London researcher answers the call to service
For the past 10 years, Lawson Health Research Institute’s Dr. Raymond Kao has applied his medical expertise, both as an attending physician in the critical care unit at London Health Sciences Centre and on the battlefield.
A member of the Canadian Armed Forces since 1977, Dr. Kao has served in Bosnia, Africa and the Middle East. More recently, Dr. Kao served four tours in Afghanistan-Kandahar as an Internal Medicine and Critical Care physician and to Mazer-e-Sherif as an advisor to the Afghan 209th Army Medical Corp.
In recognition of his ongoing contributions to the military, Dr. Kao was awarded the first Canadian Chair in Military Critical Care Research this past January.
Canada has a strong tradition of sending medical personnel to war. Founded in 1904, the Canadian Army Medical Corps has played an essential role in keeping soldiers alive. During World War I, casualties among Canadian troops in France and Belgium were so heavy that more than half of all Canadian physicians served overseas to treat them. During the course of World War I and World War II many doctors and stretcher-bearers served close to the front, and the medical service suffered thousands of casualties during the war.
The process of blood transfusion was one of the most important developments in military medical service. By quickly replacing lost blood, transfusions helped prevent the wounded from going into shock and dying – if the soldier survived long enough to get back through the lines to proper medical care.
While military technology has advanced dramatically since the early years of war, this issue – getting back through the lines quickly to receive proper medical care and blood transfusions– is still one of the greatest challenges to face wounded soldiers today.
An innovation in care was needed to bridge the gap between the time of injury, and the point at which medical intervention could be given. Preserving injured tissue posed an incredible challenge, and this is exactly where Dr. Kao’s research comes in.
Dr. Kao found that when erythropoietin, a protein produced by the kidneys, is combined with saline, it can improve the flow of blood and oxygen to injured tissue – preserving it for longer periods of time and allowing the injured individual a better chance at reaching medical treatment, including transfusions.
“An evacuation takes time – usually 45 to 60 minutes to get soldiers out by helicopter or vehicles,” says Dr. Kao. “Erythropoietin can be easily given in the field through a syringe, and helps preserve tissues while injured personnel await transfer to definitive care.” The solution does require refrigeration, but this obstacle can be overcome in the field.
Having served in various military units as a medical officer since 1991, Dr. Kao’s dedication to his work on and off the battlefield is palpable. “What drives me is my passion for the military and my understanding of what our soldiers go through when they are wounded,” says Dr. Kao. “These young soldiers deserve everything we can do to bring them back alive, safe and in a state where they can return to their families and friends and live as normal of a life as they can.”
Dr. Kao says accepting the first Chair in Military Critical Care Research is humbling. The Chair is named after Group Captain G. Edward Hall. Although best known in the London area for his service as Western’s University’s Dean of Medicine and longest-serving president, another of Hall’s great contributions to Canada was as a military health researcher.
“If I can only strive to achieve a fraction of what Hall did during his career, I’ll be satisfied,” says Dr. Kao. Hall’s research into the development of oxygen equipment and protective clothing for pilots made such a huge contribution to the Canadian and Allied war effort, he was one of a very few non-aircrew officers to be awarded the Air Force Cross.
The Chair, provided by the Canadian Armed Forces, will help fund Dr. Kao’s ongoing research projects. Recently, Dr. Kao has been studying the use of C-peptide in shock and resuscitation. C-peptide is an insulin-connecting protein, which has anti-inflammatory and other protective effects on stressed organs.
“Early results have been promising,” says Dr. Kao. “We have found that it reduces both lung and gut injuries after hemorrhagic shock and fluid replacement.”
Dr. Kao says his Chair position will allow him to be more proactive and prepared for whenever and wherever the next conflict begins.
“The Research Chair makes me much more enthusiastic to do as much as I can for the research and clinical work on behalf of the men and women who serve in the armed forces…we cannot be slacking off. When the time comes, we have to be ready – not only military wise, but in support of our soldiers. Because what I have seen in Kandahar, I feel our soldiers deserve the best we can give them and that’s really the bottom line for me.”