Medical corps trains to save lives in future war with Hezbollah
At Galilee drill replicating conditions on the northern front, IDF physicians and paramedics introduce new techniques designed to reduce combat deaths
BY MITCH GINSBURG December 12, 2013,
IDF troops practicing the evacuation of a wounded soldier on a sling-like stretcher (photo credit: IDF Spokesperson's Unit)
On the morning after last week’s late-night killing of top-tier Hezbollah officer Hassan al-Laqis, the IDF’s medical corps, in a pre-planned drill, practiced for war with Hezbollah.
The drill, conducted under the watchful gaze of three members of the General Staff, is part of a strategic shift within the medical corps, which seeks to prevent the deaths of savable soldiers on the battlefield by bringing better technology closer to the scene of combat, thereby significantly cutting down the time between injury and treatment, according to the IDF’s Chief Medical Officer, Brig. Gen. Yitshak Kreiss, MD.
“We know that 90 percent of the dead who could have been saved on the battlefield died of blood loss within the first hour,” Kreiss told The Times of Israel. Therefore, he said, improving the level of trauma treatment all the way down the line, from GI to surgeon, and improving the medical corps’ tactical understanding of the new battlefield, is a crucial step toward drastically reducing combat fatalities.
In any future war with Hezbollah, Kreiss said, this entails figuring out how to evacuate wounded soldiers from densely foliaged regions, how to swiftly and safely raise a wounded soldier out of a subterranean space or tunnel, and how to maintain “a continuity of combat” in an urban setting while transporting a soldier to the rear for treatment.
Last week, Kreiss, along with several dozen physicians and paramedics called up for reserves for a command-wide drill, watched as paratroops practiced combat in each of those three arenas.
IDF medical corps commander Brig. Gen. Dr. Yitshak Kreiss (Photo credit: Flash 90)
Amid the brambles and terebinth trees of the Lower Galilee, which resembles south Lebanon, a squad of paratroops from the brigade’s recon unit moved in the sort of clustered formation that the landscape demands. Sticking close in order to maintain visibility, a mock burst of fire felled two of the soldiers. The squad, maintaining a balance that was often lacking during the Second Lebanon War, continued to engage the enemy while treating their comrades. When the fire died down, one of the soldiers took the seatbelt-like straps off the wounded soldiers’ weapons, slipped one beneath a wounded soldier’s shoulder blades and another beneath his bottom, and then, after briefly lying down face-up on top of him and clipping the rifle straps to his own gear, flipped onto his stomach and rose to his feet with the soldier strapped to his back. Moving quickly through the brambles, which are nearly impassable to a shoulder-held stretcher, he transported the soldier to a protected clearing for initial stabilization.
Col. Dr. Tarif Bader, the chief medical officer of the Northern Command, watched from nearby. During the Second Lebanon War he served as Golani’s 13th Battalion’s doctor. He said that since that last round of warfare with Hezbollah, the army has made improvements in combat medicine all the way down the line. Watching the infantrymen treat the wounded with the help of a paramedic, he displayed several palm-sized items, which have been given to the combat soldiers and their medics on the front lines. “The wisdom is in the miniaturization, in providing small, useful tools,” he said.
The first item he pulled out was a small black tourniquet. In the past, the army has used silicon tourniquets for all gushing wounds on extremities aside from the femoral artery, which, on account of its size, requires what the IDF once called, forbiddingly, a Russian Tourniquet. The drill, instilled in combat soldiers for generations, was to find a stick, wrap it in a gauze bandage and, once the bandage was applied, to turn the stick in order to increase the pressure until the blood had stopped. “It’s not practical in a combat situation to start searching around for a stick,” said Bader, displaying the alternative, a US-made Combat Application Tourniquet, which comes with a Velcro strap and a hard rubber-coated rod and has been used by all US combat personnel in recent years.
Additionally, he said, the old pad bandages, meant to apply pressure and absorb the blood flow from combat wounds, have been replaced by small, vacuum-packed hemostatic dressings. “These don’t just absorb, but also help blood clotting,” Bader said.
The next station was situated in a mock “nature reserve” – the IDF name for Hezbollah’s thickly wooded combat centers, which, in the vicinity of the poor, Shiite villages near the border with Israel, stand out against the largely bare hills, exposed for their firewood and marking a noticeable line in the landscape between Israel and Lebanon. The thick pockets of cultivated green, IDF troops learned during the Second Lebanon War, were off limits to Lebanese civilians and often served as Hezbollah strongholds. The guerrillas fired mortars and short-range rockets from within the foliaged canopy and entrenched themselves in concrete-enforced tunnels that kept them safe from artillery and airstrikes.
A shot from within the IDF’s ‘nature reserve,’ which mimics Hezbollah strongholds in south Lebanon (photo credit: Mitch Ginsburg/Times of Israel)
Retrieving a wounded soldier from inside those tunnels can be especially difficult. The doctors, congregated around one such tunnel in the Elyakim training grounds, watched as an officer wrapped a combat soldier in a short, rigid, flak-jacket-like harness that held the wounded soldier’s neck still and allowed four other soldiers, using an anchor and pulley, to raise the wounded soldier to the surface. An instructor, who noted that the pulley locks automatically if the soldiers have to run and take cover while in the middle of an evacuation, said that the system, the only one currently in use in the IDF, was one of the lessons of the battle of Maroun a-Ras, in which, on the first day of fighting, two Maglan soldiers were killed, in steep territory, by Hezbollah fighters who emerged from a subterranean chamber.
A soldier donning a harnass and stretcher built for evacuation from a subterranean space (Photo credit: Mitch Ginsburg/ Times of Israel)
Finally the doctors and paramedics moved to the most likely combat arena in any future war with Hezbollah — a mock city. The paratroopers worked in pairs, rifles stabbing the unseen spaces between the concrete buildings. As they ran, an IED exploded, wounding two of the soldiers. The rest continued to fire at the enemy and then dragged the mock wounded behind a wall and readied them for evacuation. Running with the soldiers on a newly introduced soft, foldable stretcher, which allows the soldiers to stay low and hold the wounded at knee level, they placed the wounded on either end of an ATV and ran back to the scene of combat. “The first responders in the field can save one-third of all injured if they act quickly and correctly,” said Major Saba Saba, the head of the Northern Command’s medical training department.
Soldiers that have been evacuated from the front lines arrive at what the IDF calls the Team of Ten. This is where soldiers are treated, stabilized and monitored by doctors and paramedics, and where, the IDF medical corps believes, small improvements can significantly lower the fatality rate.
One such measure, Bader said, is the introduction of freeze-dried plasma, a powdered 400 cc unit of blood that can be kept at room temperature, unlike the commonly administered plasma, which must be kept at negative 25 degrees Celsius and therefore can only be given in hospitals. Mixed with IV flood, the doses of freeze-dried plasma raise a patient’s intra-vascular volume and help stabilize trauma victims. Bader told The Times of Israel that the plasma has been successfully used dozens of times on Syrian wounded in the Golan Heights but not yet on an IDF soldier. “The IDF,” he added, “is the only army in the world to use it in the field.”
A unit of freeze-dried plasma, which is administered in the field (Photo credit: Mitch Ginsburg/ Times of Israel)
Additional technologies moved up to the battlefield include small coagulation-measuring devices, a far more effective, orally administered morphine substitute called fentanyl citrate, an oxygen saturation clip that slips onto a soldier’s finger, and a host of portable standard tools, including a defibrillator, a vital sign monitor and an automatic oxygen resuscitator.
The advance of these technologies to the front lines, coupled with a “better tactical understanding of the battlefield,” said Kreiss, the army’s top doctor, “will help us reach our goal of saving the savable wounded on the field of battle.”
They will not, however, alter the overriding mission, which is an awkward one for a physician. Enabling the fighting to continue, said Kreiss, “is our primary goal.” At the same time, he added, speaking of the wounded soldiers, “we have to aspire to save them.”
Bader, reflecting on the role of all medical personnel on the battlefield, said that there would always be tension between the desire to treat and evacuate the wounded as soon possible and the necessity of continuing to fight the enemy. “It’s a balance,” he said. “But first you push back the threat, then you treat.”