This article on futuristic wound care is part of the Science in Sci-fi, Fact in Fantasy blog series. Each week, we tackle one of the scientific or technological concepts pervasive in sci-fi (space travel, genetic engineering, artificial intelligence, etc.) with input from an expert. Please join the mailing list to be notified every time new content is posted.
The Expert: Rachel Berros
Rachel Berros is an emergency physician assistant who works closely with a virtual visit development team for her healthcare organization. During her spare time she writes speculative fiction that mixes the laws of science with magic, or just skirt the edge of possibility. You can check out her website, or follow her on Twitter for more information. She’d love to connect.
The Past and Future of Wound Care
Wounds, like mouths, are often best when closed.
The medical community is constantly updating and improving. As an emergency medicine physician assistant, I have access to a few new innovations that are starting to make appearances in hospitals and ambulances near you. I’d like to share those with you today.
Quick Clotting Materials
These items were first designed and used by the military. The Army’s (and other branches, I assume) on-field medics still use versions of these to save lives previously lost due to hemorrhage. More and more EMS and wilderness medicine, in addition to pro-sports and event organizers are also using them. The products contain an engineered mineral or compound that reacts with blood to speed up or simulate the clotting process. Within seconds, a true or gel-like clot is formed that will slow or stop bleeding even with arterial wounds. They are shelf-stable and non-allergenic. And, they come in all sorts of forms.
The most commonly available product is powder packets. Simply tear it open, sprinkle on the wound, and apply pressure until the bleeding stops. There are also gauze pads and gauze rolls impregnated with the compounds for wider or deeper wounds, as well as gels or granules that are injectable for puncture wounds (gun or sword).
Once the patients arrive at a medical facility the providers will need to clean the material from the wound prior to any definitive treatment. This usually restarts the bleeding but allows the providers to choose which wounds to address first instead of all of them at once.
Battlefield trauma kills many soldiers, but before antibiotics were widely available, wound infections killed many more. Therefore, while the fairly new clotting materials above are fantastic for us and your SciFi characters, a similarly packaged, older, option might work better for fantasy or “crashed on a non-advanced planet” kind of tale. This material is in gel form, impregnated in gauze, turned into fibers and spun into gauze tubes, and extremely cheap. It consumes dead tissue and thus keeps wound margins raw and able to heal (it debrides the wound, so it doesn’t heal as a gaping divot in the body but rather closes slowly for a more natural appearance) while reducing risk of infection and absorbing any exudate (liquids produced by the wound). It’s Marvelous. Know what it is?
Yup, that little, fast growing water lifeform works wonders. The only problem is that while it gobbles up dead skin cells, it too dies a quick death. And if you’ve ever walked beside a river, lake, or ocean and found algae-filled pools on the edge, you know how foul it can smell. So, in practices still using these products (mostly third-world or relief situations due to its low expense and low risk should the patient never return for additional care, I used them in free wound clinics in Ecuador) the material is applied, bandaged, removed, washed out 3-7 days later, and then reapplied until the wound is healed.
We’ve all seen sutures. Some of you have seen tissue adhesive (like super glue), steri-strips (butterfly bandages), and staples (exactly what they sound like). However, many might not have yet seen the newer combinations of those options. The newest technology we’re using in my hospital is a zip-tie style device. It has a sticky base that adheres to the skin on either side of the wound and contains, essentially, zip ties.
Like the plastic doohickeys used for controlling rogue wires in the office, these have a pull end and a lock. You simply stabilize the wound with one hand, then gently pull the tie end through the lock until the wound is well approximated (closed neatly). The skin adhesive eventually unsticks in about 4-7 days (or can be gently encouraged off if needed) when the wound is closed. It’s a wonderful, minimally painful, and less invasive option for wound care. Though please realize they’re appropriate only for certain, not all, wounds.
*Researchers are currently improving on this technology to provide post-operative and secondary (not on day of injury, usually due to infection) wound closures where skin grafts would likely otherwise be required. By gradually tightening the ties and thus gently stretching the skin, this new experimental version allows the body to heal itself without further intervention—like skin grafting.
CPR- A side note because it’s cool!
There are devices out there that you strap to a person’s body to do the compressions, freeing your hands to call for help, administer medications, or perform respirations. They have overall had good success and are transforming long transport codes (those situations which require CPR for long periods of time, as in transit from a mountain trail). Some versions have been around for a while but they’re improving and could be quite handy aboard a spaceship.
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