For the past few years, a cooperative venture by the military service medical logistics agencies located on Fort Detrick in Frederick, Md., have come together to generate synergies of operation and information. The agencies involved are the Defense Medical Standardization Board (DMSB), U.S. Army Medical Materiel Agency (USAMMA), the Naval Medical Logistics Command (NAVMEDLOGCOM), the Air Force Medical Evaluation Support Activity (AFMESA), the Air Force Medical Logistics Office (AFMLO), and the Federal Emergency Management Agency (FEMA) Hospital Type I Program Office. A physical result of this cooperative venture is a series of dates set aside for vendors of medical equipment and supplies to display their products to multiple service organizations at one time. This event is referred to as vendor day. The focus of these events is to assist the services’ medical logistics agencies with strategic market analysis of products and technologies that may be applicable to our austere medical environments. The organizers do not support brick and mortar facilities in the U.S., but rather medical units located on land and ships and in challenging environmental conditions. Support for the warfighter and their most immediate medical needs is tantamount. In 2008 there will be a total of four events. Two have already taken place—one back in March and more recently in May. Each vendor day is built around a theme or perhaps several themes. The March event highlighted en route trauma care including specialized MEDEVAC/ground evacuation medical devices, equipment and supplies. An event planned for September is being billed as distributor day allowing distributors to display no more than six of their top new products. The November vendor day covers medical-surgical consumable products. Military Medical Technology was at the May event, which featured first responder emergency trauma care, including initial assessment, medical devices, equipment, and supplies for the treatment of injuries and wounds on the battlefield, and offers this snapshot.

Triage Light

The Patient Triage/SO light is a thumb-size device developed seeking a better solution to identify and convey casualty priorities in the field. Each light contains three LEDs (red, green and blue) and two IR LEDs (steady and blinking) in a distinctively shaped shell with a forward notch to easily orient the light in the hand. A single switch operates the light on and off as well selection of the LED mode.
An opening allows the attachment of a cord or ring to attach to a casualty’s uniform while the different colors allow staff to identify needs based on color assignments. The colors can also be assigned differently depending on whether the use is in a combat or humanitarian situation—the colors, for example, could identify gender (red-men, green-women, blue-children).
The lights are waterproof to 66 feet and can come with a flexible cap that, depending on whether it is out on the front or back end of the body will cause the light to float light up or light down.
The company sees a variety of medical and SOF uses while all the while saving significantly over the cost of an equally number of chemical light sticks. Their estimate is that there will be an 87 to 94 percent savings over the use of one-time chem lights.

Single Use Intubation

Verathon Inc. was displaying their GlideScope Ranger single use video laryngoscope that provides a clear, real-time view of the airway and endotracheal tube placement, enabling quick intubation. The single use design eliminates the need for disinfecting the blade, is ideal for fast-paced intubation settings. The GlideScope Ranger single use design is based on the reusable video laryngoscope that achieves a Cormack-Lehane Grade I or Grade II view 99 percent of the time.
The device consists of a slim video baton which houses a high-resolution camera with a patented anti-fogging mechanism to resist lens contamination; a non-glare color monitor that is easily seen in bright light; and single-use, sterile GVL Stats in large and small sizes that offer a patented 60-degree blade angulation.
The Ranger can be operational in seconds, is compact for easy carrying and storage, measures 7 ¼ inches by 6 3/8 inches and weighs less than two pounds. With its rugged, high-impact construction, the device was designed to be dependable in an array of field conditions, including temperatures of -4 degrees to +122 degrees F, humidity up to 100 percent, and altitude up to 20,000 feet. The integrated, rechargeable lithium polymer battery provides minimum 90-minute continuous-use autonomy and allows for approximately 20 intubations per battery cycle (depending on usage).

