This year, the Defense Healthy Agency joins the entire nation in commemorating the 20th anniversary of the September 11, 2001 attacks — a searing moment in American history that remains all too vivid for many Americans today.
Not only were military medical personnel critical in treating and saving lives of victims of the attack on the Pentagon, but our military medical forces also responded to ground zero in New York. Many of the medical heroes of 9/11 continue to serve their country and care for patients today.
Since 9/11, the level of medical care for service members, retirees, and their families continues to improve and change. Years of military conflict in Iraq and Afghanistan brought innovations that completely transformed the Military Health System's approach to combat casualty care. These contributions not only shaped military medicine; they also transformed the overall field of medicine, helping to save lives around the country and the world.
Here's a list of just a few ways military medicine has evolved in the two decades since the 9/11 attacks:
1. Stop the Bleed
In life-threatening emergencies, minutes can make the difference between life and death. Bleeding control techniques, such as tourniquet application and packing open wounds with clean gauze – which were once primarily reserved for the battlefield – are now being widely taught to the public through the Stop the Bleed campaign, which trains Americans on how to respond to bleeding emergencies.
Early bleeding control is important both off and on the battlefield. Hemorrhage secondary to traumatic injury is the leading cause of death of Americans between the ages of 1 and 46. The Stop the Bleed campaign was launched in 2015 by the White House's National Security Council Staff. Since then, bleeding control has become widely taught and bleeding control kits are now commonplace in schools, airports, workplaces, and other locations.
2. ER-REBOA
Military research into bleeding control continues to be a priority, and lessons learned on the battlefield are being carried over to the home front. For example, the resuscitative endovascular balloon occlusion of the aorta (REBOA) device to stop hemorrhaging received approval in 2015 from the U.S. Food and Drug Administration.
The device was designed by Air Force Col. (Dr.) Todd Rasmussen and Dr. Jonathan Eliason, who served tours at the military's level III surgical hospital in Balad, Iraq and saw a need for a device that could stop blood loss in the pelvic area and abdomen. The ER-REBOA is not only being used by the military, but also in more than 250 hospitals internationally, and has greatly increased patient survival rates.
3. Osseointegration — Advances in Prosthetics
Advances in artificial limb technology since 9/11 have enabled warfighters who lost an arm, a leg or the use of multiple extremities, in Iraq or Afghanistan to function better. On December 7, 2015, two amputees who were Iraq and Afghanistan veterans, Bryant Jacobs and Ed Salau, became the first Americans to get a percutaneous osseointegrated prosthesis, or POP implant, through a clinical trial funded through the Department of Veterans Affairs.
While traditional prostheses involve placing the residual limb into a cup-like shell called a socket – which can cause pain, discomfort, and infection – the POP implants are surgically anchored into the patient's remaining thigh bone to allow connection to the prosthesis. Patients report a number of benefits including improved mobility, improved comfort, a decreased risk of falls, and a more "part of me" experience compared to socket prostheses.
In 2020, FDA approved the Osseoanchored Prostheses for the Rehabilitation of Amputees Implant System, the first implant system approved specifically for adults who have above-the-knee amputations.
4. METC Training – Prolonged Field Care
To prepare for future battlefields where there is limited ability to quickly evacuate a patient to a higher level of care, the Medical Education and Training Campus' Combat Medic Specialist Training Program in San Antonio, Texas has developed an Introduction to Delayed Evacuation Care component to its capstone Combat Field Training Exercise.
The goal is to expose the Army's point of care medical personnel – the 68W Combat Medic Specialists assigned to the US Army Medical Center of Excellence – to the principles of prolonged field care. The pilot program launched in June 2021 aims to better prepare medics for near-peer conflict when immediate medical evacuation may be difficult.
5. Val G. Hemming Simulation Center at the Uniformed Services University of the Health Sciences
Recent wars have demonstrated the need for more training and practice in life-saving procedures on the battlefield. Using simulation for training military medical personnel dates back to the 1960s. In 1999, the Val G. Hemming Simulation Center at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, was created through the vision of the dean of the School of Medicine, Dr. Val Hemming. The center uses live actor simulation, mannequins, task trainers, and virtual reality to help train medical students, graduate-level nursing students, and Graduate Medical Education trainees.
The center is one of the largest and most comprehensive simulation centers in the MHS. In 2005, the Army established the Medical Simulation Training Center (MSTC) program with the goal of building and standardizing the skills of Army Combat Medics. However, the MSTC did not include physician and nurse training. In turn, the MHS initiated the establishment of hospital and school-based simulation centers to enhance clinical training and experience among doctors and nurses.
6. QuikClot
Uncontrolled bleeding is the leading cause of preventable death on the battlefield. Increased use of tourniquets and hemostatic dressings, which clot the blood inside the wound, have saved the lives of many seriously wounded service members.
Soon after the attacks of Sep. 11, 2001, the Defense Department launched a series of studies to identify the most effective technology. Quikclot Combat Gauze has been used by the U.S. military in operations in Afghanistan, Iraq, and Syria. This type of bandage uses a compound found in the exoskeletons of shrimp and lobsters that helps form blood clots.
7. MHS Apps
The Military Health System is more than just a large health care institution — it is also a community. Over the years, the MHS has developed a series of apps to provide that community, including patients and healthcare providers and staff, with information on practical, easy-to-use health care mobile apps. They range from apps to help with relaxation and breathing to immunization reference material and tools for evaluation and treatment of concussions.
The goal of the app portfolio is to help improve the quality of services provided to MHS patients, providers, and staff, to ensure they have the information technology products available for all their needs. A list of available apps can be found at the bottom of the Solution Delivery Division's webpage on Health.mil.
8. MHS Centers of Excellence
Military Health System Centers of Excellence, or CoEs, were established to help the Department of Defense to speed the advancement of our scientific knowledge and evidence-based practices for diagnosis and treatment of diseases and conditions that impact our military personnel and their families with the help of a critical mass of experts.
The following are a list of MHS COEs: