Video-Review: Frontline Medicine, Episode 1 Survival

This is my favorite YouTube video of the year. In this hour-long clip, you can watch how EMS is being changed by recent medical advancements developed during combat operations.

“War drives innovation and in this series, Michael Mosley travels from the frontline of war to the frontline of research to uncover the medical breakthroughs that are coming out of current conflicts”.

It is an important clip for all EMS providers to watch. You won’t have to be embarrassed if you get caught watching it at work. This episode is an hour long and it’s really worth watching the whole thing.  It provides incredible details on some recent medical discoveries from the battlefield. Many shown were recently introduced since just 2006 and 2007. The importance of these changes for EMS providers in civilian service will be enormous.

The first to capture my attention is the shift in emphasis from the Golden Hour, to revelation of the Platinum 10 Minutes. Lives are being saved every day on the battlefield by getting the right things done very quickly. No longer is an hour an acceptable or survivable wait. How our current systems will react to this new need for better speed could be challenging.

But speed alone is not the solution. The amazing 90% survival statistics quoted reveal a range of improvements in care. As I have commented earlier, this is not a new phenomenon. Tactical EMS has led many of the biggest changes in civilian EMS.

What is new are a rapidly evolving combination of medical procedures and device technologies that are saving lives which would have been lost only five years ago. Some like the early application of tourniquets are very simple and cheap. Others point the way towards adoption of new medical devices that we are just starting to see in EMS. One that caught my eye is their use of a hand-held ultrasound device.

Emphasis at the field hospital is on managing the deadly triad of hypovolemia, hypothermia, and acidosis. Almost everyone gets a head to toe CT scan. They initially use X-Rays and hand-held ultrasound devices. If they do spot big problems on X-Ray, or see blood in the abdomen with rapid ultrasound, they take the patient straight to the OR and get the full scan later. Initial work up took only minutes and the rate of turnover was astonishing.

They also showed ultrasound being used for localized nerve blocks. These are frequently used instead of narcotics to control pain. In the example of the foot injury case shown, the soldier gets his pain managed with little it any narcotic pain reliever. This results in fewer complications while delivering better pain relief than traditional anesthesia.

The initial goals are to stop the bleeding, get you warm and keep you warm, while giving a lot of blood early and in a different ratio of clotting factors to red cells than used previously. Not long ago they would give 4 units of red cells for every unit of plasma. Today it is more often a 1:1 ratio. From the initial infusion the blood is warmed and they give a lot of it. They described giving little saline, preferring to give blood products almost immediately. Since they mention giving blood in the field too, I wonder how they store it?

One of the innovative potential therapies explored is administering progesterone for traumatic brain injury. They are also researching the use of hypothermia therapy during cardiac arrest. Some of the early results described in these areas show great promise. The lessons from our recent military experience have already impacted civilian EMS. What fascinates me is the apparent continued acceleration of development.

We are seeing more new promising therapies that save lives, born on the battlefield and then brought back home. That is why this is my favorite EMS YouTube clip of the year. What is your favorite EMS-related video of 2011?


About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I have written a lot about EMS Technology on the Paramedic Blog, the Insights on Innovation column for, on and I can be reached directly at 573-240-0002.
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