Probe urged of policy on tourniquets

Sun National Staff

Members of the U.S. Senate called on the Pentagon and Army officials yesterday to investigate why soldiers in Iraq continue to go into battle without the modern tourniquets that military leaders told them to carry two months ago - and that military surgeons and medical specialists have recommended for more than two years.

Two senators also wrote to Secretary of Defense Donald H. Rumsfeld on Tuesday, asking him to conduct a thorough and "high level" review of the issue, and requesting a timetable for outfitting all of the roughly 150,000 soldiers and Marines in Iraq with modern tourniquets. Military doctors say the simple medical devices could significantly reduce deaths from extremity wounds - the leading cause of preventable death in combat.

The defense subcommittee of the Senate Appropriations Committee made a similar request of top officials in the Army.

"We are deeply concerned by reports that the Pentagon has failed to identify and fulfill urgent requests for equipment essential to saving lives of our troops in the field," Illinois Sen. Richard J. Durbin and Michigan Sen. Carl Levin, both Democrats, wrote to Rumsfeld.

"This type of delay is disturbing during times of peace, but in the midst of the armed conflicts in Iraq and Afghanistan, it is nothing short of appalling," the letter said.

The calls for an investigation came in response to a story Sunday in The Sun detailing how efforts to supply soldiers with the $20 medical devices have been delayed while training manuals are written and the Army conducts tests to determine the best pouch in which to put the tourniquets. The U.S. Central Command, which oversees combat operations in Iraq and Afghanistan, issued a directive Jan. 6 requiring every soldier in Iraq to carry a modern tourniquet, but compliance was left up to individual units and many have not acquired the devices.

Bleeding to death

Army Rangers, Special Operations troops, U.S. Marines and other warfighting units began several years ago to carry modern tourniquets, typically a nylon and plastic version of the simple cloth-and-stick device that armies have used to stop bleeding from arm and leg wounds for centuries. A committee of military doctors recommended in February 2003 that every American soldier carry one, but many don't, and some have bled to death from wounds on which a tourniquet might have been effective, according to more than a dozen military doctors and medical specialists interviewed by The Sun. It is unclear how many such deaths have occurred, because the Pentagon does not release detailed information about combat casualties, and it has only recently created a detailed database for collecting information about combat injuries.

Army Secretary Francis J. Harvey, testifying before the appropriations subcommittee yesterday, said he is "generally familiar with the issue" and promised to provide a detailed report to the Senate. Gen. Peter J. Schoomaker, the army chief of staff, said he was unaware that some troops in Iraq do not have tourniquets, and added, "I see no reason why there would be any shortage."

Everything they need

Schoomaker also assured the committee that none of the nation's front-line soldiers enter combat without everything they need, and he said soldiers are trained to make improvised tourniquets out of bandages. Some of the military's top surgeons and medical specialists have recommended for more than two years that ready-made tourniquets be issued to every soldier in a combat zone, arguing that improvising can be impractical and unreliable under fire and that injuries in modern warfare are not limited to the front-line fighting troops.

A spokesman for Virginia Sen. John W. Warner, Republican chairman of the Senate Armed Services Committee, said the committee is working with the Pentagon to "verify that all possible steps are being taken" to ensure that soldiers in Iraq are provided with tourniquets.

Durbin, the Senate's Democratic whip, said he intends to "put enough pressure on the military so they move and make this happen."

"The answers I got from the secretary of the Army were troubling," Durbin said. "If certain branches of the military - Rangers, Special Ops, 82nd Airborne - if they think this should be standard issue, then it ought to be standard for anyone who's going into a combat area."

Harvey also said yesterday that the Army's efforts to outfit every soldier with a new blood-clotting dressing, which can stop bleeding in some cases when even a tourniquet is ineffective, have been hampered by concerns about the technology. One product, a granular clotting agent called QuickClot, has been shown to cause burns when poured into a wound, he said.

The U.S. Marines, however, has approved the use of QuickClot and outfitted each of its combat troops with a pouch of the material, according to the Marine Corps Warfighting Laboratory. The Army continues to buy a blood-clotting bandage called HemCon, but its manufacturer can produce only about 10,000 a month and has made only about 82,000 since the product was invented. Mike Williams, vice president of finance for HemCon Inc., said he considers the Marine Corps product a good alternative until production of his bandage can be increased.

"Certainly if you were about to bleed to death, QuickClot is something that could help you," Williams said.

'Hemostatic' dressings

The Central Command policy requiring each soldier to carry a tourniquet also required each to carry one of the new "hemostatic" dressings, but few soldiers do. An Army combat surgeon told The Sun he is unaware of any conventional Army units outfitted with them.

Raymond Huey, chief executive officer of Z-Medica LLC, which manufactures QuickClot, said his product has "absolutely no manufacturing issues" that would delay sending it to American troops. He said his company filled an order in February for the Iraqi Ministry of Defense, taking about five weeks to manufacture, package and ship 80,000 to troops in the Iraqi National Guard.

The manufacturers of the Army's two combat-approved tourniquets said they are prepared to produce as many as 100,000 a month between them if an order is placed.

The committee of doctors and medics that recommended widespread tourniquet use in 2003 wrote its report for the U.S. Special Operations Command, but its recommendations have since been adopted by surgeons and medical specialists throughout the military. The new doctrine of Tactical Combat Casualty Care goes against the long-taught advice that tourniquets should be only a last resort, advising soldiers instead to make liberal use of tourniquets to ensure they live long enough to reach a hospital or aid station.

The new guidelines have filtered into the Army's basic training program, and they led the Army surgeon general several weeks ago to approve a new first-aid kit for soldiers that includes a modern tourniquet and other lifesaving equipment. The Army is conducting tests to determine the best pouch for the kits, a process that could take months. Durbin said he intends to accelerate the process.

"The experts have determined that putting a tourniquet in the hands of every soldier is a vital life-saving measure," Durbin and Levin said in their letter to Rumsfeld. "Holding up the fielding of a life-saving medical kit simply to optimize its carrying pouch suggests a mindset oblivious to the wartime needs of our soldiers."

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