets that soldiers can apply in seconds to wounded comrades

"Approximately 200,000 of these tourniquets have recently been ordered and shipped to theater," says Colonel Robert Vandre from Army Medical Department (AMD). "It is starting to be used now and reports are coming in from our surgeons that they are receiving patients with these tourniquets on damaged limbs."

* A pair of new bandage designs -- one based on desiccants (like you find in the pockets of new coats) and another on crushed crustaceans -- that encourage rapid clotting of wounds

Vandre again: "Since the beginning of the Afghanistan conflict, the Department of Defense has fielded two new bandaging technologies for stopping bleeding: the Chitosan Bandage, [made by] Hemcon, and QuickClot, [made by] Z-Medica. The Chitosan bandage is made of shrimp shells and sticks to the wounded area, sealing it off much like a tire patch. The QuickClot is made up of desiccant granules that physically adsorb the liquid from blood, thereby concentrating the clotting factors and encouraging rapid clotting to stop the bleeding."

* A new medicine, developed by Defense Advanced Research Programs Agency (DARPA), that helps organs survive temporary blood shortages

"The focus in this program is using the consequences of blood loss," says DARPA spokeswoman Jan Walker. "What we want to be able to do is protect the organs from the impact of oxygen loss and ensure that the wounded soldier can recover fully. What that allows us to do is it gives us more time to get the casualties to a hospital."

* A sonic blood coagulator, another DARPA project

Walker: "We have another program that is looking at acoustic energy to stop bleeding -- that is, deep bleeding, not in an extremity, not in some place where you can apply pressure. It's called Deep Bleeder Acoustic Coagulation. It uses sound waves to encourage clotting. It's a device that could be used by a layperson, a medic on the battlefield. It's portable, light and automated."

* Another clotting agent, Recombinant Activated Factor VII (RFVIIA), developed by AMD

"Through an extensive collaboration with the Israelis, we promoted the first use of RFVIIA in for the treatment of severe surgical bleeding in trauma patients," Vandre says. "RFVIIA stops bleeding in trauma patients when their own clotting mechanisms are not working properly. As a result of this collaboration, RFVIIA is now being used in major trauma centers throughout the world and has been used on over 400 wounded patients in Iraq. Currently the drug's maker, NovoNordisk, is pursuing clinical trials to gain a trauma indication for this drug with the Food and Drugs Administration (FDA)."

* New ways of freeze-drying replacement blood to facilitate transport and storage

"The Army is actively developing freeze-dried plasma and hopes to have a product available within five years," Vandre says. "Plasma is the liquid part of blood which contains the majority of its clotting factors and is highly desirable for early resuscitation of patients. Currently it exists on the battlefield only as frozen plasma and, as such, cannot be given any place but at our field hospitals. DARPA and the Navy have both pursued freeze-dried platelets, another clotting product. The Army has also developed a process to allow red blood cells to be kept refrigerated for up to 12 weeks, which is twice as long as they currently can be stored. We are working now to get funding to push this product through advanced development and FDA certification."

* A new container, developed by AMD, for transporting perishable replacement blood

Vandre: "To allow medics to bring blood products far forward on the battlefield, our researchers developed the 'Golden Hour' Blood Transport Container which can keep four bags of red cells at 10°C for 72 hours with no electricity or wet ice. This container is being used in theater on evacuation missions where red blood cells may be of help to the wounded patients."

The survival rate of troops injured in Iraq and Afghanistan is better than ever. Thanks to these technologies and others, even more soldiers will survive their injuries on future battlefields.

PTSD Sensors for Returning Troops

The Pentagon wants to know how its soldiers are handling the transition from wartime to regular life. But getting them to see a counselor isn't easy, even in the age of Oprah. So the Defense Department's fringe science division is funding development of wireless sensors (scroll down) to tell whether a veteran is stressed or hitting the bottle too hard after coming home from deployment.

