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Scallan NJ, Keene DD, Breeze J, Hodgetts TJ, Mahoney PF. Extending existing recommended military casualty evacuation timelines will likely increase morbidity and mortality: a UK consensus statement. BMJ Mil Health 2020; 166:287-293. [PMID: 32665423 DOI: 10.1136/bmjmilitary-2020-001517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Future conflicts may have limited use of aviation-based prehospital emergency care for evacuation. This will increase the likelihood of extended evacuation timelines and an extended hold at a forward hospital care facility following the completion of damage control surgery or acute medical interventions. METHODS A three-round Delphi Study was undertaken using a panel comprising 44 experts from the UK armed forces including clinicians, logisticians, medical planners and commanders. The panel was asked to consider the effect of an extended hold at Deployed Hospital Care (Forward) from the current 2-hour timeline to +4, +8, +12 and +24 hours on a broad range of clinical and logistical issues. Where 75% of respondents had the same opinion, consensus was accepted. Areas where consensus could not be achieved were used to identify future research priorities. RESULTS Consensus was reached that increasing timelines would increase the personnel, logistics and equipment support required to provide clinical care. There is a tipping point with a prolonged hold over 8 hours, after which the greatest number of clinical concerns emerge. Additional specialties of surgeons other than general and orthopaedic surgeons will likely be required with holds over 24 hours, and robust telemedicine would not negate this requirement. CONCLUSIONS Retaining acute medical emergencies at 4 hours, and head injuries was considered a particular risk. This could potentially be mitigated by an increased forward capacity of some elements of medical care and availability of a CT scanner and intracranial pressure monitoring at over 12 hours. Any efforts to mitigate the effects of prolonged timelines will come at the expense of an increased logistical burden and a reduction in mobility. Ultimately the true effect of prolonged timelines can only be answered by close audit and analysis of clinical outcomes during future operations with an extended hold.
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Affiliation(s)
- Nicholas James Scallan
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK.,Currently Serving: 3 Medical Regiment, Army Medical Services, Preston, UK
| | - D D Keene
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Breeze
- Department of Maxillofacial Surgery, Royal Centre for Defence Medicine, Birmingham, UK
| | - T J Hodgetts
- Senior health Advisor & Head of Army Medical Services, Army Headquarters, Andover, UK
| | - P F Mahoney
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
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Harper PN, Taylor N, Royal P, Smith MB. Role of the pre-hospital treatment team on the UK military exercise SAIF SAREEA 3. BMJ Mil Health 2020; 166:421-424. [DOI: 10.1136/bmjmilitary-2019-001366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022]
Abstract
The prehospital treatment team (PHTT) involves a small team working under the clinical supervision of a clinical lead. The clinical lead can be a general duties medical officer (Post Foundation Years Doctor), military nurse practitioner or more senior clinician. The team is mounted in vehicles appropriate to the environment they expect to operate in. A PHTT is closely located to the front line reducing transportation timelines from the point of wounding to more definitive care. The PHTT can provide medical support on the move or when time is available; a more permanent fully erected treatment facility can be established. Either configuration can provide both trauma and primary care. The size of the team allows for multiple trauma subteams enabling care to casualties that arrive simultaneously. The PHTT can move independently which could leave the team vulnerable as there is no integral force protection within the current structure. In such a small team, the right balance of medical and soldiering skills among team members is essential to success. Exercise SAIF SAREEA 3 represented a large-scale battlegroup exercise to the Middle East in the austere desert of Oman. This provided an ideal environment for employing the PHTT concept is a large deployed force undertaking dynamic activity.
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Caubère A, de Landevoisin ES, Schlienger G, Demoures T, Romanat P. Tactical tourniquet: Surgical management must be within 3 hours. Trauma Case Rep 2019; 22:100217. [PMID: 31338408 PMCID: PMC6611996 DOI: 10.1016/j.tcr.2019.100217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/30/2022] Open
Abstract
Despite longstanding controversy, tourniquets are widely used in tactical combat casualty care, with undisputed benefits for recent conflicts in Iraq and Afghanistan. Increased time delays are a particular issue in large areas, such as the Sahel-Saharan band. Complications associated with tourniquet use are predominantly related to acute ischemia with risk of amputation and ischaemia-reperfusion injury, as shown in the first clinical case. Often stated but poorly described, misuse of tourniquet and subsequent failure to interrupt arterial blood flow is also a clinical scenario that should be recognized. In the case of misuse of the tourniquet, more significant blood loss may be expected because of venous compression (« venous tourniquet », second clinical case). Early medical re-evaluation of the tourniquet is an essential component in prolonged field care. This includes reassessment of the tourniquet's ability to achieve hemostasis, abolish the downstream pulse and the relevance of the tourniquet altogether. This combat tool requires training to be successful and complications are time dependent. Tourniquet use requires appropriate application, re-evaluation and triage of wounded personnel within 3 h towards more structured surgical management.
