About 10 years ago, Dr. Swaminatha Mahadevan was conducting research at a Nepalese hospital, when he witnessed something that would never happen back at home in California.
An older man had been in a road accident and was thrown from a car. He was lying on a hospital gurney. He was bleeding to death. "But no one was doing anything about it," says Mahadevan, an emergency medicine professor at Stanford University. "In the states, this man would have had a whole team of doctors leaning over him."
But in Nepal, there was no one. The hospital didn't have the staff or resources to save the man's life.
Mahadevan jumped into action, tying a sheet around the man's wounds to slow the bleeding. "I don't know if he survived," Mahadevan says. But the incident helped him realize something: Most poor countries just aren't equipped to deal with such emergencies. And yet, violence and injuries cause more deaths each year worldwide than HIV, tuberculosis and malaria combined.
Now researchers in London think tools developed for battlefield hospitals in Iraq and Afghanistan can help fill in this gap. They want to adapt wartime medical techniques to help civilians in poor countries, which often have high rates of traffic accidents, building collapses, fires and gun violence.
With new technologies and some innovative tricks, army medics have gotten really good at treating injured troops. Battlefield casualties have fallen sharply, says Richard Sullivan, an epidemiologist at King's College London. "It's one positive thing that has come out of these conflicts," he says.
Sullivan and his colleagues published a study last month in the Journal of the Royal Society of Medicine exploring advancements in battlefield medicine, along with recommendations on how to use them in low- and middle-income countries.
In many cases, the key to saving someone — whether they've been injured in a war zone or a traffic accident — is to keep them from bleeding to death before they get to a hospital, the team wrote.
Military medics often rely on haemostatic powders (like this one), which were developed during the course of the Iraq and Afghanistan wars, Sullivan says. These low-cost powders can be poured directly onto open wounds to stop bleeding.
"You have to have no experience at all to use this," Sullivan says. "And it's low cost."
For more severe injuries, another wartime staple might come handy: tourniquets.
Modern tourniquets can stop bleeding if someone loses an arm or a leg. They look a bit like a blood pressure band, and can be applied with one hand, Sullivan says.
"They're absolutely fantastic for controlling bleeding," he says. They cost less than 50 cents to manufacture.
Of course, if you can't get to a hospital in time, it won't matter if a doctor has a tourniquet there.
In many parts of the developing world, the nearest hospital may be hours away. So Sullivan says, "Why not train community members, bus drivers and police in basic first aid?" Then they can help stabilize the injured person until they reach a hospital.
Equipping drivers and police with two-way radios so they can quickly alert the nearest hospitals when an accident occurs would also help, he adds.
The second step, Sullivan says, is to teach doctors who deal with emergencies and accidents about the latest techniques in battlefield medicine.
During long, bumpy trips to the nearest clinic, injured soldiers are often given needles that go into their bones instead of regular IVs. "When somebody is bouncing around at the back of a helicopter, it's virtually impossible to put a needle into a vein," Sullivan says. The same goes for patients who are traveling to hospitals on bumpy, unpaved roads, in the back of trucks and buses.
A needle in the bone will hold up better and help deliver vital fluids to patients who are suffering from major trauma, Sullivan says.
Most first responders in poor countries don't think to use this technique, but they could easily learn, he says. "It's not a complicated thing."
The researchers' final recommendation is for communities to build small, mobile hospitals — similar to those developed during the First Gulf War.
During the war, the military experimented with stationing smaller medical clinics closer to the frontline. Injured soldiers didn't have to travel as far to get treatment. As a result, death rates dropped dramatically.
In poor countries, Sullivan says, small health clinics strategically placed near major roadways would ensure that patients get help quickly, before it's too late.
These small health clinics could give first-line treatment to the severely injured, Sullivan says. Patients who need more help, or complicated surgeries, could then be transferred to larger hospitals with more resources.
"Some middle-income countries are already starting to try this," Sullivan says. In India, some cities are starting to put fully equipped ambulances at busy intersections — ready to pick up and treat patients at a moment's notice.
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