AFrame Digital and Barron Associates, both based in Virginia, are focusing on veterans recovering from battlefield injuries. They both are investigating a "low-cost, noninvasive 'trip-wire' system [that] required that functions as a safety net, detecting when assistance or intervention is needed and issuing advisories to health care providers concerning significant changes in important medical indicators." These monitors will "collect and analyze real time data of vital signs, patient activity, fall acceleration and location parameters to detect deviations." AFrame already makes a version for seniors, that picks up "pulse, temperature, and mobility" and comes with a "panic button and fall detection."

Massachusetts' Erallo Technologies is focusing on whether a vet falls down from drink or stress, instead. According to the Associated Press, one in eight returning troops has PTSD symptoms. CNN puts it at one in five. Its "Intelligent, Wireless, Agent-based Health Monitoring Network for PTSD and Alcohol" will include "a wireless transdermal alcohol sensor, heart rate monitor and accelerometer."

Presumably, like AFrame, Erallo is expecting its system will incorporate "socially acceptable form factors, secure wireless networks, intelligent analysis software, displays for medical personnel, and interfaces to medical record systems."

But those form factors better be pretty dammn small. Because if a soldier feels shy about paying a private visit to a therapist, how eager is he going to be to walk around with some clunky armband?

Grow Your Own Limbs?

We've all seen the pictures, at least: soldiers and marines coming home with legs and arms gone. It's a long shot, but maybe this could help: "A newly created form of protein known as 'elastin' may one day be used to build replacement body parts," according to National Defense magazine.

"This technology would allow surgeons to 'build a person from the molecular level,' says Kenton Gregory, chief cardiologist at the Oregon Medical Laser Center, in Portland, Ore. [He's the guy who founded HemCon Inc., which makes a controversial bandage for the Army designed to stop bleeding in a hurry. -- ed.]

The U.S. Army Combat Casualty Care program so far has funded $20 million worth of research work at the medical laser center...

Elastin is being studied as a possible means to “put injured soldiers back together,” Gregory explains. After nearly a decade worth of research, his lab has found the human gene for elastin, he says. Elastin is a durable, stable protein that makes up human tissue. The thinking is that the body won’t reject replacement parts that have the patient’s own DNA.

“Based on natural protein, we developed a whole series of tissue-repair parts for the stomach, esophagus, skin, arteries,” Gregory says. “We are developing cell therapy program to help regenerate tissue.”

Prosthetic Prof Climbs New Heights

I went to Popular Mechanics' Breakthrough Awards last night with pretty low motives: a chance to schmooze with some of the editors who pay my rent. Maybe I'd grab a beer or four in the process. Instead, I walked out uplifted by one of the most inspiringly cool stories I had heard in months. It came from the night's final honoree, MIT media lab professor Hugh Herr.

As a kid, Herr was a lousy student and good rock climber -- a very good rock climber. Then, in 1982, he "became stranded on Mount Washington, New Hampshire for nearly four days in -20 °F temperatures and blizzard conditions," one biography notes. "Severe frostbite damage took its toll on his lower legs, and both of his feet had to be amputated six inches below the knee."

Improbably, Herr swore he'd climb again. So he became a bookworm, eventually winding up in field of prosthetics. He developed a knee that "adapts to the user’s walking style, adjusting resistance to allow for a secure, agile gait," Pop Mech observes. "Next, he plans to distribute sensors beyond the knee to allow the device to move in response to subtle electrical changes in muscles nearby."

Herr is already helping out soldiers wounded in Afghanistan and Iraq. And he is making good on his promise, to get back to climbing. In fact, he says, his new artificial legs are better than his old biological ones. Special wedge-like "feet" allow Herr to slide into cracks in the rock face that he could never use before. For ice climbing, Herr can slip attach spiky crampons to the end of his prosthetics. Or he can use Inspector Gadget-esque extending legs for extra reach.

