September 18, 2019
The Office of the Secretary of Defense (OSD), in its guidance to the Defense Health Program (DHP), identified the Uniformed Services University of the Health Sciences (USU) to expand its role in the next phases of combat casualty care research. To accomplish this, The Department of Surgery at USU (USU-Surgery) has initiated the Battlefield Shock and Organ Support (Battlefield SOS) research program to fill priority clinical gaps and new requirements.
The purpose of the program—a $7 million cooperative agreement awarded to HJF with the University of Maryland as a subrecipient—is to expand the capability of the larger Department of Defense (DoD) Combat Casualty Care Research Program in response to new and emerging challenges. Battlefield SOS at USU-Surgery focuses on integrated, inter-departmental research efforts on novel approaches and technologies to stop hemorrhage, mitigate the effects of ischemia reperfusion and extend the Golden Hour of survival in future and more complex battlefield scenarios, including those in the multi-domain battlespace.
“By launching this Program, we are expanding the Combat Casualty Care presence at USU in a coordinated effort with the Defense Health Agency and the Services. The findings from our research will directly impact warfighter survival through clinical practice guidelines and the development and evaluation of novel life-saving interventions,” said Colonel Todd Rasmussen, M.D., Director, Battlefield Shock and Organ Support Research Program.
Battlefield SOS integrates various departments and disciplines at USU, Walter Reed National Military Medical Center, R Adams Cowley Shock Trauma Center in Baltimore, MD, and University of Maryland School of Medicine in Baltimore to focus on new approaches and technologies. This team is also attuned to maintenance of the military’s lethal fighting force by maintaining and reducing the Casualty Fatality Rate in future combat scenarios, including those constrained by a multi-domain battlespace.
Battlefield SOS has oversight of the DoD Combat Casualty Care Research Program (CCCRP) whose staff is currently headquartered at Fort Detrick, Maryland. Oversight by and integration with the larger DoD CCCRP is critical for the Battlefield SOS research effort to effectively identify unique areas of innovation, research and development not already being addressed by the core DHP appropriation or the individual services in this area.
The mission and overarching aim of Battlefield SOS is to test, evaluate, develop and deliver new innovative solutions that increases the survivability of, and recovery from combat wounding during the immediate and early phases after injury (i.e., Golden Hour and prolonged field care).
The objectives of this program are intended to be specific, measurable, achievable, relevant and timebound. Battlefield SOS achieves these objectives by pursuing four lines of effort to prevent death due to non-compressible torso hemorrhage, to develop new strategies to stage and definitively treat large-vessel vascular injury and shock and to prevent and mitigate the effects of ischemia reperfusion and organ failure.
The four strategic lines of effort include:
- Exsanguination Shock and Endovascular Resuscitative Technologies: examining the mechanistic and physiological features of exsanguination shock, while testing and evaluating the next-generation endovascular resuscitation technologies such as resuscitative endovascular balloon occlusion of the aorta and the selective aortic arch perfusion.
- Extremity Ischemia and Vascular Shunt Devices: developing, testing and evaluating technical adjuncts (e.g., a miniaturized, self-contained vascular shunt devices) or pharmacological adjuncts (e.g., valproic acid) to mitigate the effects of extremity and end-organ ischemia and to aid in the management of blood vessel trauma.
- Biosensing Technologies: testing, evaluating and developing miniaturized biosensing technologies including skin-like wearable polymers and injectable hydrogel that enable assessment of real-time physiology.
- Organ Failure and ExtraCorporeal Life Support (ECLS): characterizing organ dysfunction/failure (e.g., heart, lung, liver, kidney) and evaluating next-generation ECLS technologies to mitigate organ failure from battlefield injury and shock.
Battlefield SOS provides novel approaches and technologies to stop hemorrhage and mitigate the effects of ischemia reperfusion in future complex battlefield and multi-domain battlespace to help extend the Golden Hour of survival.