Bleeding is the leading cause of preventable deaths on the battlefield. One of the major goals of the IRMM is to develop advanced technologies for bleeding control.

Our researchers are developing novel more efficient personalized limb tourniquet that adds an additional torque generating strap over and above the conventional combat tourniquet (CAT) currently in use.

We are also developing a novel tourniquet for difficult areas of anatomical transition such as the armpit and inguinal region. We have successfully tested this junctional tourniquet, which we term "Adonis," on a pig model of hemorrhage, and now we seek funding for advanced perfused human cadaver-based testing required by the FDA.

With the collaboration of partners from the medical device industry, we are also developing a next-generation personal hemostatic bandage equipped with self-contained low profile, low amplitude electrical current for early, low-cost, easily applied, prehospital control of hemorrhage in the field.

Advanced development and testing in animals of an individual automatic auto-injector syringe for on-site intramuscular injection (by the victim himself or first responder) of a new, advanced formulation of the synthetic anti-fibrinolytic (anti-clot-dissolving) agent, TXA (tranexamic acid) for acceleration of cessation of severe bleeding in field conditions. If successful, this auto-injector could revolutionize hemorrhage control not only on the battlefield but in civilian settings with a profound effect on survival.

As a spinoff of this approach, we also propose incorporating topical TXA as an improved version of the advanced personal hemostatic bandage being developed in our institute. In another configuration of this novel approach, we propose the development of a novel TXA-based local introducer to allow for direct application into penetrating wounds such as stab wounds. We plan to test the efficacy of the TXA impregnated personal bandage, and the local introducer, in the already established animal model in our institute. Successful results in these animal studies would provide essential evidentiary support for testing this novel approach in humans.

Hemorrhagic shock after major bleeding is often of insidious onset. Many overt hemodynamic changes appear only at late stages. Our collaborative efforts with several leading medical device manufacturers include the development of novel advanced technologies for non-invasive, tagged monitoring of vital physiological parameters in order to enable early detection of impending shock, better management of the wounded in the prehospital setting, and direct interface with hand-held smart-phone for online, immediate, in-the-field recording, storage, and transfer of vital diagnostic and treatment data.

The likelihood of survival from major hemorrhage depends, in large measure, on the length of time from injury to definitive surgical treatment. It is known that the first hour ("the golden hour") is the most critical for predicting outcome. In many cases, successful prolongation of compensatory responses to major hemorrhage for even 15 minutes can mean the difference between death and survival. This project therefore focuses on testing several advanced approaches for effect on survival during hemorrhagic shock. To this end we are currently assessing remote ischemic preconditioning as well as a variety of molecular and protein-based pharmacological agents on a swine model of hemorrhagic shock (further details on request).

Tablet-based Hololens Technology for guided field ultrasound diagnosis or surgical procedures for of critically wounded soldiers in the field with or without remotely positioned medical commanders can provide expert online procedural guidance.

This is a collaborative project instituted between the IRMM, the IDF Medical Corps, and the Italian Ministry of Defense for the development of advanced algorithms for predicting likelihood and duration of survival and outcome in acute hemorrhagic shock. In this project, we are collaborating with mathematicians from the Italian Ministry of Defense for development of algorithms based on "big data" collected from our studies at the IRMM in swine models.

PTSD can develop after any traumatic or stressful event such as (but not limited to) exposure to death or life-threatening experiences including combat with injury to the person himself or fellow-soldiers, actual or threatened sexual or non-sexual violence, or serious accidents. Our PTSD group includes the leading senior physician/scientist health care providers in the field from the civilian and military sectors of the Faculty of Medicine and the IDF Medical Corps.

Most people exhibit significant emotional distress following exposure to traumatic events; however, only a minority develop the persistent mental health disturbance diagnosed as PTSD. It is estimated that between 0.5% and 3% of all adults world-wide have PTSD in any given year. The prevalence of PTSD in operational units globally can be over 10%. Why some individuals suffer debilitating intrusive, psychopathologic responses, but others do not or recover quickly to virtually identical experiences, and why some patients with PTSD respond favorably to psychotherapy and/or medication, but others do not, remains unclear.

