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Battlefield Resuscitation For Immediate Stabilization Of Combat Casualties (BRISCC)

The Battlefield Resuscitation for Immediate Stabilization of Combat Casualties (BRISCC) portfolio focuses on improving hemorrhage control, resuscitation following combat related injury, and the treatment of acute battlefield pain. Research ranges from basic discovery research all the way through clinical development. Portfolio staff concentrates on developing interventional strategies and countermeasures for areas of blood products, fluid resuscitation, mitigation of shock physiology, coagulopathy, pathophysiologic responses to traumatic hemorrhage, and the battlefield management of pain. The overall vision of the BRISCC portfolio is to provide safer, more effective, and more logistically supportable materiel solutions and products to mitigate the consequences of combat trauma injuries for our Warfighters. Pain, both acute and chronic, is recognized as a leading problem among US soldiers injured on active duty or during deployments. Pain is experienced throughout the continuum of trauma care and within all ranks of the military. Recent initiatives track pain scores from as early as time of admission to the Emergency Department (ED) at Level 2 and Level 3 facilities. Preliminary results indicate that, of soldiers admitted to Level 2 and Level 3 facilities, 71% experience pain of 5 or greater on a scale of 0 to 10. Accepted clinical guidelines classify pain of 5 or greater as severe pain and recommend treating pain rated as 4 or greater. Treatment of acute pain is particularly important because recent evidence suggests that uncontrolled acute pain leads to neuronal remodeling and increased incidence of chronic pain.

Recent efforts in blood products research have centered on finding suitable replacement compounds for use in blood component therapy. That is, when fresh whole blood is not available, various components of blood (plasma, platelets, red blood cells, etc.) are administered. Various methods to prepare such components including drying and freezing components are being investigated. However, a requirement to identify and treat the underlying causes of the lack of effective coagulation in severely injured patients has become apparent. Current efforts to address the "coagulopathy of trauma" are largely focused on attempting to improve outcomes using treatment regimens that incorporate available products in different ways, for example, more aggressive use of plasma transfusion, earlier correction of pH, etc. These efforts provide incremental advances in care but are necessarily limited by the existing products and knowledge. Major advances in patient care will require new products and knowledge. Development of new diagnostics, therapeutic targets and drug candidates requires a more in-depth knowledge of underlying mechanisms. This work is closely coordinated with the studies undertaken in the Damage Control Resuscitation area.

The main goals of this portfolio include:

  • Providing improved methods and devices to stop bleeding and restore blood loss to the warfighter
  • Providing new therapeutics to mitigate the consequences of hemorrhage and shock physiology
  • Providing safe and effective acute pain management starting at point of injury