In school, Herr told the crowd of a hundred or so at the American Museum of Natural History, he kept raising his height an inch a day, to see how long it would take for people to notice. "It took until I was about eight feet tall," he laughed.

Standing on that stage, hopping around on his man-made legs, eight feet seemed like an understatement to me.

Hear This -- or Better Yet, Don't

War is hell -- on your ears. Everything is a combat zone is death metal loud, from the props on the transport plane that takes you into Iraq to the rotors of the Black Hawk which hauls you from base to base to the sirens on the Humvee, keeping potential adversaries away. And that's before the bombs or the RPGs start going off. A buddy of mine lost 75% of his hearing in one ear when a bomb detonated nearby. The military has to shell out more than $300 million per year to compensate soldiers for their busted ear drums, according to one study.

Soldiers are supposed to wear ear plugs at all times. But often, they don't. Makes hearing orders and warnings tougher, they say.

The Air Force Research Lab has developed a pair of new jack, noise-cancelling ear plugs that might change some minds, however. The Attenuating Customized Communications Earpiece System (ACCES) was designed for the maintennance crews who work on the deafening F/A-22 stealth fighters.

The system filters out high-frequency noises from fighter aircraft while using tiny speakers to allow the wearer to hear radio communications.

“The real issue was the sound pattern around the F/A-22 was so loud, maintainers couldn’t hear,” said Hendrick Ruck, director of the Air Force Research Laboratory’s human effectiveness directorate. “With these, communication is almost perfect.”

The system makes use of several features to reduce noise.

“By being molded, (the ear plugs) have good passive protection,” Mr. Ruck said. “They are perfectly fitted. They also use active noise reduction. They take the predictable noises and cancel the wave forms.”

All fighter aircraft have high-frequency noise, Captain Kevin Divers, 27th Fighter Squadron aerospace physiologist, said. The plugs are made from silicone, which blocks out the higher frequencies while the form-fitted seal provides better protection from noises on the lower end...

“Our tests are pretty good,” he said. “(The ear plugs) canceled out 47 decibels in tests, which we think is a record.”

Larger ear protection devices and foam plugs, like those used now, only block out a maximum of 40 decibels, Mr. Ruck said...

Along with the F/A-22, the system is being considered for helicopter pilots and special operations forces troops. It was used by civilian astronaut Mike Melvill aboard SpaceShipOne, the first manned, private spaceship that made history with its voyage into space.

“Before these plugs, we had problems because we were using little foamy earplugs,” Mr. Melvill said.

“When I switched to the new system, I had perfect hearing of what was going on from mission control throughout both of my flights and had no discomfort at all from the noise of the rocket motor,” he said.

It's Just A Box

It's one of those things that you scratch your head about and ask, what, no one thought of this before? Issue - keeping units of blood cool while conducting critical field surgery where there's no power. Standard practice - using Vietnam-era cardboard boxes and styrofoam technology to keep blood at the required 38-50 degrees Fahrenheit for about eight hours. Question - has anyone, in this day of camping enthusiasts and high-tech sporting gear, thought that there might be a better solution?

Answer - yes, thanks to a Minnesota-based firm called Minnesota Thermal Science, LLC. Bill Mayer, the chief scientist there, designed a portable 10-inch square container that uses insulation similar to that used in store-bought coolers and a liquid similar to those freezer packs that people use to keep their mayo from spoiling at picnics. The result? A container that kept red blood cells good for more than 97 hours at minus 9 degrees Fahrenheit, for more than 78 hours at 105 degrees Fahrenheit, and for more than 121 hours at room temperature. It doesn't require batteries, ice, or electricity.

Mayer says in the article, "It's not really all that complicated. ... It's not real exciting. It's just a box." The simplicity of the design is what he believes is the rationale why larger scientific labs had not already invented it. The Army leadership disagrees, and is giving one of its top ten Greatest Invention Awards to the firm. The other awardees are listed here.

-- Armchair Generalist

REPLACEMENT ARM, GOOD AS NEW

Thought-controlled robotic limbs were only the beginning.

