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MILITARY
MEDICINE
U.S. Army Institute of Surgical Research
By Lt. Col. (Dr.) Erik K. Weitzel, USAF
Deputy Director, U.S. Army Institute of Surgical Research
The U.S. Army Institute of Surgical Research (ISR) is proudly
recognized as the premier military medical research institution in
the world. Currently at 74 years old, this institution located at Joint
Base San Antonio-Fort Sam Houston, has led the field of burn re-
search for decades and has contributed greatly to the fund of knowl-
edge for all aspects of combat casualty care. From the point of injury
to comprehensive rehabilitation, the ISR researches innovative so-
lutions to every facet of the Wounded Warrior’s completed recovery.
The mission of the Institute is to “Optimize Combat Casualty
Care.” In order to accomplish this, 10 independent scientific task
areas split the complexities of battle injury, from Damage Control
Resuscitation and Tactical Combat Casualty Care to Pain Manage-
ment and Regenerative Medicine.
To highlight some of the spectacular and wide-ranging projects
occurring within the ISR, I sat down with a few of the Task Area
Managers to discuss their research. Jose Salinas, Ph.D., Task Area
Manager for the Clinical Decision Support and Automation Re-
search Branch, runs a lab whose purpose includes development of
algorithms and systems to support real-time decision making for
combat medics during battle and assist with defining the best treat-
ment and triage of Wounded Warriors. A recently released public
video from this lab shows a simulated battle scenario that evokes
scenes from the movie, “The Minority Report.” Medics wear spe-
cially manufactured mixed reality glasses that overlay heads up
translucent windows containing patient status, vital signs, and
records while the patient is undergoing treatment. Consultants from
thousands of miles away quickly pop in and out to add in their as-
sessments and guide the medics through best practice treatments.
In this way, the wounded soldier can receive the best possible care
by experts in the field within seconds of injury. The equipment, cur-
rently on display in Dr. Salinas’ lab, represents an awe-inspiring leap
into the future of battlefield medicine.
Exploring another aspect of the ISR’s broad-ranging mission, I
spoke with Task Area Manager Col. Elizabeth Mann-Salinas, RN
Ph.D. One of her current research focus items includes something
that is quite dear to physicians who perform procedures. She is
studying competency of the support team with regards to combat
readiness. Specifically, she is developing a series of core competencies pose, allowing them to put aside their egos and become great col-
for nurses who support interventional procedures and mapping out
40 San Antonio Medicine • August 2017
how different tasks they perform contribute to their readiness to
support the task at hand. This program, entitled “Transition in Prac-
tice Towards Optimal Performance” is defining how many hours
each nurse must be supervised prior to becoming independent. She
can also track whether student nurses are missing expected mile-
stones and should be diverted to other career fields. We all know
that the medical team is only as strong as its weakest link. A nurse
who isn’t up to speed or who has not been trained to support the
task at hand is a major liability for the patient’s outcome. Col.
Mann-Salinas’ goal is to make sure each patient has a solid chain of
qualified individuals supporting their acute interventions.
Finally, I spoke with the outgoing Deputy Commander of the
ISR and Director of the RESTOR regenerative medicine program,
Lt. Col. (Dr.) Michael Davis. Lt. Col. Davis is internationally rec-
ognized for his work in reconstructive transplantation. He has de-
veloped novel immunomodulatory strategies to reduce and even
possibly obviate the need for systemic immunosuppression when
transplanting arms and faces. These treatments, once refined could
allow severely injured service members to be made whole again
through transplantation following devastating injury. Arm amputa-
tions remain a significant surgical challenge due to the immense
amount of sensory input they require for appropriate function. Un-
like the leg, which tends to be rehabilitated quite well with pros-
thetics, the best option for functional rehabilitation of arm
amputations is an allograft transplant. The problem here is that in
order to prevent donor rejection, toxic chemicals must be adminis-
tered to the amputee to support the transplanted limb, placing the
patient’s overall health at risk. Lt. Col. Davis reports that RESTOR
researchers have recently identified a new technique for delivering
localized immune modulation to overcome the need for systemic
immunosuppression thereby eliminating one of the major hurdles
for successful limb transplant.
In reporting on just three of the myriad projects occurring at the
USAISR, I have become amazed at how impressive a research engine
we have in San Antonio. Surprisingly, the researchers themselves are
incredibly humble. Ubiquitously, they point to their mission as their
strength. They coalesce around the Wounded Warrior as their pur-
laborators for improving Combat Casualty Care.