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Black Hawk Down

Endeavour

The Arizona Republic

A child of Holocaust survivors from Poland who grew up in New York, Bernard Bar-Natan made aliya in 1979. He had a variety of jobs – sold jewelry, worked as a freelance photographer, ran a photography store in Jerusalem’s Plaza Hotel, joined the Tourist Police in the Old City – while also doing immigrants’ “Phase Two” IDF service and subsequent reserve duty.He didn’t have any medical background, but two days before the end of his IDF basic training in 1984, the recruits were offered the opportunity to become combat medics, and Bar-Natan thought to himself, why not? It was to prove a propitious decision.When he was drafted, he had noticed that the “personal bandage” he, like all other recruits, was given – a rudimentary field dressing in a small, rectangular green wrapping – happened to be dated 1942.“1942,” he mused. “Astonishing. Planes have obviously evolved since 1942. Tanks certainly aren’t the same. And yet here I am getting the very same bandage they were giving out over half a century ago. Surely, we should be able to make a more effective bandage to stop hemorrhaging in the field by now.”The seed was planted.It grew, slowly, through his medic’s training. When he and his colleagues were taught how to bandage a wound in the field that wasn’t clotting quickly, they were told to grab a stone and place it over the bleeding to add pressure to staunch the blood flow. And they were shown how to use additional bandages to create extra pressure. Somewhere, at the back of his mind, Bar- Natan knew there had to be a more efficient and effective way of doing all that.The idea continued to germinate through his subsequent years of reserve duty, even as he gathered an expanding collection of geriatric IDF personal bandages – those bizarrely unchanging fixtures in a relentlessly modernizing army. “The 1942 one wasn’t even the oldest,” he laughs now. “I once got issued with one dated 1938.”Many of us have occasional flashes of radical creativity. Few of us follow up on them. Fewer still bring them to fruition with dramatically successful results. Bernard Bar-Natan is one of those fewer than few.Through the late 1980s and into the early 1990s, iterations of his better bandage sat on the kitchen table at home. “I would leave it for a while,” he recalls. “And then I’d come back to it again.” And again. And again.He tinkered with various fabrics and various weaves, turning to a tailor on King George Street to produce his evolving designs. He experimented with different “pressure bar” devices for boosting the amount of pressure that could be applied to a wound – devices, unlike the “grab a stone” approach, that were built into the bandage itself. He worked on ways to tighten the bandage – finalizing a “reverse wrap” technique – that would, again, bolster pressure on a wound but would not create a tourniquet effect. He fiddled with all kinds of clips that would swiftly and conveniently fasten-off the bandage.“I didn’t invent any wheels,” says Bar-Natan modestly. No, but he did drag bandages out of the 1940s into the modern era. And in doing so, he’s helping keep people alive all over the world.FOR ALL his varied employment history, Bar-Natan, who is married to a Sabra and has two children, had never run a business. He had an invention in which he believed, but no idea whatsoever of how to bring it to market. Which is where, along with his father, who helped with some initial funding, Israel, in a number of admirable guises, came to his aid.First, in 1990-91, he was accepted into Iscar boss Stef Wertheimer’s Tefen entrepreneurial program – on the strength of the evolving bandage. Then, an application to the Office of the Chief Scientist in the Ministry of Industry, a hierarchy established precisely to encourage Israeli innovation, secured him a place in a technology incubator program in Jerusalem’s Har Hotzvim.With the state providing some three-quarters of his funding, Bar-Natan was free to concentrate for three years on perfecting his product. He successfully filed his first patent request, confirming that he was breaking ground. He managed to attract outside investors. He set up a business, geared up to start making the product at a factory up north, and then attempted to sell it.“From 1995, I started traveling to medical exhibitions overseas, and went to meet with various representatives of NATO armies,” he recalls.It was, at the risk of understatement, a tough sell. Bar- Natan had an unproven product and no business track record. But, as the relentless process of turning his idea into something of real value had demonstrated, he certainly didn’t lack for persistence. And eventually it paid off.His first sale came in 1998, via a Belgian medical equipment distributor he had met at one of those exhibitions. The bandages were issued to Belgian and French forces fighting with NATO in Bosnia. The feedback was emphatically positive; the bandages were deemed to have improved treatment. So then they were introduced to NATO forces in Iraq and Afghanistan.