After hundreds of years of dressing wounds in the same old way, physicians have come up with a new twist: a bandage that stops life-threatening blood loss in 10 to 15 seconds.
With more than half of all trauma deaths caused by blood loss, the advance may save thousands of lives, particularly on the battlefield, where soldiers sometimes have to wait hours for medical help.
The bandages, developed by the U.S. Army and American Red Cross, are made of the proteins the body uses to seal injuries.
The super bandage won't be tested on humans for at least a year. But physicians are enthusiastic that the new dressing, and similar forms in a foam and spray, might take trauma care to the next level.
"This is a real big deal," said Dr. Howard Champion, director of research at the Maryland Shock Trauma Center.
"When you have a crushed liver from a car crash you can't easily repair it. If you can pack these bandages around it, you could save somebody's life."
Roughly 50,000 Americans bleed to death each year.
Depending on the wound, a person can die in a few hours or even a few minutes.
Until now, outside of hospitals, people could do little more than put pressure and gauze on a wound or use a tourniquet.
In the case of internal bleeding, surgeons must frantically search for the source of the leak, hoping to fix it in time.
Of the people who die early in the emergency room, Champion said, about 82 percent pass away because the wounds are so complex that doctors cannot immediately control hemorrhage.
"What we need is the world's first major advance in hemorrhage control," said Rear Adm. Michael L. Cowan, the Pentagon's deputy director for medical readiness.
"We still use for hemorrhage control what Hippocrates used. He wadded up a piece of papyrus and held it down real tight.
"We wad up a gauze bandage and hold it down real tight. That's not an advance."
But using proteins culled from blood, the new tools may turn these odds around.
Unlike the glue that surgeons have been using to stem oozing during operations, the bandage, spray and foam don't take a half-hour to prepare.
They're ready to use at any time, and they're capable of stopping the high-pressure flow of an arterial bleed -- a bleed so ++ fast and strong that a person can hear it. The whoosh sounds like water pouring from a pipe.
Each form of the new dressing -- the bandage, foam and spray -- relies on the same principle.
They deliver 10 times the amount that the body does of two blood proteins, thrombin and fibrinogen, which interact to form a clot, said Dr. Martin MacPhee, an investigator at the Red Cross' Jerome H. Holland Laboratory for biomedical science in Rockville.
Essentially, it's like getting an instant scab.
For internal and external wounds, the bandage is used. A quarter-inch thick and powdery, the bandage consists of dried proteins.
When it is placed over a wound, the blood activates the proteins, and they start forming clots. Rather quickly, the spongelike bandage melts away.
The bandages can be made as small as postage stamps and as large as a person's chest.
Doctors may also use the foam for internal injuries.
Physicians can spray it inside the patient's abdomen, where it expands and hardens, attaching to organs or tissues that are bleeding.
The spray is a fine powder that will also be activated when it hits the blood.
The new treatment may stretch the golden hour -- the time doctors have to save trauma victims -- to two hours, said Champion, who attended a Senate briefing this week on the issue.
He sees it as part of a series of steps that will dramatically improve the treatment of shock victims by 2005.
In Baltimore, most of the wounds paramedics deal with -- whether from guns or accidents -- can be controlled through direct pressure, said Lt. Terry Horrocks of the Baltimore City Fire Department's medical bureau.
L But he said they would most likely try the bandage and foam.
"Quick and easy and effective," he said, "is what we like."
At the Walter Reed Army Institute of Research in Rockville, Col. John Hess, commander of the blood research detachment, said the technology may eventually be on every ambulance and police car, in every mountain climber's gear.
The National Aeronautics and Space Administration has also inquired about the bandages.
The challenges now are to find a way to make the proteins on a large scale.
Clinical trials are expected to begin in 12 to 18 months.
Eventually, the bandages and foam may also be used for other health conditions, such as delivering chemotherapy or antibiotics a specific site in the body, rather than pumping medicine through a person's entire system.
Broken bones might be repaired through a similar strategy, Hess said, noting that specific growth factor substances could be implanted in certain spots to encourage healing.
Pub Date: 10/17/98