# Marine modifies body armor to treat gunshot wounds



## Ooh-Rah (Nov 19, 2016)

Really interested to read the opinions of the medical folks here...

Marine modifies body armor to treat gunshot wounds

Marine Cpl. Matthew Long designed an inventive way to offer fellow soldiers immediate treatment for gunshot wounds on the battlefield.

A tweak on the body armor already provided to soldiers in the field, Long created a tear-proof package that rests under flak jackets. The packet contains a blood clotting and pain-killer cocktail that aims to treat shock and provide immediate first aid.

“The whole point of this is immediate first aid,” Long told the U.S. Department of Defense.

Long’s insert would sit behind the Small Arms Protective Insert that rests under most flak jackets. The ceramic body armor is rated to stop small arms rounds; however, the SAPI doesn’t always prevent multiple bullets from penetrating.

In the event a round makes its way through, Long’s packet seeks to buy solders a little more time before medics make it on scene.


----------



## policemedic (Nov 19, 2016)

I think it's an interesting idea but I see some practical problems.  It'll be interesting to see if they can be overcome.


----------



## compforce (Nov 19, 2016)

policemedic said:


> I think it's an interesting idea but I see some practical problems.  It'll be interesting to see if they can be overcome.



You mean like foreign debris from the packaging being introduced into the wound after it's been in that sweaty, dirty nasty area between the armor and the uniform for months on end?


----------



## R.Caerbannog (Nov 19, 2016)

compforce said:


> You mean like foreign debris from the packaging being introduced into the wound after it's been in that sweaty, dirty nasty area between the armor and the uniform for months on end?


There's going to be gunk and nastiness in the body armor anyways; with or without the packet. That pouch sounds like a good temporary solution while the defense industry works on making better ppe. 

Just as an aside, when would a grunt have time to sterilize his body armor anyways?


----------



## compforce (Nov 19, 2016)

R.Caerbannog said:


> There's going to be gunk and nastiness in the body armor anyways; with or without the packet. That pouch sounds like a good temporary solution while the defense industry works on making better ppe.
> 
> Just as an aside, when would a grunt have time to sterilize his body armor anyways?



That was my point...  So you have the layers...  body armor->packet->uniform->body  That packet is going to be sitting in between the uniform, which is always nasty when it's under body armor and the body armor itself.  I gathered from the description that the idea is that a bullet penetrating the body armor would go through the packet and the vacuum would suck the clotting material and the AB into the wound.  Now you have pieces of the packet going into the wound as another thing that the surgeon has to dig out.  And those pieces are covered with literally months of grime.  Grunts don't wash their body armor, they may brush if off, but it is NOT clean enough to get into the blood stream.  That would extend to the packet as well.  (I say that grunts don't wash body armor from experience, not to be hurtful.  I deployed as a grunt wearing the old flak jackets)


----------



## policemedic (Nov 19, 2016)

The article states the pouch would have some unspecified clotting agent and a painkiller.  I'm having trouble seeing how an AK round piercing the SAPI plate would be able to propel enough of either agent into the wound cavity to be effective.


----------



## compforce (Nov 19, 2016)

policemedic said:


> The article states the pouch would have some unspecified clotting agent and a painkiller.  I'm having trouble seeing how an AK round piercing the SAPI plate would be able to propel enough of either agent into the wound cavity to be effective.



I'm thinking maybe the pouch has positive pressure to help out.  That's pure conjecture though.


----------



## Ranger Psych (Nov 20, 2016)

Pressurized foam coagulant and minor narc load, perhaps with a dash of epi for assistance with vasoconstriction, in a bubble-wrap-esque containment system installed on the backside of the kevlar.

Simple fact: the wound is going to be debrieded anyway. Gunshot wounds aren't clean in the first place, you already have the ceramic particulate, kevlar, and uniform that will be entering the wound anyway. You're not worried about wound cleanliness at all in the incipient stages, it's simple prevention of exanguination.  Cleaning it up, dressing it, and treatment to HEAL comes down the line.


----------



## R.Caerbannog (Nov 20, 2016)

@Ranger Psych That was way better than I could have said it.

@compforce I get where your coming from. You are right about body armor kind of being a germfest. Thought the whole "nasty" body armor part was funny, reminded me of old times and how gross gear and people can get.


----------



## TLDR20 (Nov 20, 2016)

We don't inject coagulation agents into the core to stop bleeding.  Also, agents like the one's being considered are for use on junctional bleeds that can not be stopped via a tourniquet. While sure debridement takes place surgically, you don't want a bunch of quick clot going into someone's liver, lungs, kidneys, bowel, and other important organs. Further injecting a possibly unknown quantity of "pain meds" into a potentially hemodynamically unstable patient is just bad juju.