Deployable Response Facility

North Coast Outfitters, showcased the Charlie’s Horse Deployment System, a complete, rapid-deployable medical emergency response facility (MERF). Some key foundational elements went into the development of this MERF including the need to be deployable worldwide within 24 hours and be able to be operational within one-hour of hitting the ground. It was also imperative that the entire system be fully independent for the first 72 hours. When responding to large humanitarian situations, material handling equipment is not always available or at least is in short supply. Counting on manpower alone, the entire system is locally transportable in multi-functional carts and low-friction transfer devices. The basic nature of the design means that it can be easily expanded to meet a larger need and can stay operational longer after its initial entry and setup.
The basic unit provides a 10-bed facility with equipment to manage medical scenarios from triage, treatment, a holding area, an ICU and an operating room.
While many of the components were specially designed by Charlie’s Horse, partnerships with leading suppliers, each a specialist in their field, provide much of the patient care devices. The partners include Aseptico, Carleton Life Support, DHS Systems, Global Hydration Treatment Systems, Impact Instrumentation, Lifesaving Systems, Mid-Atlantic Telerad, Oceanic Medical Products, Sonosite and Welch Allyn.

Decreasing Exposure

BD Medical has developed Nexiva, closed IV catheter system designed to reduce insertion attempts for first-stick success, as well as reduce the exposure to blood. This pre-assembled system creates a closed single lumen fluid path that reduces blood leakage from the catheter hub, and the potential for contamination.
For needle stick prevention as the needle is withdrawn, passive needle-shielding technology is engaged, which is designed to help reduce accidental injuries and ensure compliance without compromising insertion techniques. Once removed the pull handle and shielded needle tip are connected for safe disposal.
An all-in-one split-septum has two ports, this giving the capability for the simultaneous administration of fluids and medication as required. According to BD, a needleless access can reduce catheter-related blood stream infections between 64 and 70 percent over a mechanical value.
A soft, flexible stabilization platform is integrated within the catheter system designed to stabilize the device, prevent side-to-side rotation and provide a surface for tape application.
Nexis comes in 11 variations, coded by color. Each color represents a different gauge size ranging from 24 to 18. There are also varying catheter lengths within each gauge size.

Medical Distributor

Frederick, Maryland-based L1 Enterprises is a medical equipment and supplies veteran-owned small business representing a number of manufacturers to the military medical community. They had a number of products on their table representing a number of their clients.
Two products were from Medline—a surgical object detection system and a hand antiseptic. RF Surgical Systems Inc. has developed RF-Detect, a system that alerts the user when surgical disposables remain in the patient before closing procedures. The system consists of three components: a micro RF tag embedded in gauze, sponges and towels; a sterile handheld wand that is connected to the third component; and a self-calibrating consul. By passing the wand over the patient staff will be able to detect retained surgical disposables.
The second Medline offering by L1 was their Sterillium Comfort Gel which is a hand antiseptic that kills 99.999 percent of germs in 15 seconds without water. Ethyl alcohol is the active ingredient balanced with a blend of emollients that, according to the company, leverage the skin care technology of Nivea and Eucerin—a combination that “significantly” increases skin hydration.
CoFlax absorbent foam dressing was also on display. This multi-layer dressing consists of an absorbent foam layer, a waterproof film and the CoFlex LF2 layer that is designed to be an all-in-one cohesion bandage.

Home Oxygen

At a time when military and VA health care costs are rising, saving can be found in a variety of areas. Home oxygen support is one example and Invacare is providing options. Home care oxygen providers will also benefit from the virtual elimination of time-consuming and costly service calls associated with cylinder and/or liquid oxygen deliveries. Major product lines include the HomeFill and XPO2.
The HomeFill oxygen filling system allows patients to fill their own cylinders from a 5-liter and 10-liter concentrator. The 5-liter has an output of about three liters per minute while the 10-liter device has a 5-liter output capability of about five liters per minute. The available Patient Convenience Pack for the HomeFill uses the latest integrated pneumatic conserving technology while remaining lightweight. The convenience pack (available in M2, ML4, ML6 and M9) requires no batteries, no cumbersome connection tubes, and uses a standard single lumen cannula.
The XPO2 portable concentrator is the latest addition to Invacare’s line of home oxygen technologies. With five settings, the small portable device can provide pulse volumes as little as 15 ml and as much as 42 ml per pulse. The concentrator itself weighs about six pounds, or a total of about 7.1 pounds with the supplemental battery added. In addition to the battery, the device also runs on AC or DC power.

