Stop the Bleeding
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‘In the Blood’ Review: How to Improve a First-Aid Kit
In March 2000, at a Rand Corp. conference session on the medical support of urban military operations, John Holcomb ruefully acknowledged that the tools for controlling bleeding in battle had not advanced much since the Trojan War. Gauze and pressure—that was it. An Army trauma surgeon, Dr. Holcomb had served on the ill-fated mission in Mogadishu in October 1993, when 18 Army Rangers died, many from excessive blood loss.
Determined to figure out (as he put it) “better ways to stop bleeding,” Dr. Holcomb joined the Army’s Institute of Surgical Research when he returned from Somalia. Assertive by nature, he pursued successive collaborations, first with the Red Cross, then with a physician developing a clot-promoting chemical from shrimp shells, and later with a pharmaceutical company touting a new use for a hemophilia drug.
Yet the most effective product—and the one that is now carried in the first-aid kit by every member of the American military—was discovered and commercialized by two unknown middle-aged men working at a nondescript gas-equipment company in New England. “In the Blood,” by Charles Barber, a writer in residence at Wesleyan University, tells the captivating, often cinematic story of how a medical innovation was improbably developed, fiercely resisted (by Dr. Holcomb, among others) and ultimately adopted.
“On a fall day in 1999,” Mr. Barber writes, in a style reminiscent of Richard Ford, “a man named Bart Gullong drove his ten-year-old brown Ford Thunderbird into the parking lot of Paradise Pizza in New Britain, Connecticut.” Looking at himself in the mirror, Mr. Gullong, once an elite rower, “did not particularly like the man he saw. For the last fifteen years, he’d felt bruised and battered, seething with unfulfilled promise.” He had decided to return to his home state, hoping that the “Land of Steady Habits” would help him re-establish his life. Increasingly desperate, he answered a newspaper ad placed by a businessman named Frank Hursey seeking a partner for a small oxygen-generator company.
Mr. Hursey, we learn, had grown up in an impoverished town in South Carolina. When his father died, he moved in with an uncle in Connecticut, finding work as an engineer’s assistant. After several failed attempts to start a business, he achieved a glimmer of success by developing an approach to purifying oxygen from air. A key ingredient in this process was zeolite, an “inexpensive and inert mineral,” Mr. Barber reports, “strip-mined by Union Carbide in the American South.” Mr. Hursey was “fascinated” by zeolite, which is composed of tiny caverns “in a series of endlessly repeating honeycomb patterns” that capture small molecules. Zeolite can help to separate nitrogen from oxygen since oxygen molecules pass through it more easily.
In 1983, as Mr. Hursey was thinking about those caverns, he found himself wondering if ground-up zeolite could treat an open wound by absorbing the liquid component of blood while leaving in place the components for clotting. After an encouraging experiment on a pet-store mouse, he collaborated with a local surgeon to conduct further studies on pigs. “The zeolite stopped the pigs’ bleeding every time, in a matter of seconds,” Mr. Barber writes. “It was miraculous.”
Mr. Hursey filed a patent and reached out to medical-product companies, receiving in response a single “withering sneer of a rejection letter,” in Mr. Barber’s words.
Disappointed but not dejected, Mr. Hursey threw his efforts into his oxygen-generator company, bringing Mr. Gullong on board. Slowly, business took off; following the events of 9/11 and a surge in military spending, the company won a contract to develop an oxygen machine for battlefield surgical centers. Then, in 2003, Messrs. Hursey and Gullong learned of a competition in which bleeding-control products would be evaluated. They ground up some zeolite, vacuum-sealed it with a food-storage device they picked up at Target, and sent it off to the competition. The product—which they called “QuikClot”—would outperform all comers, including the shrimp-based product that Dr. Holcomb and the Army had been developing.
Even with these results in hand, Messrs. Hursey and Gullong struggled for traction in the insular world of military contracting. They pitched QuikClot at an international military trade show, with little joy. “No, we don’t need that,” a Russian general explained. “We have enough soldiers.”
New challengers appeared—seducing many, including Dr. Holcomb. Following a 1999 report conveying the successful use of a high-tech hemophilia drug to control bleeding in a wounded soldier, Dr. Holcomb and the Army pivoted to this approach. But it was pricey. Worse still, Factor Seven (as the drug was called) promoted coagulation systematically, potentially causing blood clots in unwanted places. An ethically dubious influence campaign by the manufacturer probably contributed to the product’s rapid adoption as well. In the end, concerns raised by Factor Seven clinical trials—along with a whistleblower lawsuit that culminated in a settlement with the Justice Department—damped interest, enabling QuikClot, at last, to win the day. In 2008, Messrs. Hursey and Gullong’s product was recommended—by Dr. Holcomb—for all branches of the military.
The QuikClot story, so compellingly recounted by Mr. Barber, offers critical lessons about medical innovation: the importance of recognizing insights from nontraditional sources; the value of tinkering; the dismaying lengths to which incumbents often go to defend their turf; the fact that certitude, vital in some circumstances, can be detrimental in others. (A similar pattern can be seen in the determination of longitude in the 18th century, when a clockmaker figured it out ahead of resistant professional astronomers.) But the most powerful aspect of “In the Blood” is its deeply empathetic sketches of the key figures, typically men who grew up with limited resources, who endured hard times, and who somehow forged a life for themselves and persisted in the face of adversity.
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Related to @gorge post in a roundabout way.
Scientists are studying how to make freeze dried blood that could be used on the battlefield. Less volume, less weight, etc. One of their study areas is looking at tratigrades, which is kind of cool.
"Tardigrades are the only animal known to have survived in the vacuum of open space. They can survive temperatures of up to 304 degrees Fahrenheit, and can withstand being frozen for up to 30 years, as in one documented case.
They can also survive without water for up to a decade by shriveling up and placing themselves in something resembling a state of suspended animation—and it is that trait that has scientists at Harvard Medical School, the University of Washington and MIT interested."
https://www.news-medical.net/news/20200722/Working-Toward-Freeze-Drying-Synthetic-Platelets.aspx
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You can freeze blood. At least the red cells and the plasma separate. We could do it thirty years ago. problem is, the red cells are in a glycerin solution(IIRC) and it takes a specialized (and expensive) washing machine to get them ready to transfuse.