At 35,000 feet — stacked underneath two other stretchers on a medical
evacuation flight to the States — Army Master Sgt. John P. Souza is recovering
from a blast wound suffered in Sadr City, Iraq.
On this Sunday in late June, the 52-year-old is also serving as patient No.
14 in an Air Force medical study exploring the use of the V.A.C. Freedom device
on medevac flights from Germany to the U.S.
In this flying military ambulance, in this Air Force C-17, Souza is one of
two patients hooked up to the device that eliminates the need for nurses to keep
repacking his open left leg wound with gauze during the roughly nine-hour
flight. The $25,000 machine also eliminates the painful removal of
soaked-through gauze from wounds once patients arrive at either Walter Reed Army
Medical Center or the National Naval Medical Center in Bethesda, Md.
"I gotta tell you the vac is just awesome," Souza said.
The small blue machine sucks fluid from the blast wound in Souza’s left leg.
Theoretically, it promotes healing, minimizes the risk of wound infection,
requires less maintenance by nurses and does away with the gauze changings.
Typically, open wounds require twice daily gauze changings. With the wound
vacuum system, a patient can go two to three days before having a special sponge
that was placed in the wound changed out.
Under the age-old gauze packing method, patients on medevac flights just
receive more gauze.
"Once you leave the hospital, all they do is add more dressings," said Air
Force (Dr.) Lt. Col. Raymond Fang, a trauma surgeon at Landstuhl Regional
Medical Center who is heading up the wound vac study. "So the stuff that’s in
the bottom of your wound stays there until you get to the next place."
Vacuum-assisted closure technology has been around for almost 20 years, but a
portable machine was not initially approved for flights.
The Air Force cleared the V.A.C. Freedom system for use on flights. However,
concerns over a jury-rigged wound vacuum system that had previously been used
with varying degrees of success on medevac flights during the early years of the
war prompted the formal study.
"Sometimes those wounds — at least (doctors) on the receiving end — they
thought they were much worse because of the attempts at the wound vac," Fang
said.
For the jury-rigged system, doctors and nurses would pack wounds with gauze,
put plastic over top of the wound, add a couple drain tubes and connect the
tubes to a suction machine. The home-rigged system didn’t have alarms, sensors
or meters. If it wasn’t working right, the wound could fill with fluid. Such a
warm, moist environment could increase the risk for infection.
With the V.A.C. Freedom device approved for use on Air Force flights,
Landstuhl doctors about a year ago wanted to start using the portable system on
eligible patients. Stateside military doctors were still unsure if the wound
vacuum system would be safe given their encounters with the jury-rigged systems.
"We said, why don’t we really see rather than people’s emotions or single
experiences dominating something that could help a lot of people," Fang said.
"Why don’t we see? We’ll do 30, see if it’s safe and see how much work it is for
the aircraft team."
The Air Force surgeon general’s office funded the study, and U.S. Air Forces
Central loaned the devices for the study, Fang said.
The study — which will include 30 patients — was set to get under way last
October, but in part because of improving conditions in Iraq, doctors are only
halfway through the study now.
So far, comments from the medevac crews on the use of the V.A.C. Freedom
system have been excellent, Fang said.
On a June 29 flight from Ramstein to Andrews, Air Force Maj. Bonnie Bosler, a
flight nurse with the 514th Aeromedical Evacuation Squadron, tended to wounded
Marine on a V.A.C. Freedom system.
"The system’s working great," she said. "This is three hours into the flight.
The dressing looks very good. I don’t have any issues with it leaking or having
seal issues."
Bosler’s recommendation is that sample V.A.C. Freedom systems be available on
the ground for practice so medevac nurses know how to operate it before getting
on a flight.
"I think it’s going to optimize patient care for the individuals that require
it," she said. "We’re only going to help them out."