I see neither the necessity, nor the practicality of something like this.


----------



## Ranger Psych (Nov 20, 2016)

So something of say, a foaming coagulant that was pressurized enough to self-apply and self seal/adhere to an extent, allowing additional time for that troop between point of injury and point of care.... on the exterior of a patient's torso is useless?

Incorporating a system that would actually deliver agent completely throughout the wound track would obviously be a bad idea, you want something sterile for that and a more controlled environment. 

I have to disagree with the utility and versatility that would be added to a troops kit with a lightweight delivery system that would provide an instant attempt at staunching blood loss.


----------



## TLDR20 (Nov 20, 2016)

Ranger Psych said:


> So something of say, a foaming coagulant that was pressurized enough to self-apply and self seal/adhere to an extent, allowing additional time for that troop between point of injury and point of care.... on the exterior of a patient's torso is useless?
> 
> Incorporating a system that would actually deliver agent completely throughout the wound track would obviously be a bad idea, you want something sterile for that and a more controlled environment.
> 
> I have to disagree with the utility and versatility that would be added to a troops kit with a lightweight delivery system that would provide an instant attempt at staunching blood loss.



I don't know of any foaming agent that seals and adheres to wounds. I definitely do not know of one that is approved by CoTCCC.

Currently the only approved hemostatic agents are Celox Gauze, ChitoGauze, and Combat gauze. Notice the gauze components of that.

Current treatment for penetration trauma to  the torso is an occlusive dressing.

Any other superficial hemorrhage to the torso is likely not life threatening, and the application of hemostatic agents would not be advisable.

The blood loss from non internal bleeding in the torso would likely be superficial and non life threatening, internal bleeding is the main concern, and the only fix for that is bright lights and cold steel.


----------



## Ranger Psych (Nov 20, 2016)

TLDR20 said:


> I don't know of any foaming agent that seals and adheres to wounds. I definitely do not know of one that is approved by CoTCCC.
> 
> Currently the only approved hemostatic agents are Celox Gauze, ChitoGauze, and Combat gauze. Notice the gauze components of that.
> 
> ...





so......you make one.

For a former beanie, you're stuck in the box. Fuck approved, it has to be made to be approved in the first place, and all of those products were unapproved at one point as well.


----------



## TLDR20 (Nov 20, 2016)

Ranger Psych said:


> so......you make one.
> 
> For a former beanie, you're stuck in the box. Fuck approved, it has to be made to be approved in the first place, and all of those products were unapproved at one point as well.



Yeah, for a former trauma instructor (@SOCM, and T1G) who understands the how's(practice) and why's(pathophysiology of trauma) of treating penetrating chest trauma the way we do, and will likely continue to do barring some insane advancement, I don't think this is a good idea.

The enemy in a chest injury is fluid and air inside the chest. Blood is a fluid, but we don't inject coag agents into the chest to stop it, therefore our treatment is for the thing we can stop, air. I don't know enough about aerosols and chemistry to know if it is possible to spray a foam that could seal a chest holel, but if it existed, in the places I work/ed I would have heard of it.

The box as it stands now is amazing, and will continue to improve as good new technology is made up, tested exhaustively, and shown to have a benefit.


This technology is one that is not practical in application, nor is it in line with our understanding of treatment of penetrating chest injuries. That is all I am saying.


----------



## Ranger Psych (Nov 20, 2016)

Woo, wag that meat bat a little more. If I remember correctly you also were bitching heavily about having to be an instructor, which makes flouting creds chuckleworthy.

True Facts: 

The box is filled with things that were thought up, made, tested, then approved and produced for widespread use.
The whole modern battlefield medical processes employed today were born out of challenging the product/procedural status quo in order to provide a better end product and service to the patient.

Guess where this is in that process, and where it will be if it performs.  Practicality has yet to be proven in either direction, as the actual agent matrix it employs, method it deploys the agent, packaging, effectiveness, as it's a concept at this stage.

The totality of your negative commentary is purely speculation which also specifically ignores your own commentary (IE: "*good new technology is made up*, tested exhaustively, and shown to have a benefit.") ,  combined with 4th point verbal articulation effectively condensed into "it's not the way we do it now so it's wrong". 

