A one-handed tourniquet. Bandages that seal blood-pumping wounds in minutes. A cream that protects the skin from chemical weapons. Intravenous fluids that can be used more sparingly. Far-forward surgical teams and flying intensive care units.

These are among the innovations in the care of battle casualties being brought to the field in the new war with Iraq.

Some of the items are literally rolling off the assembly line into packages bound for the front. The first shipment of a coagulating bandage made from shrimp shells went out six days before the war began. Other changes, such as the reconfiguration of surgical teams, have been in the works for years. But all are new since the first Gulf War 12 years ago.

"A lot of people say this is Desert Shield/Desert Storm all over again. They don't realize that tremendous advances have been made," Lt. Gen. James B. Peake, the surgeon general of the Army, said last week.

Some of the strategies reflect improvements in trauma care developed in the civilian world. Others arise from lessons learned in the Gulf War and in smaller campaigns. Several of the new medical supplies were designed specifically for military use.

Two themes -- each featuring speed -- underlie many of the innovations.

The first is the effort to improve the initial care of the wounded, particularly in the "golden hour" after injury, when control of bleeding and stabilization of breathing can make the difference between life and death.

This requires that medics (and soldiers themselves) carry better first aid kits. It also means there must be something equivalent to a hospital emergency room close by.

"The types of injuries that came out of the battlefield convinced us that we needed a far-forward mobile surgical capability," Rear Adm. Kathleen L. Martin, deputy surgeon general of the Navy, said last week. "The question was, did we have the technology to do it and could we do it safely?"

All of the military services have answered the question in the affirmative. Each now fields surgical teams that can move rapidly around the theater, untethered to hospitals.

Although there is some variation, a team generally consists of five people -- two surgeons, an anesthesiologist or anesthetist, a critical care nurse, and a respiratory technician. They carry an entire operating room -- surgical instruments, diagnostic ultrasound, oxygen concentrator, anesthesia machine, ventilator, drugs and miniaturized clinical lab -- in five 70-pound backpacks.

The second theme involves the marriage of risky, labor-intensive ICU care and long-distance air travel. This frees up space in field hospitals and gets gravely wounded soldiers to "definitive treatment" quicker.

The two themes combined -- better early treatment and critical care during transport -- "is a monstrous change for us," said Lt. Gen. G. Peach Taylor Jr., the Air Force surgeon general. "It is, in a word, the great organizational change since the Gulf War."

The 18-month deployment in Afghanistan, Pakistan and Uzbekistan has been the major test plot for this new system.

As of March 1, the Air Force (which provides long-distance medical transport for all military services) had moved 2,025 patients from that theater of operations. Of that total, 355 were moved urgently, and 185 were on ventilators in critical condition. None died in transit.

As an example of the ideal working of the system, Taylor cited the care of two helicopter pilots whose craft went down in Afghanistan in April. Both men had spinal fractures and extensive lacerations. One had two broken legs. The other had a complicated facial fracture.

The men were treated in the field by a medic and flown by helicopter to a surgical team, which stabilized them. Then they were flown by plane to an airbase, where they were immediately loaded on another craft with an onboard ICU. They arrived at the Army hospital in Landstuhl, Germany, 161/2 hours after the accident.

Bleeding is the cause of death in about half of battlefield casualties. Since the Gulf War, much work has gone into controlling it.

The first new advance is a one-handed tourniquet designed by several combat medics and refined at the U.S. Army Institute of Surgical Research, in San Antonio. It consists of two concentric loops of webbing. A person who has the use of only one arm can put a bleeding limb through the inner loop and cinch it tight like a noose by pulling the outer loop.

Although the Army plans to issue one to every soldier, only 20,000 of the tourniquets have been distributed so far, mostly to Special Operations troops.

In the current hostilities, the military is also inaugurating two bandages designed to stimulate the clotting of blood in wounds and a powder that can do the same thing.

