April 16, 2023: Over the last two decades, emergency medicine, administered by civilian EMTs (Emergency Medical Technicians) or military combat medics has made huge strides. Now the new medical tech is coming to band aids or bandages for people with minor bleeding injuries like cuts or scrapes. Some people do not heal as quickly and these minor injuries can take a long time to heal. The solution is the self-monitoring polymer band-aids or bandages. This smart bandage tech has completed animal testing and now faces up to a decade of human tests and development of larger bandages before it is generally available.

This smart bandage is worn for a week or two until the chronic bleeding is healed. The smart bandage consists of two parts. The most obvious is what appears to be a disposable band-aid or bandage containing biosensors, electrodes and hydrogel containing medications in hydrogel form as well as a device delivering low-level electrical stimulation to speed the healing. The second component is a flexible reusable electronic patch that monitors the healing process by tracking temperature, PH and other items that allow a doctor or medical technician to monitor the healing process. Each year there are millions of people with slow-healing wounds and the smart bandage is designed to speed the healing process.

The smart bandage benefits from two decades of dramatic developments in emergency and combat medicine. These new techs and procedures led to a reduction of combat deaths by more than half since 2003. This was the result of new treatments to deal wounds for which there was previously no battlefield treatment. That meant the victim would die before more extensive treatment could be applied. Chief among these were deep (abdominal or thigh) wounds where large arteries (like the abdominal aorta) were opened. When that happens the victim bleeds to death in minutes.

There have been several new battlefield treatments for catastrophic injuries like this. The first appeared in 2013 in the form of a belt that is placed on the abdomen and activated. A bladder inflates which puts sufficient pressure on the abdominal aorta to stop the bleeding or reduce it enough to make it possible to get the casualty to a surgeon. The belt does not always work. This led, in 2014 to the introduction of another more thorough solution. This was XStat, a syringe-like device that injected nearly a hundred small cellulose sponges into deep wounds. The tiny sponges were infused with anti-bacterial and clotting chemicals that stop the most severe bleeding in 20 seconds or less. The latest version of Xstat sponges also contains a material that can be detected by X-rays and makes it possible for a surgeon to be sure all the tiny sponges are later removed.

While tourniquets have been around for thousands of years, these devices only work on limbs and not well enough when extensive damage is done to major arteries. Preventing death from most other rapid blood loss situations was achieved with the development and widespread use of powders and granules that could quickly stop the bleeding. First (in 2004) came special bandages like the Chitosan Hemostatic Dressing (more commonly called HemCon). This was basically a freeze dried substance that caused rapid clotting of blood and was incorporated into what otherwise looked like a typical battlefield bandage. This bandage greatly reduced bleeding, which had become the most common cause of death among wounded American troops. This device was a major breakthrough in bandage technology. Over 95 percent of the time, the HemCon bandages stopped bleeding, especially in areas where a tourniquet could not be applied. This did not work for extreme cases, especially if the abdominal aorta was involved. HemCon was followed by WoundStat powder to deal with some of the bleeding that HemCon could not handle. While medics, and troops, prefer the bandage type device, there are situations where WoundStat (a fine granular substance) is a better solution (especially in the hands of a medic). Only the medics got packets (usually two) of Woundstat powder. That's because this is only needed for deep wounds and has a theoretical risk of causing fatal clots if it gets into the bloodstream.

WoundStat was but one of many new medical tools for battlefield medicine that greatly increased the effectiveness of the immediate, as within minutes or seconds after getting hit, medical care for troops. This effort consisted of three programs. First, there was the development of new medical tools and treatments that troops could quickly and safely be taught to use. This included stuff like HemCon. Then came the equipping of medics (about one for every 30 or so combat troops) with more powerful tools, so that troops were less likely to bleed to death or suffocate from certain types of wounds that are not fatal if treated quickly enough. Finally, there was the Combat Lifesaver program, which more than tripled the number of "medics" by putting selected soldiers through a 40 hour CLS (Combat Lifesaver) course in the most common medical procedures soldiers can perform to deal with the most dangerous types of wounds usually encountered. These CLS trained soldiers were not medics, but they did make true emergency medical treatment more widely available in combat. In other words, CLS qualified troops are sort of "medics lite," which is close enough if you are badly wounded and in need of some prompt medical treatment.

During the last two centuries major wars have tended to produce significant improvements in medical care. This is what has happened since 2001 but in a much accelerated fashion. For example, since September 11, 2001, over two million American troops went off to war and about two percent of them were killed or wounded. Only 12 percent of the 57,000 combat zone wounds were fatal, the lowest percentage in military history. This was largely due to major improvements in dealing with rapid blood loss from a major artery being severed and the increased speed with which complex medical care could be delivered to wounded troops. New medical technologies also made it possible to detect injuries (like brain trauma) that, in the past, was very difficult to detect and treat.

The Combat Lifesaver course teaches the troops how to do things like inserting breathing tubes and other emergency surgical procedures to restore breathing. The CLS troops have skills most likely to be needed in life saving situations when a medic is not available. The additional emergency medical training, and new emergency first aid gear (the "CLS bag"), has saved hundreds of lives and reduced the severity of even more wounds. Enough troops have taken CLS training so that there is one for every 10-15 combat troops and one for every 20 or so support troops on convoy or security duty.

These new developments were also popular with civilian emergency medical services, and many of the experienced combat medics coming out of the military went to work as EMTs, thus increasing the quality of care for civilian accident victims. This was similar to what happened to the EMT field after the Vietnam War, when ambulance crews rapidly evolved from simply transporting accident victims, after a little first aid, to EMTs who could administer procedures that previously only doctors could handle. This followed the experience in World War II, where war demands led to development of mass production of the newly created antibiotics and that led to a revolution in surgery techniques.