Together, this group treats over 1,000 post-trauma patients in any given year. These include approximately 300 active duty soldiers, 300 additional former combat soldiers in our IDF Mental Health Clinic, and an additional 400 civilians in our Hospital PTSD clinic. The IRMM, therefore, has access to the largest concentration of post-trauma patients in the country. The current project was designed to utilize advanced computational techniques of interrogation of "big data" sets in order to identify individual, patient-specific parameters (e.g. genetic, cognitive, epidemiological, biochemical, hematological, demographic, psychological, professional, and social) that might be associated with negative or positive responses to treatment thereby identifying predictors of resilience or chronicity. This will provide important additional information for how to modify treatment on an individual patient-specific basis and therefore improve outcomes.

Abdominal aortic aneurysm is the 13th leading cause of death in the western world. It occurs in 8% of Males over the age of 65, is 4 times more frequent in men, and is seven times more frequent in smokers with soldiers and army veterans being among the most common culprit population. We have reported that low level laser phototherapy prevents the de novo development and further progression of abdominal aortic aneurysm (AAA) in a mouse model.

We found that the cellular mechanism by which LLL prevents aneurysm development and progression is upregulation of extracellular matrix reinforcement of transmedial defects that occur in the vicinity of orifices of side branches of the abdominal aorta.

At the molecular level, we also found that LLL inhibits the decay of aortic smooth muscle cell mitochondrial membrane potential thereby preserving the energy sources of the cell required for repair of aortic wall damage.

We are now expanding these studies to determine whether the profound protective effect of LLL on mitochondrial function points to the possible molecular explanation for why AAA is less frequent in women and more frequent in smokers.

We are now applying these molecular insights to the development of novel LLL-based technological and pharmacological strategies for manipulation of mitochondrial function for which we need support. Application of this approach to the setting of stubbornly progressive, small aneurysms that are refractory to risk factor modification and conventional pharmacological therapy, may prevent the patient from reaching the stage of high risk obligatory surgery or complicated endovascular stenting for prevention of impending rupture.

As mentioned, the incidence of AAA is seven times greater among smokers of whom soldiers and army veterans are among the most frequent "offenders." Hence, development of a minimally invasive treatment approach based on these studies is of direct relevance to military medicine worldwide.

These studies involve testing the effect of low level laser (LLL) phototherapy, used widely empirically for reduction of pain in a variety of ambulatory situation, for reducing the intensity and duration of overuse injuries, as well as lower back pain in fighter pilots, and knee pain in combat soldiers during training. In addition, we intend to initiate a project testing the effect of LLL on burn victims the frequency of which is, unfortunately quite significant in the active combat setting.

Victim identification at poorly accessible sites remains to be a world-wide challenge. This project focuses on development of remote digital-based technology for victim identification and detection of vitality at sites of severely limited access such as an active combat zone, presence of chemical, biological, radiological, or nuclear (CBRN) contamination, or sites of severe natural disasters, without endangering the lives of victim identification personnel.

The remote digital victim identification (RDVI) system presented here involves the use of unmanned aerial vehicles (UAV). The principal components of the system include: personal encrypted electronic chips located on the victim, blue-tooth reader, central processing unit, high resolution imaging devices, communications modem for online transmission of encoded data and images regarding the victims and disaster site, and capabilities for landing and sampling of body tissue, earth, or other objects from the site. The relatively low-budget technology allows for real-time communication with a dedicated, central command platform that provides for continuous monitoring, analysis and mission management.

This system can also be configured to collect physiological data for determination of vitality that can be of critical importance to tactical commanders and first responders. The RDVI will also greatly increase preparedness of the responsible jurisdiction for victim identification in mass casualty events -- particularly when the number of fatalities exceeds the capabilities of investigators using conventional techniques. Finally, this system has the capability for transmitting immediate information regarding the identity, location, and basic physiological condition of combatants abducted from the battlefield thus providing information of major strategic national importance.