In his first deployment to Iraq in 2005, Air Force Col. Todd Rasmussen saw firsthand why innovation was needed to change combat casualty care. An outdated system of evacuating wounded service members from the battlefield no longer worked with the high number of casualties.
“We were evacuating and caring for injured patients based on an old system, in which the unit’s doctor or surgical team were the ones responsible for that unit’s injured,” Rasmussen said. The joint force in Iraq and Afghanistan and the nature of combat had changed. “As the volume of casualties increased, it was important for us to shift our thinking to allow, for example, an injured Marine to be evacuated by an Army medevac helicopter to an Air Force theater hospital.”
As a result of his experiences, Rasmussen and others developed what would become the Joint Trauma System, a system built around coordination among the services. Now, a wounded service member soldier is transported within the “Golden Hour” – the first hour after injury – to the surgical facility with the right capabilities regardless of which service owns the facility or staffs the transfer. This changed the course of combat casualty care. It also helped sustain what Rasmussen considers one of the most important aspects of the U.S. military – the all-volunteer force.
“Every combatant commander I’d see said the reason our guys and gals fight is because they know – if they’re injured – they’ll be taken care of by the best, most enabled trauma care system in the world,” said Rasmussen. “What the Military Health System did in combat casualty care to increase the survival rate to greater than 98 percent and to coordinate care afterward – including getting injured service personnel back to Germany and the states quickly – has a direct link to a talented young person’s will to enlist and to take the fight to the enemy.”
Since then, Rasmussen has seen and been a part of many changes in DoD trauma care. As deputy commander of the Army’s Institute of Surgical Research in San Antonio from 2010 to 2013 and now director of the DoD Combat Casualty Care Research Program (CCCRP) at Fort Detrick, Maryland, Rasmussen has helped develop solutions that improve combat trauma care and, in many cases, trauma care in civilian settings.
One CCCRP project now being investigated by the Food and Drug Administration is a device to stop bleeding and keep a person’s blood pressure from dropping after significant blood loss. The balloon-like device is inserted inside the aorta and inflated above the level of bleeding in order to slow or stop the bleeding. The innovation came from a military patent now shared with the University of Michigan. It could work in both military and civilian settings.
Other devices and techniques developed or improved on the battlefield have already saved civilian lives. Tourniquets that are used to stop the flow of blood from extremity injuries were revisited and revamped by the Military Health System to be more durable. The new tourniquets are credited with saving between 1,500 and 2,000 military personnel during the Iraq and Afghanistan wars. The same tourniquets were used to save limbs and lives in the aftermath of the Boston Marathon bombings in 2013.
“This translation of military lessons into best practices in the civilian sector is important,” said Rasmussen, “especially during any interwar period when it’s easy for interest to wane. But, sustained commitment to the military’s requirements-driven trauma research program and ongoing collaborations with the civilian community are essential.”
Rasmussen and the staff at CCCRP are already looking to the future, toward military operations that will present new challenges. During the most recent wars, U.S. troops had the ability to fly fleets of helicopters, relatively unimpeded, to most conflict areas. The next operation may have injured troops in remote locations with no nearby surgical facilities. Rasmussen said CCCRP’s mission is to answer the question: How do you treat a service member who is severely injured and can’t be evacuated for 40 hours?
In May, Rasmussen was awarded the 2015 Air Force Hero of Military Medicine Award by the Henry M. Jackson Foundation, a moment he ranks as one of the most meaningful of his career. That statement carries extra weight from someone who has deployed six times during a 21-year career as a vascular surgeon. He performed more than 1,000 operations in Iraq and Afghanistan alone.
Rasmussen said the award was recognition of work performed by thousands of men and women to improve the military’s response to trauma. For him the evening was matched in importance by one other accomplishment in his career.
“The other truly rewarding moments came during early deployments, when I was able to put my surgical training to use as part of a remarkable team caring for the most important patients I’ll ever treat: the young men and women of our volunteer force.”