VCURES: Operation Purple Heart

By Frances Dumenci

Researchers at the Virginia Commonwealth University Reanimation Engineering Science Center (VCURES) – one of the largest and most diverse civilian efforts in the United States engaged in conducting combat casualty care research – are improving survival, care and quality of life for soldiers and veterans through Operation Purple Heart.

As an internationally recognized center of excellence, VCURES is devoted to the study of critical illness and injury, including its causes, diagnosis, treatment and prevention, with an ultimate goal of improving survival and the quality of life for victims.

“VCU and its medical center has a world class reputation for the care of the critically ill and injured dating back to the Civil War,” said Kevin Ward, M.D., professor of emergency medicine, physiology and biochemistry; associate chair and director of research in the Department of Emergency Medicine; and director of VCURES. “Our goal is to leverage the unique talents and expertise of the entire university and apply them to the unique challenges facing the critically ill and injured and those caring for them.

“Our motto of ‘Restoring Life Through Innovation and Collaboration’ is resulting in multidisciplinary efforts across the campus to produce translational research needed to give every patient the best chance of survival from the first moment of injury or illness and throughout their care. This is team science at its greatest.”

Unique to VCURES is its emphasis on rapid translational research, accelerating discoveries from the laboratory to patient care that, in turn, leads to further studies.  One area of research focuses on improving survival, care and quality of life for soldiers and veterans.

The Operation Purple Heart program leverages the extensive multidisciplinary resources of a major university and medical center to attack the problems of critical battle injuries.

“Injuries incurred on the modern battlefield are unlike most injuries encountered in the world of civilian trauma,” Ward said. “They are much worse and when coupled with having to provide care in the austere environment of battle, we must use enormous creativity to innovate the almost science fiction type technologies that will be necessary to improve survival of our wounded warriors.”

Here are some examples of current research and educational efforts through VCURES and Operation Purple Heart:

• VCURES and BodyMedia Advanced Development, Inc., received a Phase II Small Business Technology Transfer award from the U.S. Army to continue its work on developing a wearable bioinformatically enabled monitor for remote triage battlefield casualties. A major goal of the military has been to develop low-profile wearable monitors capable of tracking the health status of the soldier in combat, both before and after injury. The ability to do so would provide valuable information enabling earlier intervention and decision-making. Current products have severe limitations due to their physical size and limited number of variables monitored. VCURES and BodyMedia are co-developing armband technology that will be adapted for use in critical injury detection, including real-time remote monitoring of soldiers on the battlefield. The work is an extension of a successful Phase I award issued to the group in 2008.

• VCURES researchers are working in collaboration with investigators at the NASA Space Laboratory at the Brookhaven National Laboratory in Upton, N.Y., on developing and testing countermeasures for radiation poisoning. Astronauts have the potential to be exposed to lethal amounts of radiation from galactic cosmic rays. Such radiation exposure has the potential to cause neurologic and bone marrow damage, leading to cancer, infection and other complications. Similarly, exposure to radiation from a nuclear dirty bomb through bioterrorism can lead to these same complications. The research group has demonstrated that the use of a special hormone, called Androstenediol, given after a dose of damaging ionizing radiation to mimic that which would be encountered in space, was able to almost completely restore bone marrow function.

• Control of bleeding after severe trauma is key to improving survival. VCURES was awarded a grant from the U.S. Army to characterize platelet function in victims of severe trauma. Severe traumatic shock creates a complex cascade of events, which can significantly compromise how the body’s coagulation system functions. This includes development of abnormalities in the function of platelets, which are specialized blood cells tasked with helping to form strong clots at the site of injured vessels after trauma. When these cells don’t function properly, clotting can be delayed or clots that form are weak. VCURES has developed one of the country’s most advanced coagulation monitoring laboratories capable of examining the complex interactions between the coagulation and inflammatory systems.

• VCURES was awarded several grants totaling more than $3 million as part of an Office of Naval Research program to develop the next generation of resuscitation fluids for use in combat casualty care. The research aims to develop resuscitation fluids capable of reviving the most critically wounded on the battlefield and will find application for civilian trauma as well. VCURES is partnering with Entegrion, Inc., for the project. Entegrion chose VCURES as its academic partner based on its expertise in combat trauma model development and expertise in oxygen therapeutics and coagulation/hemostasis medicine. The basis of the new fluid will be a special spray-dried form of plasma developed by Entergrion, which will negate the need for special storage requirements allowing for life-saving plasma to potentially be given on the battlefield.

• The provision of life-saving supplemental oxygen to victims of trauma and medical emergencies is taken for granted. Oxygen tanks are readily available for paramedics. However, taking a traditional oxygen tank on the battlefield is not routinely possible and can be a real hazard. Newer oxygen concentrators, which concentrate oxygen from air, have numerous drawbacks. As such, the wounded may go without oxygen until they reach hospital aid stations, which may cause further complications, especially for the wounded with traumatic brain injuries. A team from VCURES developed a solution – a portable chemically based oxygen generator, or POG. The POG uses a special combination of chemicals that when mixed produce a constant and highly controlled rate of oxygen for up to several hours. The VCURES POG requires no power source, does not use ambient air and operates at a very safe temperature. VCURES was awarded a $1 million grant from the U.S. Office of Naval Research to continue its work on developing unique oxygenation strategies for combat casualty care.

• VCURES leads and directs a special educational program at VCU that provides critical clinical training to the U.S. Military’s Special Operation Combat Medics (SOCM). Shortly after 9/11, the U.S. Military began relying more heavily on its Special Forces to lead its war on terror. Since 2004, VCURES, in conjunction with the VCU Medical Center and Henrico County Fire and EMS, has provided training to nearly 1,000 SOCM students coming from the Joint Special Operations Medical Training Center at Fr. Bragg, North Carolina. Faculty within VCURES with clinical expertise in emergency medicine, trauma and burn surgery, anesthesiology, obstetrics, critical care and pre-hospital emergency care provide an intensely focused clinical experience for more than 100 of these “Quiet Professionals” a year. Soon after their intense training, many of these young heroes are then deployed for action. “The program reflects the tremendous commitment of VCURES, the VCU Medical Center and indeed the entire Richmond area in supporting the country’s military and its war on terror,” said Ward. “VCU is really one of the few institutions in the nation that can claim such a vital role in this effort.”

 For more information on VCURES, visit www.vcures.org