Off Label

Photo By Spc. John Stauffer | A patient with a gunshot wound came to the 126th Forward Resuscitative Surgical Team (FRST) for treatment during a deployment to Southwest Asia. The FRST used an off-label x-ray machine to determine where the bullet went in the body. This x-ray shows how a bullet is stuck in the left-side of the patient’s chest. This visual information allowed them to make a better decision about evacuation and treatment options.  

SYRIA

09.25.2019

Story by Spc. John Stauffer 

Combined Joint Task Force - Operation Inherent Resolve   

Spc. John Stauffer
25 September 2019
Off Label

SOUTHWEST ASIA – It is a device resembling the Ghostbusters’ proton pack, which you’ll never see inside of a hospital. It was designed for something else entirely – though not ghost hunting. However, it is a machine that medical staff in the field can use to save money, resources, time, and more importantly, lives. The only problem is, it’s not intended for use on humans. But when lives are on the line, medical teams can now go “off-label.”

“In the medical field, off-label means using something outside the scope of its primary use”, said U.S. Army Maj. Caitlin Howard, 126th Forward Resuscitative Surgical Team (FRST) doctor.

Howard’s unit, along with staff from all Forward Surgical Teams (FST) have various ultrasonography equipment available as their primary means of imaging. The equipment can be as small as a cell phone.

Though light-weight, portable, and effective it does not give the teams enough information to make better decisions, said Howard. What her unit really wanted was an x-ray machine. However, there was no such device immediately available to them during their deployment to an austere environment.

That was until someone had an idea, Howard said. A local non-medical team had a hand-held x-ray machine. Though not specifically designed for use on human beings, it can be used in that manner or off-label for such a purpose.

“It’s essentially the same x-ray we can use in the states,” said Howard. Additionally, the amount and type of radiation when used at the lowest settings is comparable to normal radiographs, said Howard.

“The big thing about using radiation is the cancer risk,” she said. Radiation exposure is cumulative, Howard continued. “There is always a risk when using it no matter what the application or from what device.”

Emergency medicine is a tough field. It’s even harder while deployed forward in an environment with minimal equipment. Using this off-label equipment brings benefits.

“The ability to assess someone and adding an additional piece to our decision making puzzle, outweighed the risks of radiation exposure. And so that is kind of where the whole off-label thing comes into use,” said Howard.

Normally, the tools available to stabilize and triage patients are what a person can carry by hand or by backpack. It can limit a medic or doctor’s options on the battlefield making decisions that can mean the difference between life and death.

This particular machine contains three pieces; a plate, the x-ray generator and a tablet to view the finished image. It weighs under 50 pounds and can fit into a backpack.

“The ability to use x-ray in the field has several benefits”, said Howard. “First, it streamlines patients’ care as it gives more information about the injury. Second, it saves valuable assets, such as helicopter evacuation, because it can more accurately determine the severity of the injury. Third and fourth, it saves time and money due to the better allocation of available resources.”

Howard gave a real-world example of a patient with a gunshot wound and collapsed lung, during her deployment.

“We didn’t know where the bullet had gone,” she said. If it had gone deeper into the body, the patient would have needed an evacuation to an operation room at a location…. There was simply no way to find out without the other team’s x-ray machine. “It turns out it was stuck on the left side of his chest,” said Howard.

Which was good news. The bullet had not gone further into the body and the patient did not need a helicopter evacuation, keeping the helicopter available for a more critical situation.

“We started talking about how we could utilize this equipment even more,” said Howard.

Another opportunity presented itself after an IED blast. It hit a partner nation soldier who had injuries to his lower body and ankle. The staff thought the ankle could have been fractured. After using the x-ray device, they saw that the ankle was, in fact, not fractured.

“Again, the radiographic evidence proved vital to preserving medical time and resources, allowing for effective non-surgical management of this trauma patient,” said Howard.

Howard and her team are proving that even if a tool is “off-label,” it can help save lives.

• Date Taken: 09.25.2019
• Date Posted: 10.15.2019 09:17
• Story ID: 347648
• Location: SY