Operation Just Cause...                                                                                ...for as long as it takes
GAINESVILLE, Fla. -- When service members suffer battlefield
injuries, their survival may depend on receiving the right
treatment as quickly as possible.
Although the military services train and equip their medics to
handle any emergency, DoD continues seeking better treatment
methods. Medical research is key to improving health care and
behind a DoD decision to contribute $18 million toward the
University of Florida's state-of-the-art Brain Institute.
Opened in October 1998, the institute provides laboratories and
facilities for physicians and scientists to research new ways of
treating brain trauma and spinal cord injuries. The institute's
goal, according to Director William Luttge, is to help DoD, the
Department of Veterans Affairs and medicine in general by
transferring research findings to clinical practice as quickly
as possible.
Besides co-funding the building with VA and the university, DoD
has awarded large grants for research at the Brain Institute.
Luttge said DoD is primarily interested in the long-term effects
of brain trauma as well as of Parkinson's Disease.
For example, DoD awarded $291,580 to Dr. Camilynn Brannan for
her research in juvenile leukemia; Dr. Kenneth Heilman received
$538,812 to study cognitive changes in presymptomatic
Parkinson's disease; and James Simpkins, a pharmacist, received
$335,367 to research the effects of estrogen treatment on brain
injuries.
Each of the new people Luttge has hired to staff the facility
came with DoD research grants, he said. "We've gone out, we've
got DoD money, and we're doing things that are relevant to DoD,"
he said. What the institute provides them is laboratories
equipped as well or better than any other lab in the world, he
said.
In the surgical research and teaching laboratory, Dr. Richard
Fessler manages 16 individual stations, each comprising a full
surgical operating room setup. A part-time instructor at the
Uniformed Services University of the Health Sciences, Bethesda,
Md., Fessler said the laboratory is ideal for teaching new
surgical techniques to physicians who have been in the field and
want to update their skills. Closed-circuit TV monitors at each
station allow them to observe an actual operation and practice
the procedure on research cadavers. Each session is videotaped,
so they have a permanent record, he said.
One objective is to shorten surgical procedures and get people
out of the hospital and back on their feet sooner, he said. "For
example, the way I do lumbar discs now is an out-patient
procedure where the patient goes home in four hours and can
resume unrestricted activities in one to two weeks, as opposed
to six weeks in the past. There's cost cutting for
hospitalization, and the patient requires one-tenth as much pain
medicine.
"The difference is, we no longer have to dissect any muscle,"
Fessler said. "That's what hurts, it turns out."
Luttge said available courses will be announced at national
medical meetings and on the institute's Web site at
University of Florida Brain Institute.
Luttge also touted the institute's advanced magnetic resonance
imaging facility. Containing the largest magnets in the world,
the facility is staffed to help researchers invent better ways
of using clinical scale magnets and to show them what they can
expect in the future. "This is the future," he said, pointing to
the world's first wide-bore 12 and 17.6 Tesla magnetic resonance
imaging spectroscopy systems.
A Tesla is the international unit for measuring magnetic field
strength, Luttge explained. One Tesla is 20,000 times stronger
than Earth's magnetic field, "so you can get an idea how strong
these magnets are," he said. The instruments will enable
researchers to examine the functional processes within living
animals at a resolution far greater than they could with other
MRI systems.
In an adjacent laboratory, Dr. Sanford Meeks manages a linear
accelerator capable of producing high-energy X-rays that home in
on damaged tissues while not affecting healthy tissues. Called
radio surgery, the technique is used for cancerous diseases and
benign lesions in the brain. "We can get the accuracy down to
about two-tenths of a millimeter," Meeks said.
Not everything at the institute, however, is geared to high-
level research. Samsun Lampotang, a mechanical engineer, helped
develop a medical manikin that simulates a human patient.
Currently, Gainesville-area paramedics train on the simulator at
the institute every Friday, Lampotang said. They practice the
same emergency medical procedures combat medics at far-forward
locations need to know to save wounded combatants' lives. In
fact, he said, the Army has begun purchasing the $200,000
simulators from the Sarasota, Fla., manufacturer for medical
training at several locations, including Fort Detrick, Md., and
Fort Sam Houston, Texas.
Without the manikins for training and exercises, military medics
have to rely on volunteers, whom they "moulage," or apply with
makeup that resembles various wounds.
"Trouble is, you can't make their blood pressure drop or their
oxygen saturation drop, and you can't administer morphine and
other drugs to volunteers, because they're healthy people,"
Lampotang said. "You can do all these things with the human
patient simulator, which breathes, takes in drugs, simulates
paralysis and can even be given tracheotomies."
Under development is a complex structural model of the human
neck. Equipped with sensors, it will help medics learn to handle
compacted spinal injuries such as occur during diving accidents.
"In 25 percent of neck injuries, the trauma is aggravated by the
health care providers who worsen the patient by moving him,"
Lampotang said.
In the confusion and noise of battle or aboard a loud, vibrating
evacuation helicopter, medics may also mistakenly insert
breathing tubes, which can prove fatal. Better to "kill" the
simulator a few times than make mistakes on a live human, he
said. The simulator allows medics to understand the implications
of erring and motivates them to perfect their skills, he said.
Luttge foresees the institute becoming a resident and Internet-
based school of continuing education for military physicians and
others. "Like everyone in medicine, DoD needs improved
technologies," he said. "This place is capable of providing
that."