Also, I had heard of this as soon as it was made public, so there's one foam agent that could possibly be used. While designed for interior use, it wouldn't be a far stretch to introduce a coagulation agent to assist the clotting cascade for positive exterior effects, given a captured application between the patient and the worn equipment. 

Mind you, the foam mechanism is purely my own thought process as most foaming products are a binary agent, which could be easily packaged with a minimal depth gridded plastic layer and two bladders, with say a CO2 cartridge on an "oh-shit" handle you or someone else could pull if you got hit to charge a stacked bladder providing the force to pump the binary foam agents through the worn grid platform, with obvious leakage from the grid, at the point of injury being the intent.  A positive delivery system would be preferable to solely relying on the minimal suction from a projectile penetrating a containerized wound care media, and also could provide some minimal padding if properly implemented for prevention of skeletal trauma from impacts that may have exited the trauma plate, but were captured by the kevlar layers most commonly used backing plates that aren't stand-alone.


----------



## TLDR20 (Nov 20, 2016)

@Ranger Psych 

First off, I don't know what you are talking about with me complaining about being an instructor. I loved teaching, and am proud of the time I taught young pipehitters, and I am proud of what I continue to teach to those at the tip of the spear as a per diem with both T1G and Simmec. I have the creds to have a serious discussion about this. In my non teaching life I currently work full time in a Cardio- Thoracic Surgical ICU, in a precepted clinical currently, then at Baltimore Shock Trauma as a paid employee starting in January. I bring my experience up only to illustrate that I am not talking from no knowledge or perceived knowledge. 

we have almost 16 years worth of data on how best to treat penetrating chest trauma on the battlefield. This wouldn't meet that best practice. I don't think injecting anything into the thoracic cavity is going to do much, particularly in unknown quantities with no specificity. 

From a HEMCON perspective there is little to be gained via this method, at all. 

Uncontrolled narcotic pain management is super dumb. It only takes watching one trauma patient drop their pressures to sear in your mind that lesson forever.

I know you were some kind of EMT/paramedic, I'm not trying to talk down to you or show off my man meat. I just do not think this is a great idea. I think my reasons are pretty based in practical experience.


----------



## TLDR20 (Nov 20, 2016)

Here is the other thing. It doesn't matter. Likely 3 years from now we will have not heard a peep about this. If it is great and works I will eat my crow. I think it won't though, so we will never hear anything about it most likely.


----------



## Ranger Psych (Nov 20, 2016)

I know you work as a nurse. I was an infantryman cross-trained into being a battalion level medic including specifically NBC casualty care, with subsequent employments due to my credentials in the public and private sector.  I also came under the tutelage while active duty, for my own thoughts regarding this, through working with/for a couple rather key founders of T3C, who still contribute to it and associated things to this day. 

We tried a shitpot of new things in Ranger Regiment while I was there, and it has continued to this day.  If we collectively had an idea and something wasn't on the market currently to do what we identified as a need, we had the shit made, or we figured out how to use something "off label" to do it. Some of the things we tried, we tossed in the trash as they didn't work as advertised when tested, or while they did as advertised, the positive effects weren't worth the additional hassle and could be reproduced through more effective application of current techniques/equipment/skills. That's how the R&D process works, there's a field testing component.  Hell, I could argue that the fucking ETD is in mass use today,  as are TQ's primarily due to the training and fielding Ranger Regiment did with RFR, Isralie dressings, and our original ratchet strap tourniquets in lieu of the vietnam era dressings and tourniquets that were standard issue for the Army as a whole, and got more exposure through our training at "big army" installations and training events. 

That might be why I'm more open minded regarding where this could be a positive thing, provided it's overall weight and dimensional footprint increase on the troops having to carry it is minimal to flat out negligible.

*Point one:* *At what point in this discussion was injection of anything brought up? *

That seems to be one of the major sticking points for you, and it's not mentioned in the article nor my own concept of how this could work. My last personal concept I laid out in an above post takes a currently in design/testing injectible binary medium and repurposes it, or something like it, for a generally topical application within the confines between the damaged armor, penetrated uniform, and punctured body. I'll agree with you that something full-blown injected that went beyond say, muscle layers, would be bad as once you actually go from the confines of the wound track to that point into the thoracic cavity, you lose control of where agents actually accumulate. A perfect example would be the DARPA foam product, I would wholly assume application above the diaphragm and application with a possibly perforated diaphragm would be contraindicated. 

