GAITHERSBURG, Md. – Paramedic Dean Elliott rummaged through the ambulance's emergency kit and pulled out a pint-sized red power drill, a tool whose use was honed on the battlefields of Iraq and Afghanistan.
The drill allows high-speed insertion of a needle directly into a bone's marrow to give a patient intravenous fluids when life-saving seconds count, said Elliott, a lieutenant with the Montgomery County, Maryland, Fire and Rescue Service.
"The needle sits on there and you basically drill it right into the bone. It's much easier and quicker," Elliott, who is also a 30-year Navy corpsman, said as he demonstrated in the back of the ambulance.
The needle drill is among a raft of products and techniques learned on battlegrounds in Iraq and Afghanistan that have transformed how U.S. doctors and emergency personnel back home help trauma patients survive life-threatening injuries.
Modern tourniquets that can be applied with one hand and have attached turning devices are replacing the makeshift handkerchiefs and stick or belt of past decades.
Clamps, needle drills and wound gauze impregnated with blood-clotting agents have been developed commercially from the hard lessons learned from more than a decade of fighting, trauma treatment experts say.
Improved transfusions and airway tubes, a focus on stopping blood loss, and training to coordinate and improve care from injury site to operating room have also been critical to the new approach in emergency medicine in U.S. streets and hospitals.
"All of this together has massively increased survivability and pretty much all of them have been brought into the civilian ambulance population," said Dr. Howard Mell, a spokesman for the American College of Emergency Physicians.
LESSONS OF WAR
Many U.S. agencies have adopted the military's Tactic Combat Casualty Care protocol, while a bill moving through Congress would allow more former military medics to move into civilian emergency jobs by streamlining requirements for veterans who already have extensive training. There are no numbers readily available for how many veteran medics have already transferred their skills to civilian life.
About 35 million people are treated in the United States each year for traumatic injuries, such as those cause by gunshots and car accidents. Trauma is the leading cause of death for Americans under 44, according to the Trauma Center Association of America.
The techniques brought home since the Sept. 11, 2001, attacks on the United States are a reflection of the historic low in combat deaths in Iraq and Afghanistan.
Only about 10 percent of casualties in Iraq and Afghanistan were killed in action, with 90 percent wounded, according to Pentagon data. During World War Two, battle deaths made up 30 percent of U.S. casualties.
Before 9/11, the normal practice in U.S. emergency care was first to clear the airway, make sure the victim was breathing and then deal with bleeding.
But with the biggest number of wounded in the two recent conflicts coming from homemade bombs that blew off arms and legs, the emphasis switched to stopping bleeding.
"What difference does it make if we're oxygenating the patient if the blood is squirting out on the ground?" said Caleb Causey, a former Army combat medic and owner of Lone Star Medics, a training company in Arlington, Texas.
The Boston Marathon bombing in April 2013, which killed three people and wounded 264, became a grisly showcase for the stop-the-bleeding protocol.
Tourniquets, sometimes improvised, stanched heavy bleeding from wounds to victims' feet and lower legs caused when the nail-filled pressure-cooker bombs exploded at ground level. All of the victims who made it to a hospital survived.
"From two wars on two fronts over a dozen years, we've learned a lot of what's worked and what's not worked," said Causey.