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From Star Trek to Iraq: McCoy’s Sickbay in the Real World

Apart from being the most successful franchise in television history, Star Trek – from “The Original Series” through its most recent outing, “Enterprise” – fired the imaginations of astronauts, scientists, inventors and those who just had a desire to see its advanced technologies become reality.

Perhaps surprisingly, that is occurring far more quickly than Gene Roddenberry and his successors anticipated. The perennial flip-phone bears a striking resemblance to Captain Kirk’s hand-held communicator, for instance, and the Internet is humanity’s first attempt at a Memory Alpha. But some of the most interesting evolutions from science fiction to fact are occurring in medicine.

The senior medical officers of today believe a simple version of Dr. “Bones” McCoy’s medical tricorder will be fielded with the US armed forces. Not “at some time in the future”. Not in a couple of decades. But very soon. Perhaps before the end of this decade.

in fact, the US Army is already beginning to try ou the first elements of its new Land Warrior battle ensemble, which will upgrade a battlefield soldier from being a cog in the combat wheel to a central and primary part of a new system-of-systems approach. The success of this effort up till now is important to medicine since the on-going research and development (R&D) side of this continuous process – Future Force Warrior (FFW) – is analyzing some important advances not only in protecting soldiers from injury, but in caring for them should they be wounded.

US military injuries in Afghanistan and Iraq already hold the record for the least number of “killed in action” (those who die in combat before they can be treated) of any war in the history of warfare. That is primarily down to two factors: Advanced body armor that has nearly eliminated head and torso wounds and far better medical intervention in the field. That ranges from medics (and Navy corpsmen) who are trained to a higher degree and are better equipped than their predecessors, to surgeons who were put on the front-lines during the primary phase of combat.

Therefore, the so-called “golden hour” has turned into what one Army surgeon calls the “platinum 10 minutes” – the amount of time from the moment a soldier becomes a casualty until he (or she) receives life-saving medical care.

Continuing breakthroughs are aimed at extending the armor to protect arms and legs – the primary locations for wounds, mostly from explosions and fragmentation, among US military personnel today. Ultimately, should the final kinks be ironed out, would be the Future Force Warrior prototype, which almost everyone compares with the full-body armor worn by the imperial troops in Star Wars.

But much closer to reality are other Future Force Warrior components that could very well become part of standard military gear in the coming years. These include systems that constantly monitor a soldier’s vital signs, fluid intake, even sleep, passing that information there-and-then (and wirelessly) to any medic. It may even send out a radio call to the closest medic should those vital signs show that a soldier has been injured.

Not a hand-held tricorder, but getting there.

Military personnel also will wear electronic dog tags containing their entire medical histories (updated regularly), making it possible to tailor any medical care, taking account of allergies, how different drugs interact or other medical conditions or recent treatments. That could include updates at each stage of care along the evacuation line from the point of a combat injury all the way back to a hospital in the US.

Every soldier, airman, sailor and Marine also will be provided with a personal first aid kit that contains, among other items, a single-handed tourniquet and special blood-clotting bandages to stop bleeding (rapid blood loss remains the primary why soldiers die on the battlefield). Each also will be trained in advanced first aid – and one in six (at least) will be trained as a Combat Life Saver (CLS). While rated as non-medical, the CLS will provide assistance, as needed, to regular medics, as well as adding a new layer of on-site support to his or her fellow war fighters.

Corpsmen and medics also are undergoing significant upgrades in both equipment and training. With the addition of a constant stream – and history – of data from every soldier and the capability to “reach back”, with both audio and video, to better medical resources, from the Forward Surgical Team operating close to front-line gunfire to top-notch specialists in the US, the Future Warrior Medic will be able to give an unprecedented level of medical care within minutes of a combat casualty happening.

Some of these elements already are in place in Southwest Asia; most will be used within a few months. Others coming along include:

A testing kit using biomarkers to determine the presence and severity of brain injuries

Automatic controls built into ventilators, that allows medics to deliver a level of resuscitation currently only available from intensive-care nurses

Hand-held ultrasounds that can pinpoint internal injuries

A digital handbook of diagnostic and treatment protocols medics can carry into combat

Small oxygen generators that can turn ordinary air into medical-grade oxygen

The ability to identify and diagose ten biological weapons including smallpox, anthrax and the plague

Ways to provide replacement blood without the need for whole blood bags that must be refrigerated

An advanced, self-contained training simulator for medics (not a holodeck, but also getting there)

While such breakthroughs are aimed at providing fast, competent medical care to soldiers, they will also become an integral part of the medical field capability the US Armed Forces will be able to give to civilians and enemy combatants.

Prior to the current conflict, there was no provision for US military medicine to care for the elderly, children or illnesses and diseases not found among the young, physically fit members of the armed forces. Today – and to an even larger extent in the future – such care is part of the training and equipment the Air Force, Army and Navy will take to war and to disaster relief and humanitarian missions, too.

Before some in uniform today retire, future military and civilian research and development may even go beyond what Star Trek doctors could do. The Surgeon General of the Army, Lt. Gen. Kevin C. Kiley, has written that he believes one of the “most exciting possibilities in modern medicine” to be the ability to repair or re-grow lost or damaged tissues and limbs. “Regenerative medicine”, Kiley says, is the subject of encouraging research that he feels “has implications for military medicine in the near future”.

Dr. Leonard McCoy’s sickbay on the Enterprise was set in the 23rd Century, some 200 years into our future. It may well be, though, that “Bones” would find himself old-fashioned and outdated in the midst of 21st Century combat medicine. We can only dream of the advances to come in the next 50-100 years, let alone the next 200!