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.
Wound Debridement
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?
Algae.
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.
Suturing
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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These are good points which would be appropriate for anything from far future to near future and I appreciate the “historical” option
There are some other developments that might occur, based on current techniques and practices I would suggest:
(1) focused pain control: pain is/can be debilitating, a systemic painkiller is something like morphine or acetaminophen (paracetamol) but has the side effect of going through the whole body. On the other hand local anaesthetics work in a particular area and generally don’t affect other parts of the nervous system, allowing you to still move and even feel some things (like someone poking around in a wound!) but can be difficult to get into the part of the body affected whether injected or using a patch on the skin. There is a “middle ground” – regional analgesia or anaesthetics – these are also known as nerve blocks and can provide excellent or even complete pain relief by blocking the pain carrying nerves at some point between the injury and brain. The problem with nerve blocks is that the nerve centres are often buried quite deeply and so need finding with something like ultrasound or x-rays; a sci fi option might be to have a non-invasive external “stimulator” that can be applied – for example if you break your wrist you might put it on your upper arm or if you take a gut shot you might put it between the wound and head. My thought on how to do this would be to have a gel or quick-solidifying foam you spray where you need, a bit like a tourniquet, and then plug in a little device to control the effects.
(2) wound cleaning and antibiotics: we are seeing a rise in antibiotic resistance and with drug development taking *ages* novel ideas may see a breakthrough, things like antibiotic viruses are sort of a thing and an anti-virus virus might be another although one problem with these is that they often need to know what they are treating (not that that isn’t also true of more conventional antibiotics). Another thing to do is to try to avoid getting an infection in the first place, for wounds that might be using a rapid decontamination – again this is something used for quite a long time but could be improved – the problems generally being either bugs from you (eg normal skin bacteria getting into the wound and causing an infection in the place they aren’t normally supposed to be) or the environment (in other words, from dirt around you, not just on the sword or bullet but the general environment). Your skin is a huge part of your immune system, blocking things from getting into you and causing infection, so something that could be slapped on over a wound (laceration, abrasion or burn) that would act as a skin and also kill anything underneath it that doesn’t have your DNA would be ace. It might be that to activate the second part of the “synth-skin” you would need to get a DNA sample from something like a mouth swab (except your mouth is full of bacteria!) or a tiny skin prick and then “activate” it, a bit like the control for the pain control stuff.
I would not have the two systems in one, despite the apparent convenience, as one you want *on* the wound and one you want *upstream” of the wound (technical language would describe this as proximal).
DoI: qualified doctor for 15 years