11-mar-2019: INMAS develops 'Combat drugs' to reduce casualties in Pulwama type attacks, warfare

With 90% of gravely wounded security personnel succumbing to injuries within a few hours, DRDO’s medical laboratory has come up with a range of ‘combat casualty drugs’ that can extend the golden hour till the trooper is shifted to hospital. The spectrum includes bleeding wound sealants, super absorptive dressings, and glycerated saline, all of which can save lives in the event of warfare in a jungle and high altitude areas as well as in terror attacks.

According to the developers of the drugs at the Institute of Nuclear Medicine and Allied Sciences(INMAS), a laboratory of the Defence Research and Development Organisation, chances of survival and minimum disability are highest when effective first aid care is given within the golden hour.

Scientists at INMAS, entrusted with research and development in a number of areas concerning the defence sector, said the main battlefield emergencies are excess bleeding, sepsis, shock, hypovolemia (decreased blood volume) and pain. DRDO’s indigenously made medicines will be a boon for paramilitary and defence personnel during warfare. These medicines will ensure that our brave soldiers do not suffer from unwanted blood loss while being taken to better healthcare from war zones.

The challenges are many. There is only one medical person and limited equipment to take care of soldiers during combat in most cases. This is compounded by battlefield conditions such as forests, hilly terrain, and inaccessibility of vehicles.

Among the drugs developed is glycerated saline, a battlefield intravenous fluid that does not freeze till -18 degrees Celsius and is useful in handling trauma cases in high altitude areas. Glycerated saline, unlike normal saline, reduces inflammation. The drug can be life-saving, particularly if the traumatic edema(the collection of fluid in tissues and cavities of the body) is in the brain or lungs. Glycerated saline has life-saving capacities as it gives more time to the medical personnel to shift the wounded patient to a higher care facility.

INMAS has also developed a special medicated dressing material which is 200 times more absorptive than normal dressings during bleeding wounds. The cellulose fibre-based dressings are more effective in stopping bleeding and keeping the wound clean. Additionally, antiseptics, antibiotics and curcumin can be impregnated in the dressing which acts as a slow drug release system.

Normal cotton dressing used for bleeding wounds has sub optimal absorptive capacity and is soiled after sometime. In heavily bleeding wounds, putting a normal dressing can actually enhance the bleeding by sucking out the blood. It is safer and more effective to put in a long stuffed absorptive strip rather than individual gauge pieces. It has four-five times higher capacity to absorb blood.

Scientists have also developed a chitosan gel which helps in preventing blood loss by forming a film over the wound. Coupled with platelets and red blood cells aggregation, it stops the bleeding. Its antibacterial and wound healing properties are of added benefit.

Chitosan gel is suitable for sealing wounds by twin action: haemostasis by chemical action and filing action. It can be used for wounds on the limbs and also cavities such as abdomen and thorax. The gel is poured onto the wound and held with physical pressure for few minutes till the bleeding stops. It is topped by Chitosan wound cover. If the wound is deep, filters like silk and cellulose granules may be used after Chitosan gel.

The products developed for jungle warfare are at the stage of implementation. The Ministry of Home Affairs has recommended the cost-effective drugs to be inducted into their paramilitary forces while efforts are on with other forces for induction.

Hypochlorous acid (HOCL), a disinfectant for troopers involved in jungle warfare is also developed. It is helpful in treating necrotising fasciitis, a rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. In such cases, pure 0.01% HOCL which has broad-spectrum antimicrobial activity can rapidly neutralise bacterial toxins.

Jungle warfare wounds have significant infection risk. The standard approach is to treat them with antibiotics. However, overuse and misuse of antibiotics often leads to breeding resistant strains of superbugs. A safe and effective alternative method for managing infected wounds is by using a more non-traditional cleansing agent. While the use of HOCL does not obviate the need for antibiotic, it augments treatment and speed of wounds healing. Undesirable side effects and antibiotics resistance gets reduced.

