More than 24,000 American soldiers have been wounded in Iraq since the war began in March 2003. Most of the injuries have been to the arms and legs, and hundreds of soldiers have suffered infections that led to the amputation of one or more limbs.
In January, a small group of surgeons at University Hospital began collecting data from soldiers at two U.S. Army hospitals to study the infectious bacteria in their wounds. The surgeons hope to develop new antibiotic regiments that could result in fewer amputations in both military and civilian hospitals.
Leading the study is Jason Calhoun, chair of MU’s Department of Orthopedic Surgery and an expert in osteomyelitis, bone or bone marrow infections. Calhoun said battlefield wounds are particularly susceptible to infection, and military surgeons are having trouble keeping soldiers’ injuries free of dangerous bacteria during prolonged hospitalization.
The principle danger to American troops in Iraq is the improvised explosive device, or IED, a “homemade” weapon that, in many cases, packages shrapnel with toxic chemicals, biological toxins and even animal manure.
“IEDs in particular are such a big problem because they have a combination of contamination from outside agents and actual injury to the tissue,” Calhoun said. “What they leave for us to figure out is what to actually treat the infected wounds with, and how and at what pace to treat them.”
According to the U.S. Department of Defense, more than a third of the roughly 3,200 soldiers killed in Iraq have died as a result of an IED attack, which often takes the form of roadside bombs aimed at American convoys. Electronically detonated, they take numerous forms and are placed almost anywhere — in roadbeds or medians, under paving stones and walkways or even in the carcasses of dead animals. They can create a “blast zone” of up to 30 feet or more, Calhoun said, and are also used in car bombs and suicide attacks.
Gregory Della Rocca, an MU orthopedic surgeon working with Calhoun, said the body armor worn by U.S. soldiers is saving lives that would have been lost in previous wars. But the higher survival rate has required new approaches to battlefield medicine.
Despite the armor, Della Rocca said “arms and legs are still susceptible to massive injury. Since more soldiers are surviving events that years ago would have caused their death, we are seeing a higher proportion of injured soldiers needing medical care.”
The nature of the injuries caused by IED attacks are similar to those suffered by combatants in the Civil War, said George Wunderlich, executive director of the National Museum of Civil War Medicine. IED explosions resemble those of some Civil War artillery, which often fragmented on detonation and produced similar injuries.
“No matter what way you look at it, shrapnel is shrapnel,” Wunderlich said, “and when something is propelling at you at 900 feet per second, it’s going to do some damage no matter what.”
Wunderlich said many of the battlefield medical techniques practiced during the Civil War are alive and well today.
“Obviously, there are differences in the quality of medicine and the knowledge we possess,” he said. “But you can look at many other areas of our medicinal care — the organization, the logistics, the ambulance system and establishing a center of operations — and we’ve never gotten away from those roots.”
The study by Calhoun and his colleagues is funded by a $1.6 million grant from the U.S. Army Institute of Surgical Research. For the first 18 months, the surgeons will be gathering information from patients at Walter Reed Army Hospital in Washington, D.C., and Brooke Army Medical Center in San Antonio. They will also have access to soldiers’ medical records from Landstuhl Regional Medical Center in Germany, the nearest treatment center for wounded soldiers coming from Iraq and Afghanistan.
After studying the bacteria, the surgeons will try to attack it with different antibiotics to determine when the drugs should be administered for an injury and for how long in order to maximize its efficacy.
Calhoun said the practical goal of the study is to develop a system of administering antibiotics that could be used in civilian hospitals across the country. If medical personnel had information on how to treat infected open-fracture injuries suffered in farm and automobile accidents, for instance, Calhoun said outcomes would improve.
“We’d be able to get an earlier diagnosis on the cause of their infection and be able to quickly treat it,” he said. “Our results could have a huge positive impact on patients with many types of injuries.”