“God blessed me,” says Bar- Natan, and, twinkle in his eye, looks up to the heavens. “I came up with a new kind of personal bandage to stop hemorrhaging in the field. It has gradually been adopted by various militaries – Australia, New Zealand, most of NATO. It has been standard in the US Army since 2003, in the British Army since 2007, in the IDF since 2006 – one-and-a-half months before the Second Lebanon War. It’s amazing,” he says, shaking his head. “Amazing.”Widespread awareness that more needed to be done to prevent soldiers bleeding to death in the field, he adds, was also heightened by the book and film, which dealt with US assault forces fighting in Somalia in 1993, and the loss of life after the shooting down of Black Hawk helicopters.But it’s not just armies that use the bandage nowadays. “In time, some people who came back from the various war zones began expressing interest in buying the bandages for civilian use,” Bar-Natan notes.Which is where the shooting of Gabrielle Giffords, in Tucson in January, comes in.ON WEDNESDAY, US Congresswoman Giffords flew from Houston, where she has been in a rehabilitation program, to Florida’s Cape Canaveral to watch Friday’s scheduled launch of the space shuttle. Her husband, astronaut Mark Kelly, is the mission commander. The event marked the first time Giffords had been seen in public since she was shot.Bar-Natan can’t say for sure that his bandage saved the congresswoman’s life. He can’t even say for sure that it was used to treat her terrible head wound in the frantic, chaotic first minutes after gunman Jared Loughner opened fire on the congresswoman and the crowd around her at a “Congress on Your Corner” gathering she was holding outside a Safeway grocery store on January 8. Six people were killed in the attack; Giffords was very nearly the seventh – a bullet had passed in through the front and out through the back of her skull.What Bar-Natan can say for sure is that his bandage was part of the kit issued to the local sheriff’s office whose team was first on the scene. “I’m told that a paramedic who worked for the Pima County Sheriff’s Department had realized his officers weren’t protected properly and put together an IFAK – an Improved First Aid Kit for them,” he says. “Our bandage is integral to their kit, which sits on the waist.“My understanding is that when the shooting happened, the police didn’t know how many shooters there were – so while some of them went looking for the shooters, some were treating the injured, and the emergency medical teams were kept away for somewhere between three to six minutes until the police were confident they had cleared the area of further gunmen. In that time, the police, using their own kits, rendered first aid.”According to a Jewish Telegraphic Agency article, “First responders credited the emergency bandage colloquially known as ‘the Israeli bandage’ with saving lives in the aftermath of the shooting... Pima County officials displayed the kit at a January 21 news conference in Tucson, along with other military-grade gear used in ministering to the wounded... The county had switched last June to the upgraded gear, and the shooting was its major first field test.”“Without this care,” said Dr. Katherine Hiller, who had attended the wounded at University Medical Center, “it would have definitely been a different situation.”As of this week,reported – and the trip to Florida confirmed – Giffords is “able to walk under supervision with perfect control of her left arm and leg.” Her language abilities have improved and are catching up to her cognitive ability, the newspaper said. She speaks most often in a single word or declarative phrase: “love you,” “awesome.” But with considerable effort, she is also “able to string words together, and to produce complex sentences fluently.”Giffords is daughter of a Christian Scientist mother, and the great-granddaughter of a Lithuanian rabbi on her father’s side. As the JTA article put it in February, “Israel changed Gabrielle Giffords’ life when the budding politician first visited the country in 2001 and it drew her close to Judaism. After the Arizona congresswoman was shot in the head a month ago, an Israeli innovation invented by an American immigrant to Israel may have helped save her life.”Says Bar-Natan simply: “I heard about the shooting just like you did. I was in New York at the time. I don’t know if my bandage was used specifically to help the congresswoman. If it helped, I’m glad. I’m glad.”IT’S EASY to warm to Bar-Natan. For one thing, he’s refined a basic medical item into a simple but sophisticated product that really makes a difference. For another, he is personable, good-humored, tenacious and articulate – qualities that must have helped him along the tortuous route to perfecting, winning approval for, and building a business to produce that product.It evidently wasn’t all plain sailing. Trying to make