WASHINGTON -- The combat soldier in 2010 will wear a computer chip around his neck, capable of storing up to 40,000 pages of medical history. Inside his pack, a small box will contain a unit of powdered blood. His wounds will be treated in a battlefield operating room that blossoms from a desk-sized crate.
Goodbye, M*A*S*H. This is front-line medicine of the 21st century.
Recognizing that future battles will likely be fought by smaller, more mobile units farther from base hospitals and that soldiers could face enemy chemical and biological weapons, military doctors are scrambling to adapt. They are developing everything from high-tech bandages to modular intensive-care units aboard aircraft and ships to care for the injured GI.
In addition, the Pentagon is still smarting from the unsolved Persian Gulf war illness, which continues to afflict thousands and has left the military with a "bloody nose," says one top defense official. Military leaders hope to prevent another such mysterious syndrome by meticulously detailing the hazards a soldier faces along with his personal medical profile, including the air quality and diseases he faces in a war zone and his inoculations, sicknesses and surgeries.
"We're working very hard to push our way to the battlefield of the future," says Rear Adm. Michael L. Cowan, a physician who is the Pentagon's deputy director for medical readiness and is overseeing the emerging technologies. "All of this is at some stage along the road."
The old model of military medicine -- where helicopters swept in under fire to evacuate the wounded to a distant, olive-drab field hospital -- is "a failure," the admiral says.
Most combat deaths occur before a soldier is evacuated, usually from severe blood loss. Sixty-five percent of those who are "killed in action" die within the first five minutes of being hit, according to the Defense Department.
So the Pentagon is trying to give the combat medic more tools to stabilize a wounded comrade, who would then be handed off to the new pop-up field operating room.
Among the items for the medic is a bandage developed at Maryland's Fort Detrick.
"It looks like a rice cake; when it gets wet, it will clay," explains Cowan, saying the fibrant sealant bandage can stop the most severe arterial bleeding by using two proteins involved in blood coagulation.
The bandage was tested on a research pig in Texas, which was given a large liver wound, treated with a 4-inch-by-4-inch bandage and stitched up. Within 12 hours, the porker was happily eating in his pen.
Plans are also under way to equip medics with helmets that include video cameras. The pictures would be flashed to medical specialists miles or oceans away so they can offer guidance to the medic.
Cowan says the bandages, now undergoing human trials with the Red Cross, could be in the field within a few years. The powdered blood substitute -- hemoglobin encased in lipoprotein -- can be reconstituted with sterile water or saline solution.
"It weighs about what a box of Jell-O would weigh," Cowan says of the powdered blood.
While no soldier wants to carry an additional ounce, this will be an exception, Cowan predicts. "If we said, 'Here's two units of blood,' he'd say, 'You're damn right I'll take that.' "
Pentagon researchers say powdered blood is about a decade away from use.
After treatment by a medic, the wounded soldier would head to the Advanced Surgical Suite for Trauma Casualties, which is folded inside a container that can be dropped to the front by parachute or pulled in by Humvee. It expands into a 30-foot-by-30-foot surgical suite and would be staffed by 10 medical people, Pentagon officials say.
The collapsible operating suite -- running within 30 minutes -- could handle 10 patients over 24 hours.
"We currently use tents, which take a long time to assemble," says Army Capt. Antoine Cooper, who was product manager for the pop-up suite at Fort Detrick. "It can be taken much further forward to the battlefield and also relocated much quicker."
The surgical suite can handle traumas ranging from bowel closure to air-passage repair -- wounds that would ordinarily lead to death within an hour or two. The suite would also provide enclosed, pressurized areas for victims of chemical and biological attacks.
The surgical suite "is a very self-contained unit," Cooper says. One of the suites is being tested in field exercises by the Marines at Camp Lejeune, N.C. "They're taking them around XTC trying to break them," Cowan say. Pentagon officials say the suite could be ready for the military within two years.
For the wounded soldier who has been stabilized but needs additional care, the Air Force and Navy are setting aside space in aircraft and ships for more sophisticated medical facilities. "They haul out a surgical intensive-care 10-bed unit," Cowan says. "They can haul out an infectious diseases 10-bed unit. So a commander can pick several flavors and several sizes of these things he wants."
In the spring, the military plans to start testing its "digital dog tag," a memory chip that will hang around a soldier's neck and contain thousands of pages of medical information. It even has the capacity for images, sounds and video. Thousands of the chips will be distributed to troops beginning next fall.
Cowan said the chips will solve the problem of maintaining -- and, many times, losing -- medical records in the field. "We'll be able to record with a laptop what medical things we're doing to him," Cowan says. "So when he's out at a [hospital], we don't lose that medical information."
The military is also making greater use of mobile medical laboratories and surveillance teams to determine what hazards soldiers would face in a combat zone.
In Bosnia, more than 4,000 air, soil and water samples have been collected and subjected to more than 110,000 analyses, which have identified some industrial pollution hazards, says John Resta, program manager for deployment environmental surveillance at the Army Center for Health Promotion and Preventive Medicine at Aberdeen Proving Ground.
"The main pollution is essentially soot from coal-fire boilers," Resta says.
As a result, the Army will set up its camps outside those areas, says Army Lt. Col. Robert J. Thompson, who serves with the Pentagon's Medical Readiness Division.
Both the digital dog tags and the environmental surveillance are intended to prevent another health crisis like the one the Pentagon endured during the gulf war, from which thousands of soldiers came home complaining of headaches, nausea, blurred vision and other maladies that were collectively dubbed gulf war illness.
Defense officials have no explanation for gulf war illness. And they were sharply criticized by Congress for failing to maintain medical records of troops or to foresee and guard against health hazards.
"We didn't like the bloody nose that we took over gulf war illness," Cowan says. "And while we probably did a pretty good medical job, we didn't do it in a very systematic way. We didn't document it very well. We didn't protect everybody like we should. We didn't anticipate like we should."
But through the digital dog tags, dried blood, pop-up operating rooms and mobile medical laboratories, the Defense Department hopes to avoid a similar outcome.
They will be part of "force health protection," the term that refers to the military's holistic view of health -- from preventive medicine to surveillance efforts to clinical programs.
"We're looking more at the health of people," Cowan says, "rather than a M*A*S*H unit sitting around and waiting."
Pub Date: 11/22/98