*Point two: The "painkiller" agent has yet to be determined, let alone tested, so while you have valid points that I will totally agree with, you're still saber rattling about something we don't know about yet. *

Even something like powdered lidocane would have it's issues, but part of the design and testing phase would be creating a mechanism of reliable delivery of effectively portioned hemostatic agent as well as any pain management agent. I don't think you'd be taking an AP round through this and immediately getting the equivalent of a full dose of whatever is in vogue for use now as a narcotic. More than likely it would be a topical agent, and wouldn't end up having a huge effect... and with a known average dosing being necessary for an effective hemostatic application, it falls suit that whatever pain management mechanism is incorporated would be something follow-on care could take into account when doing their own aid and associated pain management. IE, it'd have some effect to reduce the pain of injury, most likely topically, which would have the possibility to help keep the patient from going into pain-related shock, and/or help keep them in the fight as needed until they can have proper aid rendered. Adrenaline plus mindset is great and gets us bad mofrickers with CMOH's, but not everyone's wired like that and a helping hand, properly designed, might make the difference.

Open mind, man.  You appear to be steadfast against having a piece of kit that has the potential to provide, at the immediate time and specific place on patient of injury, an occlusive hemostatic dressing and possibly pain management, in lieu of the duration of time from POI to care rendered by either the injured party themselves, or buddies/medic if they are outright incapacitated by the event. It ain't putting you or any other medic out of a job, but it's a valid issue as anything that actually is a torso injury let alone armor penetrating requires extra time to ditch the armor and equipment on that patient. Provided it's proven reliable, it sure as shit could save lives.

The vision of something like this in and of itself is a great idea, the execution has yet to be seen.


----------



## TLDR20 (Nov 20, 2016)

I haven't mentioned infection at any point. That doesn't seem to be in the top 5 of my concerns here.

Narcotics were mentioned.

No saber rattling here. I just have seen things like this be the "hot new thing" then when tested(some of it by me and my compatriots) and found to be garbage, it is never heard from again.


----------



## TLDR20 (Nov 20, 2016)

Also threads like this can inspire legit conversation about actual high quality treatments and training. Which is why I don't appreciate the hostility here. All I have done is try and point out with a reasoning why I do not think this is cool,nifty, or possible. Of course I hope for the best stuff money can buy for our dudes. I just hate seeing clickbait equivalent stuff getting press.


----------



## Etype (Nov 22, 2016)

policemedic said:


> I'm having trouble seeing how an AK round piercing the SAPI plate...


You could stop there. I haven't heard of any examples of someone being killed by a round penetrating their plate.

I'm sure it happens, but I definitely don't want to be carrying ANOTHER piece of equipment that is supposed to save in some freak 0.0000001% likelihood event.


----------



## Teufel (Nov 22, 2016)

Good on this young Marine got coming up with a good idea! I'm very happy to see that the Commandant met with him to discuss his invention.  I understand this particular idea may not be a practical addition to the tactical casualty care tool kit but it's refreshing to see senior leadership seeking out ground level input.  I believe this does wonders for innovation and morale. Bravo Zulu Marine!


----------



## TLDR20 (Nov 22, 2016)

Teufel said:


> Good on this young Marine got coming up with a good idea! I'm very happy to see that the Commandant met with him to discuss his invention.  I understand this particular idea may not be a practical addition to the tactical casualty care tool kit but it's refreshing to see senior leadership seeking out ground level input.  I believe this does wonders for innovation and morale. Bravo Zulu Marine!



This I agree with!


----------



## Devildoc (Nov 23, 2016)

Every Marine I have known has taken their issued gear and treated it like the gorilla on the Samsonite (yes I am that old), and tweaked it and modified it to make it better for them.  Good on him for his resourcefulness and innovation.


----------



## Gunz (Nov 23, 2016)

Devildoc said:


> Every Marine I have known has taken their issued gear and treated it like the gorilla on the Samsonite (yes I am that old), and tweaked it and modified it to make it better for them.  Good on him for his resourcefulness and innovation.



There's nothing like Marines in a combat zone to adapt and improvise their gear to better fit the environment. Sometimes the book has to go out the window. I had a teammate who made a vest with pockets to hold 40mm HE. We laced our dogtags into our bootlaces to keep them quiet and to ID us if the boot was the only thing left. We only had 20-rd mags for 556 so we taped mags together for a quicker change. Superfluous gear like gas masks had a way of disappearing. Minor examples, but Marines have always been creative in the field.

Back in WWII the Raiders used to make stilettos out of big aviation screwdrivers, sharpening them on a bench grinder, wrapping the handle in friction tape. The long thin shaft ideal for getting between the ribs.

Good on this young NCO...and The Boss for listening.


----------

