* The Medic of the Modern Battlefield

http://www.popularmechanics.com/military/a24806/air-force-pararescuemen-medic-of-the-modern-battlefield/

Air Force pararescuemen have cutting edge tech and no fear of heights.

By Jay Bennett, Jan 19, 2017 

Soldiers don't have the luxury of deciding the best place to get wounded. It could happen in the midst of a firefight in a dense city, or out in the middle of the desert. Combat medics might need to get to a mountain valley or plunge into the ocean. But wherever they are going, they always need to get there fast. That's why pararescumen, or PJs, take the most direct route: straight down from the sky.

"If there is any valor and humanity in warfare, it's in pararescue," an Air Force Special Operations Command (AFSOC) PJ recently told me at Hurlburt Field, an auxiliary field of Eglin Air Force Base on the Florida panhandle. There are roughly 325 pararescumen in service, 180 with Air Combat Command, and 145 with AFSOC, the Air Force's special operations component, akin to the Navy SEALs. In fact, when a Navy SEAL takes a hit, it might be an AFSOC PJ who leaps from the sky to provide aid.

One active-duty PJ gave me a look at some of the most impressive and unusual gear put to use by modern airborne medics. Of all the life-saving equiptment, the flashiest must be the $85,000 anatomical dummy. The mannequin talks, breathes, bleeds, and cries out in pain, all while a series of sensors allow it to be controlled via an app. While one PJ-in-training tends to the dummy, another can monitor its vitals on a tablet.

Once you're treating a living, breathing soldier, the need for a mannequin quickly falls away and other tools come to the forefront. The priority for a patient wounded in combat is MARCH: major hemorrhages, airways, respiration, circulation, and hypothermia. On the battlefield, major blood loss is the biggest threat to life. The tool for solving this problem, often caused by an IED blast, is a large syringe that injects sponge-like pellets, called XStat. The sponges work quickly, expanding in about 15 seconds to fill wounds and create enough pressure to block severed blood vessels. This is much more reliable than older gauze bandages that had to be crammed into a wound cavity by hand, such as a hole caused by a gunshot. But when the bleeding is coming from a full amputation, common on today's battlefield, a good old-fashioned tourniquet is still the best solution.

It's worth noting that in most civilian settings, the priorities are much different. Rather than MARCH, civilian EMTs and first responders are taught ABC: airways, breathing, and circulation. That's because outside the battlefield—with the exception of car crashes—major hemorrhages are fairly uncommon. Even in the rare case when a civilian does suffer major bleeding, it is usually unlikely that they will die before the paramedics can arrive, and a blood transfusion in the ambulance or in the ER will save a patient from bleeding out. A blocked airway, on the other hand, will kill a civilian before help can arrive.

But on the battlefield, "you've got to stop the bleeding first," one PJ explains. Major bleeding, from an amputation for example, contributes to or causes pretty much every other respiratory and circulatory problem that a soldier can suffer from. Under fire, you have to treat the source of the problem—the bleeding—not focus on the symptoms.

After bleeding has been stymied, PJs move on to the patient's airways. The combat medics use a stiff tube with an attached camera to find the trachea and access the lungs. "Before we had these it could be hard to see what you were doing," a PJ says as he shows me the screen, currently displaying the anatomical insides of the dummy's throat.

These tools are not fool-proof, so proper operation is crucial. It's all too easy to mistakenly slip an air tube into the patient's esophagus instead of the trachea, and then all you're doing is pumping air into their stomach. Once the airway is cleared and the tube is inserted, an automatic respirator pump can be used, but sometimes a soldier needs to pump air for the patient by hand. If the victim has a collapsed lung, then it might also be necessary to insert a needle into the patient's chest to provide a path for air to flow into the wounded lung.

IN AN ACTIVE COMBAT ZONE, IVS GO STRAIGHT INTO THE BONE MARROW

After airways and respiration are taken care of, the next issue to address is circulation. Often that means introducing blood, drugs, or just saline solution via an IV. But in an active combat zone, IV drops don't go into the arm veins. Instead, they go straight into the bone marrow of the patient's sternum—liquids introduced directly to the bone marrow actually circulate through the body quicker than liquids introduced to the veins. A circular IV device with several sharp needles and an adhesive rubber patch is applied to the middle of the patient's chest and pushed in until the business end penetrates the sternum. In the chaos of a firefight, out in the dirt and the noise, there is no time to fumble around with needles, looking for a vein.

The preferred pain drug of choice for battlefield injuries? It's not morphine anymore, but ketamine, which you probably know as a horse tranquilizer. Morphine does not thin a patient's blood, but the sedation effect it produces often causes a drop in blood pressure. That's bad news for a person who's already suffered major blood loss, as their blood pressure has likely fallen dangerously low already.

"Morphine makes it so they can't feel the pain," explains one of the PJs. "With ketamine, they can still feel it, they just don't care as much." And that is a crucial distinction. You don't necessarily want the body to completely relax after a major battlefield injury; you want it to fight to keep itself alive.

"MORPHINE MAKES IT SO THEY CAN'T FEEL THE PAIN, WITH KETAMINE THEY JUST DON'T CARE AS MUCH."

With circulation addressed, that just leaves the end of MARCH, hypothermia. It's an issue that's more pressing in some environments than others. But blood loss combined with respiratory and circulatory issues can bring on hypothermia even when it's not freezing cold, especially if the patient is wet. Treating hypothermia depends on the specific conditions, but it essentially amounts to getting the patient warm and dry. A PJ might use blankets, chemical hand warmers, or body heat to help stave off hypothermia—but only after all the other steps in MARCH are addressed. Simply warming up a bleeding, breathless soldier is not going to any good.

None of these tools are available on sight, of course, so when a PJ jumps out of a plane, he is carrying all the gear he needs to keep someone alive. That includes tourniquets, the XStat syringes, an air tube and camera, IV equipment and liquids, possibly an automatic battery-powered respirator, and a number of other medical odds and ends. Sometimes the PJs even jump with a small hydraulic rescue tool, similar to the Jaws of Life, and an inflatable jack—a thick rubber pressurized balloon—that can be used to lift a vehicle off someone, including an aircraft.

At the heart of it all is a vitals-monitoring system is connected to an Android Tactical Assault Kit (ATAK)—a Samsung Galaxy S5 for special operators that runs a number of military-specific programs, including GPS mapping for navigation, flagging evacuation zones, and setting drop points. Combat medics used to carry large packs with heavy electronic equipment to monitor vitals. "Now all that tech can damn near fit in your pocket," says one of the pararescuemen.

Even as the tech to accomplish the mission gets smaller and lighter, the mission itself remains the same. The pararescumen who leap from the sky do it for the age-old purpose of saving brave soldiers' lives. With better tools, they can accomplish their quest faster, and with ever more success. But the job, and its creed, will never change: These Things We Do, That Others May Live.