Tactical Medicine

Tactical Medical Solutions offers a variety of applications and devices with a heavy focus on combat medicine.
One example is the Blast bandage, designed to quickly package traumatic amputations, burns and large pattern wounds. The bandage provides a 20-inch by 20-inch treatment area, but packs to about the size of a 4-inch combat bandage. This large non-adherent wound pad can be wrapped around limbs and secured with the attached elastic wrap. It provides a large sterile protective covering for shrapnel wounds or burns. The Blast bandage is large enough to cover the entire back or chest of most casualties. It also offers a removable occlusive layer that will cover a 19-inch by 19-inch area or can be used to cover abdominal contents, minimizing the loss of heat and moisture.
A novel feature of this, and of their other bandages, are built-in brakes on the bandage to help prevent accidental unrolling of the entire elastic wrap during high stress application. These brakes are especially helpful during the dressing of amputations.
Securing a casualty’s airway is a critical task in any phase of medicine. The Serpent wrap is an ultra-compact, multi-use device used to secure ET tubes and numerous other items. Its design allows it to be easily passed under the patient even when wearing heavy-weight assault gloves.

Hemorrhage Control

Severe blood loss from a wound is a leading cause of death for soldiers and civilians alike. Some U.S. army estimates indicate that 20 percent of battlefield deaths could be avoided with the availability of an effective hemostatic product. On the civilian side as many 40 percent of deaths¹ from motor vehicle accidents, gun shot wounds, and other trauma could be prevented with the use of such a product.
WoundStat is a novel mineral-based high-pressure bleeding control formulation that is the first product marketed by TraumaCure—an early stage life science company.
WoundStat is a granular dressing that is applied directly into a severe wound. It is currently available in a 5.5 ounce sterile package
According to the company, the dressing meets sever criteria noted by the U.S. Army: Stops large vessel arterial bleeding within three minutes, even through a pool of blood, and often achieves this goal in two minutes; Ready to use—no mixing or special preparation; Simple to apply by the wounded individual, a buddy or a medic/EMT with minimal training; Lightweight and durable; Stable and functional at room temperature for at least two years and in extreme ambient temperatures for several weeks; Safe to use, posing no risk of either injury to the tissue or of transmitting human bloodborne pathogens; and affordable.

Defibrillation

As part of a larger service provide plan, Cintas has entered the small external defibrillator (AED) market with the ReviveR designed by Defibtech. Designed for use by lay responders, the AED has no lids, moving parts or cases—just two buttons with pre-connected pads. When the device is in use, a clear, calm voice and visual indicators prompt the user from start to finish, making the ReviveR simple to use. Continuous monitoring of the heart will detect if the patient’s heartbeat recovers, and the AED will cancel the shock.

Cintas is quick to point out that they are offering more than a capable AED but more importantly are offering a complete range of support services from a first site visit, training to a reliable monitoring and maintenance protocol. Their tracking system, is called FastTrack and updates and reports the number and location of AED units, the expiration of pads and batteries, training conducted or needed, and other factors that help ensure AED preparedness.
The ReviveR comes in two models, the DBP-2800 and the DBP-1400. The 2800 can provide an estimated 300 shocks or 16 hours of continuous use while the 1400 can provide an estimated 125 shocks or eight hours of continuous use.

Disinfectant

EnviroLabs, Las Vegas, Nev., was offering its Stera-Pure 24 as a broad spectrum antimicrobial, colorless, odorless and non-toxic disinfectant.
Stera-Pure is an EPA registered non-toxic, broad spectrum antimicrobial disinfectant with unique 24-hour residual effectiveness. Stera-Pure kills the most deadly of superbugs, yet also kills everyday household germs. Stera-Pure is manufactured from Silver Dihydrogen Citrate and citric acid, both of which occur naturally in the environment.
Unlike traditional antimicrobials, bacteria are attracted to SteraPure 24 because it recognizes the citric acid contained within as a food source. This Trojan Horse attack allows the disinfectant to enter the microorganism through member transport proteins. Once inside, the disinfectant binds to DNA and intracellular proteins causing irreversible damage and the organism dies. SteraPure 24 also acts on the organism’s outer membrane when the silver ions are attracted to sulfur-containing thiol groups.
The disinfectant works on non-porous hard surfaces and according to the company kills multiple staph strains in about two minutes. It also reportedly will kill standard bacteria in 30 seconds and fungal/virus organisms in 10-30 minutes.
In addition, the manufacturing process produces zero discharge with no waste or byproducts.
Military Medical Technology will continue this report in the next issue