INMAS scientists have also discovered a new route for administering the Nalbuphine injection to reduce pain during mutilating war injuries. The scientists have discovered that 10 mg injection of Nalbuphine hydrochloride is more effective for an injured trooper if it is given through the submental/sublingual route instead of intra-muscular or intravenous route.

13-Sep-2018: INMAS develops India’s first indigenous anti-nuclear medical kit.

Scientists claimed to have developed India’s first indigenous medical kit that may ensure protection from serious injuries and faster healing of wounds resulting from nuclear warfare or radioactive leakage. The kit, developed after two decades of work by the Institute of Nuclear Medicine and Allied Sciences (INMAS), has over 25 items, including radio-protectors that provide 80-90 per cent protection against radiation and nerve gas agents, bandages that absorb radiation as well as tablets and ointments.

Developed in India for the first time, it’s a potent alternative to similar kits that were till now being procured from strategically advanced nations such as the US and Russia at much higher prices.

The contents include an advanced form of Prussian blue tablets, highly effective in incorporating Radio Cesium (Cs-137) and Radio Thallium, among the most feared radioisotopes in nuclear bombs that destroy human body cells. The tablet provides 100 per cent absorption from the gut and other portals of entry to the human body.

The kit has been developed for the armed, paramilitary and police forces only as they are the first ones likely to get exposed to radiation -- be it during nuclear, chemical and biomedical (NCB) warfare or a rescue operation after a nuclear accident.

The kit also has an Ethylenediaminetetraacetic acid (EDTA) injection that traps uranium in the guts and blood of victims during a nuclear accident or warfare. The kit also has Ca-EDTA Respiratory Fluid, which is the inhalation formula for chelation, or grabbing, of heavy metals and radioactive elements deposited in lungs through inhalation at nuclear accident sites. When EDTA is injected into the veins, it “grabs” heavy metals and minerals and removes them from the body. The medicine reduces the body burden of radioactivity by 30-40 per cent in controlled conditions and is highly useful for the rescue teams and victims after a nuclear accident.

The kit has Radioactive Blood Mopping Dressing -- a special kind of bandage that absorbs radiation. During radioactive accidents, he explained, thousands of patients may be rushed to hospitals. In several cases, if not most, they will also have traumatic, orthopaedic, surgical injuries or burns. The blood of such patients will have radioactive elements and will require wound dressing with significantly higher absorption capacity so that nothing leaks and infects others. Such highly absorptive dressings and gauze also make it safer for the medical staff to handle radioactive patients as the chance of their own contamination is reduced.

The kit also has a radioactive urine/biofluid collector which is cost-effective, easy to store and can safely dispose of the urine of a person affected by radiation. Bhatnagar explained that the collector has silk at its base, more than enough to jellify 500 millilitre of urine, which could be disposed of safely.

The kit has anti-gamma ray skin ointment that protects and heals the radiation damage on the skin.

Also part of the kit is the amifostine injection, a US Food and Drug Administration (FDA) approved conventional radiopharmaceutical that limits damage from gamma radiation. However, due to a very small market, availability is a major issue.

Another medicine in the form of a tablet is Indranil 150 mg. It is being introduced as a reserve emergency drug for services, rescue workers and places where high acute exposures are expected and lives will be at stake. Preliminary tests have shown the efficacy of the therapeutic dose and the result shows 80-85 per cent animals may survive at 100 per cent lethal gamma radiation if given as a prophylactic.

According to INMAS, different paramilitary forces are processing Memorandums of Understanding (MoUs) with the Institute for seamless procurement of the product. In some ways, medical and health issues faced by the military and the paramilitary are quite different to that of the general public. The three areas of particular concern to the defence sector are high altitudes, war injuries and NBC warfare.

INMAS, the medical face of DRDO (Defence Research and Development Organisation) doubles up for the paramilitary also because there is no medical research in Bureau of Police R&D.