INITIAL FINDINGS OF THE “GOLDEN HOUR” Study: Advanced New Medical Rescue Doctrine
Dr. David & Michele Tarica
Mr. Andrew & Beth Tarica
Distinguished Members of the American Iranian Jewish Community in Los Angeles
“GOLDEN HOUR” Study:
Advanced New Medical Rescue Doctrine
Based on lesson learnt from 2006 Lebanon War
Dr. Eran Schenker
Aerospace Medicine Research Center
The Golden Hour Doctrine
The Israeli Air Force has a well-earned reputation for medical evacuation (MedEvac) in wartime as well as in peace. Still, during the Second Lebanon War in July-August 2006 we had to deal yet again with some issues relating to the evacuation of wounded personnel during battle, as well as various moral and operational dilemmas. One of those perplexing issues deals with keeping casualties in the field: postponing their evacuation thus risking their lives - vis-à-vis a rapid evacuation that will endanger the rescuing teams.
With the Iranian threat looming large, it is currently assumed that in a regional asymmetrical conflict, Israel's hinterland will be targeted by missiles with different warheads to be fired from Gaza, Lebanon and maybe even Syria. Swift, safe and efficient evacuation of wounded personnel to the appropriate medical centers is still one of the important questions to be addressed.
The emergency medical disposition in Israel espouses the doctrine of urgent evacuation within the so-called Golden Hour, the very first hour from the moment of injury with the aim of getting the wounded within that hour to a medical center for the appropriate treatment.
Research both in Israel and elsewhere stresses the importance of quick and professional treatment very soon after the injury. In many cases adequate treatment could minimize medical damage and lessen the mortality rate. But in war, medical response within the Golden Hour cannot always be assured, while in the great majority of serious injuries from invasive wounds or shock wave even the quickest transfer to a medical establishment will not change the medical outcome or the chances of survival determined at the very moment of injury. In future, medical response will be significantly improved with the introduction of various technological innovations.
The key question in our study is how can we shorten the link-up time of the medical forces in the fighting zone with the casualties and how the location, diagnosis, monitoring and treatment of the wounded in the battlefield can be improved and made more efficient, from the moment of injury until reaching the hospital within 60 minutes at most.
The basic question of the study attempts to assess whether in future conflicts adequate treatment of the seriously wounded can be assured within the envelope of that Golden Hour – quicker link-up with senior medical forces, use of advanced technologies of location, diagnosis, monitoring and treatment from the very moment of injury, in order to improve the chances of survival and lessen the death toll.
Initial Findings and Recommendation
In the Second Lebanon War, the time elapsing from the moment a request for the evacuation of seriously wounded personnel was received; to the arrival of the injured at the trauma center was three hours. Similarly, more than half of the seriously wounded who were flown by med-evac reached the trauma unit two hours after sustaining their injuries. This time frame is immensely longer than the sixty minutes we should aspire to.
With non-urgent injuries, med-evac average time was more than ten hours and more than half the non-critically wounded were evacuated more than six and a half hours after being wounded. These are relatively long periods of time considering the average short flight, taking no longer than 15 minutes from the battlefield to the hospitals.
Following our intensive study, the technological measures presented hereby, as possible solution to technical problems are varied:
1. Small personal sensors to monitor vital signs of soldiers in battlefield – the Winitor, as we call it.
2. The smart wireless stretcher – our strever – for treating and stabilizing the wounded in the field as well as treating casualties without endangering the rescuing airmobile force, through the use of unmanned air vehicles such as the unpiloted medical helicopter.
Dangerous operations behind enemy lines take their toll in casualties. Very often the injuries are serious and sometimes the percentage of casualties is higher than that incurred during assault or advance in conventional warfare.
One of the solutions to be further examined is the 'winitor' – an inexpensive, available
tool which is easy to operate despite being based on space technologies employed by NASA; it is actually similar to the medical monitoring systems the first Israeli astronaut, the late Col. Ilan Ramon wore.
Nowadays every wounded soldier waiting to be evacuated is eligible to have the same. The technology is very much in place and it only needs to be adjusted to the abovementioned requirements. With an estimated – negligible – cost of less than 500 dollars per piece even in small series of 30 such machines, this can be an in-the-field monitoring kit for the unit doctor, and its warning can save human lives.
We also found that the "forehead winitor" is a tiny medical tool to monitor and transmit pulse rate and the level of oxygen in the blood. It clings to the forehead as a bandana, while on the inner side it has a miniature medical sensor no bigger than a coin measuring heartbeat and the level of oxygen in the blood.
The winitor measures sequentially both basic medical vital signs which have utmost importance in the primary evaluation of the casualty. The moment either heartbeat or oxygen levels drop or climb dangerously the winitor issues a warning both audibly and visually and also transmits those stats to the commanding officer when needed.
The research team of the this study, will try to find the ways to give the best medical response with tele-medical technology installed in a mobile medical system fixed on a military stretcher – a system that will be monitoring the vital signs of the casualty and transmit them to the medical echelon, the trauma center and each of the medical and commanding echelons.
The med-UAV that will meet the requirements discussed above will be able to carry three mobile systems for evacuating trauma victims in the form of the transmitting military stretcher. We consider that three wounded personnel is the minimal number of casualties to be thus evacuated from the battlefield to the hinterland in one flight. The helicopter should be able to hover at zero speed and cruise at 150 knots max, reach cruise ceiling of 10 000 ft at least for five hours. Some electrical fuel cells may possibly be installed in addition to the conventional engine. The helicopter has to be made of especially light flight material which will enable flying as much cargo as possible (three wounded soldiers at least with their equipment) – 360 kg in total.
The vehicle will have as low a profile as possible and a system of flexible and durable gliders, capable of shock-absorption in order to minimize any unnecessary movements when evacuating spine casualties. The vehicle will be equipped with systems of autonomous independent navigation, if possible, and with advanced optical systems to facilitate landing at a minimal landing space. It will also have com-channels to the operator-pilot and the physician at his side, on the ground, including disruption-proof broadband satellite com. Audio and video systems will be installed above every casualty and such visual control will enable the doctor to treat the patient not just with the supervision of vital signs but with a general picture of the wounded soldier and two-way communication with the patient when possible - if needed.
All life sustaining systems in the med-UAV should be modular and not inter-dependent, so that their docking station ought to fit both the med-UAV and the standard issue IDF stretcher. This way the changing medical equipment could be upgraded according to the needs.
The medical response in the battlefield most importantly aims to make it possible for the relatively few seriously injured personnel, capable of surviving the first hour, to reach the hospital for adequate treatment. From the data gathered it transpires that more than five percent of the seriously wounded soldiers expired while still in enemy territory, after the first Golden Hour. These soldiers sustained serious injuries with combined head, stomach and chest wounds compounded by amputations. It is possible that innovative treatment in the field together with the presence of senior medical personnel and speedy evacuation will ameliorate in future their survival rate.
This study is an attempt to create a change and lead a transformation of policy and decision makers in Israel. The study findings and recommendations this far will be presented to the Defense establishment in Israel so that more human lives are spared should a new conflict erupt sometime in the future.