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Affiliation(s)
- A. Caubère
- 6 Antenne Chirurgicale Aerotransportable, Department of Orthopaedic and Trauma surgery, Bégin Military Hospital, 69 Avenue de Paris, 94160 Saint-Mandé, France
- Corresponding author.
| | - E. Soucanye de Landevoisin
- Department of Orthopedic and Trauma Surgery, Laveran Military Hospital, 34 Bd Laveran, 13013 Marseille, France
| | - G. Schlienger
- 6 Antenne Chirurgicale Aerotransportable, Department of Visceral and Vascular Surgery, Sainte-Anne Military Hospital, 2 Bd Sainte-Anne, 83000 Toulon, France
| | - T. Demoures
- Department of Orthopaedic and Trauma Surgery, Bégin Military Hospital, 69 Avenue de Paris, 94160 Saint-Mandé, France
| | - P. Romanat
- 6 Antenne Chirurgicale Aerotransportable, Department of Anesthesiology and Intensive Care Unit, Laveran Military Hospital, 34 Bd Laveran, 13013 Marseille, France
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Arul GS, Pugh H, Kluth MJ, Bromiley M. Common goals, shared risk and a just culture: human factors lessons from the front line. J R Soc Med 2017; 110:93-97. [PMID: 28278395 DOI: 10.1177/0141076817692156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- G S Arul
- 1 212 Field Hospital, Sheffield S10 3EU, UK
| | - Hej Pugh
- 2 144 Parachute Medical Squadron, Colchester CO2 7UT, UK
| | - M J Kluth
- 3 RAF Odiham, Hampshire RG29 1QT, UK
| | - M Bromiley
- 4 Clinical Human Factors Group, North Marston MK18 3RA, UK
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Pasquier P, Dubost C, Boutonnet M, Chrisment A, Villevieille T, Batjom E, Bordier E, Ausset S, Puidupin M, Martinez JY, Bay C, Escarment J, Pons F, Lenoir B, Mérat S. Predeployment training for forward medicalisation in a combat zone: the specific policy of the French Military Health Service. Injury 2014; 45:1307-11. [PMID: 24952973 DOI: 10.1016/j.injury.2014.05.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/22/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To improve the mortality rate on the battlefield, and especially the potentially survivable pre-Medical Treatment Facility deaths, Tactical Combat Casualty Care (TCCC) is now considered as a reference for management of combat casualty from the point of injury to the first medical treatment facility. TCCC comprises of a set of trauma management guidelines designed for use on the battlefield. The French Military Health Service also standardised a dedicated training programme, entitled "Sauvetage au Combat" (SC) ("forward combat casualty care"), with the characteristic of forward medicalisation on the battlefield, the medical team being projected as close as possible to the casualty at the point of injury. The aim of our article is to describe the process and the result of the SC training. MATERIALS AND METHODS Records from the French Military Health Service Academy - École du Val-de-Grâce administration, head of the SC teaching programme, defining its guidelines, and supporting its structure and its execution, were examined and analyzed, since the standardisation of the SC training programme in 2008. The total number of trainees was listed following the different courses (SC1, SC2, SC3). RESULTS At the end of 2013, every deployed combatant underwent SC1 courses (confidential data), 785 health-qualified combatants were graduated for SC2 courses and 672 Role 1 physician-nurse pairs for SC3 courses. CONCLUSION The SC concept and programmes were defined in France in 2007 and are now completely integrated into the predeployment training of all combatants but also of French Military Health Service providers. Finally, SC teaching programmes enhance the importance of teamwork in forward combat medicalisation settings.
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Affiliation(s)
- Pierre Pasquier
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Clément Dubost
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Percy (Military Teaching Hospital), Clamart, France.
| | - Anne Chrisment
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Thierry Villevieille
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Emmanuel Batjom
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Emmanuel Bordier
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Sylvain Ausset
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Percy (Military Teaching Hospital), Clamart, France.
| | - Marc Puidupin
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Desgenettes (Military Teaching Hospital), Lyon, France.
| | - Jean-Yves Martinez
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Desgenettes (Military Teaching Hospital), Lyon, France.
| | - Christian Bay
- Tactical Care Training Department, French Military Health Service Academy - École du Val-de-Grâce, Paris, France.
| | - Jacques Escarment
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Desgenettes (Military Teaching Hospital), Lyon, France.
| | - François Pons
- French Military Health Service Academy - École du Val-de-Grâce, Paris, France.
| | - Bernard Lenoir
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Percy (Military Teaching Hospital), Clamart, France.
| | - Stéphane Mérat
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
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Forward aeromedical evacuation: a brief history, lessons learned from the Global War on Terror, and the way forward for US policy. J Trauma Acute Care Surg 2013; 75:S130-6. [PMID: 23883897 DOI: 10.1097/ta.0b013e318299d189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Air medical evacuations from a developing world conflict zone. Air Med J 2012; 30:313-6. [PMID: 22055174 DOI: 10.1016/j.amj.2011.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/26/2011] [Accepted: 04/09/2011] [Indexed: 11/23/2022]
Abstract
Somalia has been without effective government for close to two decades, with more than 1 million people internally displaced. The political unrest persists, with United Nations-backed African Union peacekeeping forces supporting the Transitional National government of Sharif Ahmed, struggling to maintain control of central Mogadishu from Islamist extremist groups, such as the reportedly Al-Qaeda-backed Al-Shabab. The African Union force of 5,000 troops is predominantly of Ugandan and Burundian origin, making up the African Mission in Somalia (AMISOM) effort. However, its mandate is limited to operations only in Mogadishu, and it is unauthorized to actively pursue insurgents. As with other ongoing high-profile conflicts, African Union troops face an enemy that blends into the civilian populace, fighting with a lethal mixture of improvised explosive devices and suicide bombers.
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Donat A, Petitjeans F, Précloux P, Puidupin M, Escarment J. La cricothyrotomie : données actuelles et intérêt de cette technique en médecine de guerre. ACTA ACUST UNITED AC 2012; 31:141-51. [DOI: 10.1016/j.annfar.2011.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 10/26/2011] [Indexed: 11/25/2022]
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