Scientists have had a string of remarkable successes lately, taking signals from the brains of monkeys and men, and using them to move mechanical arms.

Darpa, the Pentagon's blue-sky research division, now wants to ratchet that work up about ten notches, by developing a "neurally controlled artificial limb that will restore full motor and sensory capability to upper extremity amputee patients. This revolutionary prosthesis will be controlled, feel, look and perform like the native limb."

So, basically, what Luke Skywalker gets in Empire Strikes Back, after Darth chops off his hand. Except, researchers won't have a long, long time to get this limb ready. Darpa wants the robo-arm stat -- in four years or less.

The limb would have to be wired directly into the peripheral nervous system, instead of the brain-controlled arms being demonstrated today, Darpa tells researchers interested in working on this "Revolutionizing Prosthetics" project. Under agency guidelines, the arm will need enough finesse to pick up a raisin or to write in longhand. It needs to be sensitive enough for the wearer to handle day-to-day tasks in the dark. And the limb will have to be strong enough to lift 60 pounds at a time.

These are beyond ambitious goals, and even the even the big thinkers at Darpa acknowledge it. Breakthrough research in "neural control, sensory input, advanced mechanics and actuators, and prosthesis design and integration" will all be needed, the agency says in a call for proposals. Neuroscientists, roboticists, engineers, occupational therapists, and surgeons in the neural, orthopedic, reconstructive subspecialties will have to chip in.

"Revolutionizing Prosthetics" is so far-out that Darpa is taking the unusual step of hedging its bets, and running a parallel, more down-to-earth program.

The vision of the Prosthesis 2007 program is to leverage recent research advances in neural sensing, control systems, actuation, power storage and distribution, freeform manufacturing, neural control, microfabrication, sensory feedback, flexure and transmission design, signal processing, and information science to dramatically improve the capability of upper extremity prosthetic limbs beyond those that are currently available commercially. This vision will be realized by increasing the range of motion, strength, endurance, and dexterity of upper extremity prosthetic devices. The final product [an above-the-elbow prosthetic arm] must be ready for human clinical trials… [and] sufficiently mature to enter the appropriate approval processes for general medical use by the end of 24 months."

Sounds like a snap.

ROBODOC GETS PENTAGON CASH

For decades, telemedicine guru and former MASH surgeon Dr. Richard Satava has been pushing the Defense Department to fund systems for remote and robotically-controlled operating rooms. He's not mentioned in the AP article below. But you can see his fingerprints all over this $12 million Darpa grant to "develop an unmanned 'trauma pod' designed to use robots to perform full scalpel-and-stitch surgeries on wounded soldiers in battlefield conditions."

"The main challenge is how can we get high-quality medical care onto the battlefield as close to the action and as close to the soldiers as possible," said John Bashkin, head of business development at SRI International, a nonprofit laboratory that often handles Defense Department research. "Right now, the resources are pretty limited to what a medic can carry with him."

SRI researchers caution that the project remains at least a decade away from appearing on any battlefields. Surgeons will need to manipulate the robot in real time, using technology that prevents any delays between their commands and the robot's actions. The "trauma pod" has to keep connected wirelessly without giving away its position to the enemy, and it has to be nimble and hardy enough to perform under fire.

Still, some of the initial technology is already being put to use in hospitals, and the goal of the initial $12 million project is relatively modest — researchers hope to show that a surgeon, operating the robot remotely, can stitch together two blood vessels of a pig...

SRI spearheaded the Pentagon's first such endeavor to develop a "telesurgery" system in the 1980s. The resulting robot, dubbed the da Vinci Surgical System, proved to be too bulky and too dependent on too many humans to be used in battle.

But the Food and Drug Administration approved the da Vinci in 2000 for civilian medical use and surgeons now use the $1.3 million machines in about 300 hospitals worldwide to remove cancerous prostates, repair faulty heart valves and other procedures.