headway in the US, for instance, he went at one point to Fort Sam Houston in San Antonio, where the US Army trains its medics. He thought he’d have some credibility as an IDF medic, still in the reserves. Not a bit of it. “They just told me to ‘Go get your FDA [US Food and Drug Administration] approval first.” That process of getting FDA and US patent approval, he sighs, “was very complicated. But finally, it got to the point where they said, ‘Okay. You’re fine. Run with it. It’s a quality product.”His graying hair tied off in a ponytail, he comes into my office with a big smile and a small briefcase from which he produces, only when prompted, some promotional material and the revolutionary bandage itself.Prompted further, he demonstrates its effectiveness on me, slipping the grey-white elasticated fabric over my left arm, swiftly positioning the sterile pad above my imaginary gushing wound, keeping the grey plastic “pressure bar” close to but not directly above the injury, reverse-wrapping and tightening the bandage, and fastening it with the pen-top style “closure bar.”He does this in seconds, while patiently explaining the whys and hows: “When you cut yourself shaving, a little cut, you put a piece of paper on it, to create a little bit of pressure. The bigger the cut, the more pressure you need. You have to slow the blood pouring out, the wash, in order to allow the platelets to do their magic, to clot. If the wash is too great, they can’t connect. So this bandage does that, and it also removes the need for ‘accessories’ – the stone, the triangular bandage for extra pressure.”I’m bandaged in far less than the time it takes him to say all that, and the multiple advantages of his product are immediately obvious even to this most medically clueless of laymen. The pressure the bandage is applying is palpable; he shows me how to increase it considerably by adjusting both the fabric and the pressure bar, without halting the blood flow to the rest of my arm. And the speed and ease of application are manifest.Asked what was his key innovation, Bar-Natan first says, “the pressure bar” but then reconsiders. “It was everything together, really. It’s also very important that it’s small, and double vacuum-packed. I remember as a medic, I was less troubled by weight than by volume.”“There are two headlines,” he summarizes. “Main headline: ‘Stop the bleeding.’ Sub-head: ‘Consolidation of equipment – one product, multi-functional.’”Like so many important inventions, here is an improvement so obvious and so dramatic, it now seems staggering in retrospect that nobody conceived it earlier. But nobody did. And decade after decade went by, until Bar-Natan got his IDF-issue 1942 bandage and began musing.HE’S NEVER called his product “the Israeli bandage.” The IDF was by no means the first to use it. But he says he’s “delighted for it be called that.”He’s just been filmed by a crew sent by the pro-Israel AIPAC lobby, which, he says, is featuring “the Israeli bandage that saves American lives,” among other innovations, at its annual policy conference in Washington next month.The bandage is the flagship product but his company, First Care Products, has just introduced one more of his designs, for a pelvic “binder,” and he has a fresh innovation in the works that he’s not talking about yet.He got beaten to the patent office with yet another idea, for angular soldiers’ helmets – to deflect projectiles in much the same way as a tank’s angled panels do. “You can’t win them all,” he says cheerfully. “Someone got there first and patented it last year. I wish him well.”He says that, in his most optimistic dreams, he imagined perfecting the product and then selling it off, but he’s wound up overseeing the entire cycle, producing the bandage at a factory in the Beduin village of Tuba-Zangaria near Rosh Pina. The factory is owned by a subcontractor; First Care owns the machines.“The market’s very strong now,” he says. “We’re making about 1.5 to 2 million bandages a year.”BERNARD BAR-NATAN almost closed the circle he had opened when gazing bemusedly at the 1942 date on his first IDF personal bandage.He continued doing reserve duty as a medic until early 2006 – just before, that is, the IDF began using the bandage he had designed – “just before,” he smiles, “it might have been issued to me. Field units get it at Bakum [the IDF induction center]. Some reservists get it too. It was used in the Second Lebanon War, and it was used in Operation Cast Lead.”He’s still traveling to lots of international exhibitions, promoting sales, signing new contracts. Presumably, it’s made him a wealthy man. Plainly, he’s incredibly proud to hear, as he often does, from buyers, from doctors, that the product he devised is truly valuable.“I’ve thought often of that [Talmudic] saying, about ‘whoever saves a life, saves an entire world,’” he says. “My day will come. And, if you believe in a heavenly court, I hope that, when I get there, they’ll say, ‘You’re the guy with the bandage? You can come in.’”