Recent conflicts, most notably those in Iraq and Afghanistan, have made it clear that the nature of warfare has changed dramatically from that of prior centuries. Unconventional urban warfare, rather than that on the battlefield, would appear to be the new norm. As seen in Operation Iraqi Freedom, blast injuries from such sources as improvised explosive devices (IEDs) have greatly elevated the frequency and severity of blast-induced trauma, especially traumatic brain injury (TBI). While the modern lifesaving advances in military medicine are impressive and amazing in their success rate in reducing deaths, the surviving soldiers are now returning with serious long-term injuries that stress the military medical system with unforeseen severity. This then creates a new collection of challenges for care of the wounded warfighter. Thus in this context, if our proposed treatment with estrogen can ameliorate or assist in recovery of some of the debilitating consequences of TBI, the patient and their medical care providers, as well as the patient's family and community support network, all will benefit.

From a scientific perspective, estrogen has the capacity to protect from loss of blood, poor blood flow to the brain and other vital organs, to maintain energy supplies needed for recovery, and reduce the death of brain cells and tissues from traumatic injury. We have recently completed a successful study sponsored by DARPA for the application of estrogen treatment to severe blood loss for use under combat conditions. Our treatment would be compact and lightweight, requiring no fluid resuscitation, and thus applicable in the far-forward battlefield setting. It would be deliverable by medics, prior to the evacuation of the wounded soldier to a field hospital. If successful, our treatment could offer a new tool to extend the "golden hour," and thus increase the prospects for recovery.