One bandage is made of chitosan, the sugar-like compound in chitin, which forms the shells of shrimp and lobsters and the exoskeleton of insects. Chitosan has a positive electrostatic charge, red blood cells have a negative charge; the compound and blood cells fuse, forming a clot.

The 4-by-4-inch bandages, which sell for $90 each, stop arterial bleeding in about a minute when applied with pressure to a wound, said Kenton Gregory, a cardiologist and biomedical engineer at Providence St. Vincent Medical Center in Portland, Ore., who invented the bandage with Simon McCarthy, a chemist. They can even seal sucking chest wounds.

The second new bandage, under development by the American Red Cross, is fabricated entirely from fibrinogen and thrombin, two clotting proteins extracted from human blood. It costs about $1,000 per bandage. Like the chitosan product, it can be placed whole in a large wound or cut into pieces and stuffed in a smaller one.

"This is the first big improvement from gauze, which soldiers have been carrying since the time of the Roman Legions," Col. John Holcomb, a surgeon who commands the Army surgical research institute, said of the new dressings.

The chitosan bandage was approved by the Food and Drug Administration in November. The Army has ordered 26,000, but production just began. About 1,000 have been shipped to the Iraq theater, and another 1,000 will be shipped next week, according to an official at HemCon Inc., the manufacturer.

A similar number of the Red Cross bandages have been added to the kits of Special Operations medics. That product, however, is still "investigational," and the FDA allows its use only in people who have given informed consent.

Since Feb.21, a six-person team of Army medical officers has been touring the Iraq theater giving an hour-long slide presentation on the bandage to thousands of Special Operations soldiers. Those who sign a two-page informed-consent document have a green loop put on their dog-tag chain. Almost everyone has signed, said Holcomb, who accompanied the team for a week.

A third product, called QuikClot and made by the Connecticut company Z-Medica, is being used by some Marine Corps and Army medics. A granular material poured directly into the wound, it absorbs water from the blood and concentrates the clotting proteins.

In the effort to reduce death by bleeding, the Army's decision to give less intravenous fluid to battlefield casualties may prove equally important.

For decades it's been standard practice to infuse large volumes of saline solution into trauma patients in order to raise their blood pressure. Over the last decade, however, evidence from both animal and human studies has suggested that raising blood pressure may actually increase mortality by blowing clots off blood vessels and prolonging bleeding.

Furthermore, analysis of data meticulously collected by an Army medic who treated the wounded Army Rangers pinned down in Mogadishu, Somalia, in 1993 suggested that bleeding in some may have been worsened by the "fluid resuscitation" protocol used at the time.

"There were some guys who bled to death, and they didn't have injuries to the head, neck or abdomen," Holcomb said.

Now, Special Operations medics carry small bags of what is called "heta-starch solution." It's far more concentrated than saline, and it is given much less liberally. Medics are instructed to give it only if a person has a very weak or absent pulse or is losing consciousness, a sign of critically low blood pressure.

Not all the new medical gear is directed at control of hemorrhage.

One of the newest items is a squishy packet containing SERPACWA -- Skin Exposure Reduction Paste Against Chemical Warfare Agents. This cream contains Teflon-like compounds that, when spread on the skin, prevent blistering (such as from mustard "gas") and nerve agents from penetrating.

The factory outside of Philadelphia making it was cleared by the government for production only in January.

"It's on its way over there now," said Ronald E. Clawson, a manager at the Army's Chemical Biological Medical Systems, at Fort Detrick, in Frederick, Md., which oversaw development of the paste.

SERPACWA -- Skin Exposure Reduction Paste Against Chemical Warfare Agents -- contains Teflon-like compounds that, when spread on the skin, prevent blistering and nerve agents from penetrating. Army Sgt. Reginald Gee, a medic, prepares equipment on a Blackhawk air ambulance before flying out to evacuate a U.S. soldier wounded in combat in Iraq yesterday.