Of course, this isn't the only Darpa telesurgery program. Not by a long shot. A bunch of others are covered here.

A few months back, I wrote about an unmanned ambulance experiment that's being funded by the Army. And here is an article I wrote back in '03 about Dr. Satava's efforts to digitally recreate every element of a soldier's body, and embed it all on a chip in the soldier's dog tags.

TOURNIQUETS, AT LAST, FOR G.I.S

"Under pressure from Congress, the Army has decided to quickly dispatch modern tourniquets to troops in Iraq and Afghanistan," the AP reports. "That’s more than two years after military doctors recommended that every soldier carry one."

In an article March 6, The Baltimore Sun described a lack of tourniquets among soldiers in the field and delays in supplying them.

Virginia Stephanakis, a spokeswoman for the Army surgeon general, had no immediate details on the number of tourniquets or a timetable by which they will be sent to U.S. troops...

A committee of military doctors urged in February 2003 that every soldier carry one of the $20 medical devices, a nylon and plastic version of the simple cloth-and-stick device armies have used to stop bleeding for centuries.

But many don’t, and some have bled to death from wounds on which a tourniquet might have been effective, according to more than a dozen military doctors and medical specialists interviewed by The Sun.

The U.S. Central Command, which oversees combat operations in Iraq and Afghanistan, issued a directive Jan. 6 requiring all soldiers to carry a modern tourniquet.

However, compliance was left up to individual units, and many have not acquired the devices.

Three weeks ago, the Army’s surgeon general, Lt. Gen. Kevin C. Kiley, approved a new first-aid kit for soldiers that includes a modern tourniquet and other life-saving equipment.

But the training manual was still being written and the kits were expected to be field tested, a process expected to take months.

Now, Stephanakis said that the tourniquets would be sent without waiting for the field testing of the new first-aid kits.

SICK TEST: SNIFF A SOLDIER'S BREATH

Commanders want to know when their soldiers are sick or tired. But, so far, there's no good, quick, objective test to figure out how they're doing.

Pentagon-funded researchers think they may have found the answer, by chemically "sniffing" a soldier's breath.

"Human breath contains a treasure-trove of metabolic data, which has the potential to provide real time information representing an individual's baseline health status," notes a recent Defense Department Small Business Technology Transfer (STTR) award, given out to the University of Tennessee.

Lung health, ulcers, exposure to allergens or chemical toxins -- even stress can be picked up by sorting through the molecules we exhale, studies indicate.

Johns Hopkins scientists are looking to build sensors that can instantly detect these warning signs, by combining "tunable, mid-wave IR [infrared] semiconductor laser technology and cavity-enhanced spectroscopy."

Researchers at Argonne National Laboratory, on the other hand, think they can do the same job with a portable version of their "Electronic Nose Microsensor," which looks for the electrical signature of certain molecules in a gas. Altogether, five contracts were handed out recently by the Pentagon for the breath-o-meters.

Not to be outdone, University of Pennsylvania scientists want to build for the Pentagon a machine that can automatically spot when a soldier gets sleepy, "captur[ing] the early signs of fatigue such as lack of concentration, yawning, changes in voice characteristics, etc." The idea is to use smart cameras and eye-safe laser scanners that can tell when a G.I. yawns or blinks. It's an approach, based on a model which has "proven to be extremely powerful in characterizing human speaker and bird voice characteristics," the Pentagon STTR award says.

ARE YOU HOT OR NOT? PILL GIVES ANSWERS

It can get hot – dangerously hot -- scrambling across a desert combat zone, or scrimmaging during football's August preseason. But good luck measuring a sergeant's or a linebacker's core body temperature; getting an accurate reading usually requires, ahem, a rectal probe.

Oregon medtech firm Mini Mitter has a less intrusive approach: a pill-sized, swallowable thermometer called Jonah that transmits data wirelessly to a handheld.

My Wired magazine story has details.

