War zone trauma cases yield medical insights
Friday, December 31, 2010
BAGRAM AIRFIELD, AFGHANISTAN - On most days of his six-month deployment, surgeon David H. Zonies was lucky just to get outside and see the sun. Often, his only break from work was 30 minutes on the treadmill in the physical therapy department.
Every day, a half-dozen casualties arrived at the Joint Theater Hospital here, nearly all needing surgery in the next 24 hours, many missing limbs, a few barely clinging to life. The 36-year-old Air Force major was the "trauma czar." His job was to coordinate the patients' care and operate on about a third of them.
At the end of October, however, Zonies took two days away from the job. He exchanged blue scrubs for a brown flight suit, flew to Kandahar Airfield 350 miles to the southwest and presented two papers at a medical conference.
One described bringing dialysis to the war theater, and the other was about a new lab test for measuring the strength of blood clots. Thirty people from four hospitals in Afghanistan watched his PowerPoint presentations and asked him questions. Then he flew back to work.
Zonies' big outing - and the willingness of the Air Force to let him take it - says a lot about how important medical research is to the American military, even during one of the most intense periods of a nine-year war.
The armed services are dedicated to saving every life, limb and eye of battle-wounded service members in Afghanistan and Iraq. The task requires not only skill and energy, but also the capacity to learn from failure and broadcast success.
Military medicine has made consistency and self-scrutiny part of the mission. It takes to heart the quality-assurance mantra "If you can't measure it, you can't change it." It values publication in peer-reviewed journals as much as does the faculty of Harvard Medical School.
"Among the big challenges in medicine is taking up new stuff that works and letting go of the things that don't. My sense is that the military kind of has a handle on both," said Carolyn Clancy, director of the Agency for Healthcare Research and Quality, the federal agency assigned to finding ways to better apply existing medical knowledge.
Historically, civilian medicine has had a poor handle on those challenges.
In a famous study published in the 1990s, a group of Harvard researchers measured how long it took for knowledge to turn into action in medicine. They performed a "cumulative meta-analy-sis" - essentially a running score card - of the results of clinical trials testing new heart attack treatments. They compared when there was enough information to say something worked, and when doctors started putting the treatments into practice.
They found that clot-dissolving thrombolytic drugs weren't widely recommended until 13 years after it was clear they saved lives. For the use of aspirin in acute heart attacks, the lag was 10 years.
In the armed services, new approaches are viewed with more urgency.