BIONIC PROSTHETICS

The MIT News Office (via Near Near Future) reports that "MIT, Brown University and the Providence Veterans Affairs Medical Center have begun a five-year research project to restore arm and leg function to amputees."

The project is led by Hugh Herr (left), who I teased yesterday morning about building a robotic fish.

Unlike Dr. Herr's robotic fish, I don't have anything sarcastic to say about his very worthwhile efforts to improve artificial limbs. A recent New England Journal of Medicine article found that "a far larger proportion of soldiers are surviving their injuries" due to advanced medical technology. Many of these soldiers are suffering injuries that require ampution because IEDs are "producing an unprecedented burden of what orthopedists term 'mangled extremities'--limbs with severe soft-tissue, bone, and often vascular injuries."

While I am on the subject, I highly recommend Beyond Northern Iraq--an award winning blog by Stuart Hughes, a BBC journalist who lost his leg covering the Iraq War. Far from depressing, his blog is wry, witty and--as this post suggests--sometimes hilarious:

Reopening this posting, it's clear from the stats that having written the words "Jennifer Krum" on this blog has inadvertently done wonders for my traffic.

I therefore feel duty-bound to inform the amputee porn fetishists who shouldn't be here in the first place that Ms Krum's Playboy pictorial is now online (or so I'm reliably informed.)

Definitely not work-safe.

--Jeffrey Lewis

DARPA: NO BLOOD? NO PROBLEM!

A while back, I mentioned a Darpa plan to have soldiers survive major injuries -- despite losing half or more of their blood. In this month's Wired magazine, I've got a short piece on the Darpa project, with a few more details.

When marine mammals like whales and seals dive deep, they let sections of their bodies go cold, cutting their metabolic rates dramatically. Darpa hopes that drugs or tech might allow soldiers to pull off the same trick - the agency's goal is to enable a rat to survive more than six hours after 60 percent of its blood has been drained.

Even Darpa managers admit it's far-fetched. Plan B: minimize bloodshed at the source, including spurting arteries. The Deep-Bleeder Acoustic Coagulation project aims to build on the work of researchers at the University of Washington and elsewhere. They're using concentrated, intense sonic blasts to heat the damaged cells. "Focused ultrasound allows a noninvasive method of cauterizing" - without fire or a laser - the scientists say. But these specialized ultrasound machines are big and bulky – and need an expert hand to guide them. Darpa's looking for a portable emitter for combat that doesn't need an expert operator.

In a recent report, Darpa worried that flesh-and-blood soldiers could become the "weak link" in the military chain. This is one of a bunch of ways the agency is planning to make it stronger.

"OPERATING ROOM IN A BOX" UNFOLDS

At first, it looks like a normal shipping container. But push a button, and a minute-and-a-half later, out unfolds an operating room, 20 feet long and 8 feet wide.

"It looks like a cicada coming out," an Army engineer says of the prototype Future Medical Shelter System.

The Army's current mobile operating room comes in two containers, and it's a pain in the butt to set up. "You've got to manually unfold the existing container, which takes a fair amount of time, and then you've got to physically unload all of the stuff from one ISO container into one like this one," offers an Army program manager.

The FMSS shelter is powered by a 24 volt battery – standard for most military vehicles – and offers protection against biological and chemical agents, unlike its predecessors. The Army's prototype was built by Y12 National Security Company out of Oak Ride, Tennessee. But two other companies have designed the mobile operating rooms, including St. Johnsbury, Vermont's Mobile Medical International. Inside its version of the operating-room-in-a-box, there are "two surgical stations or four patient care stations, integrated medical gas, power and LED lighting systems," and integrated environmental controls.

Folks at the Army's Telemedi cine and Advance Technology Research Center are now testing out the FMSS, with an eye towards toughening it up against the elements. But for now, there's no cash to build a new shelter. "Congress initially funded the program, and no additional money has been appropriated for the second prototype," says the Armed Forced Press Service.