1
|
Py N, Jarrassier A, Meaudre E, Pasquier P. Reinforced predeployment training of European military surgical teams: The key requirements are technical, non-technical, and also tactical skills. Injury 2024; 55:111571. [PMID: 38703572 DOI: 10.1016/j.injury.2024.111571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- N Py
- Department of anesthesiology and critical care, Bégin Military Teaching Hospital, Saint-Mandé, France.
| | - A Jarrassier
- Department of anesthesiology and critical care, Bégin Military Teaching Hospital, Saint-Mandé, France
| | - E Meaudre
- Department of anesthesiology and critical care, Saint-Anne Military Teaching Hospital, Toulon, France; École du Val-de-Grâce, French Military Medical Academy, Paris, France
| | - P Pasquier
- École du Val-de-Grâce, French Military Medical Academy, Paris, France; Department of anesthesiology and critical care, Percy Military Teaching Hospital, Clamart, France; French Special Operations Forces Medical Command, Villacoublay, France
| |
Collapse
|
2
|
Haverkamp FJC, Van Dongen TTCF, Edwards MJR, Boel T, Pöyhönen A, Tan ECTH, Hoencamp R. European military surgical teams in combat theater: A survey study on deployment preparation and experience. Injury 2024; 55:111320. [PMID: 38238119 DOI: 10.1016/j.injury.2024.111320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Adequate (predeployment) training of the nowadays highly specialized Western military surgical teams is vital to ensure a broad range of surgical skills to treat combat casualties. This survey study aimed to assess the self-perceived preparedness, training needs, deployment experience, and post-deployment impact of surgical teams deployed with the Danish, Dutch, or Finnish Armed Forces. Study findings may facilitate a customized predeployment training. METHODS A questionnaire was distributed among Danish, Dutch, and Finnish military surgical teams deployed between January 2013 and December 2020 (N = 142). The primary endpoint of self-perceived preparedness ratings, and data on the training needs, deployment experiences, and post-deployment impacts were compared between professions and nations. RESULTS The respondents comprised 35 surgeons, 25 anesthesiologists, and 39 supporting staff members, with a response rate of 69.7 % (99/142). Self-perceived deployment preparedness was rated with a median of 4.0 (IQR 4.0-4.0; scale: 1 [very unprepared]-5 [more than sufficient]). No differences were found among professions and nations. Skills that surgeons rated below average (median <6.0; scale: 1 [low]-10 [high]) included tropical disease management and maxillofacial, neurological, gynecological, ophthalmic, and nerve repair surgery. The deployment caseload was most often reported as <1 case per week (41/99, 41.4 %). The need for professional psychological help was rated at a median of 1.0 (IQR 1.0-1.0; scale: 1 [not at all]-5 [very much]). CONCLUSIONS Military surgical teams report overall adequate preparedness for deployment. Challenges remain for establishing broadly skilled teams because of a low deployment caseload and ongoing primary specializations. Additional training and exposure were indicated for several specialism-specific skill areas. The need for specific training should be addressed through customized predeployment programs.
Collapse
Affiliation(s)
| | | | | | - Thomas Boel
- Danish Armed Forces, Medical Command, DK-8220 Brabrand, Denmark
| | - Antti Pöyhönen
- Finnish Defence Forces Health Services, Centre For Military Medicine, FI-11311 Riihimäki, Finland
| | - Edward C T H Tan
- Department of Surgery, Radboudumc, 6500 HB Nijmegen, Netherlands; Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, Netherlands
| | - Rigo Hoencamp
- Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, Netherlands; Department of Surgery, Alrijne Hospital, 2353 GA Leiderdorp, Netherlands; Division of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, Netherlands; Department of Surgery, Erasmus MC, 3015 GD Rotterdam, Netherlands
| |
Collapse
|
3
|
Sellier A, Beucler N, Joubert C, Julien C, Tannyeres P, Anger F, Bernard C, Desse N, Dagain A. Emergency Cranial Surgeries Without the Support of a Neurosurgeon: Experience of the French Military Surgeons. Mil Med 2024; 189:598-605. [PMID: 35906867 DOI: 10.1093/milmed/usac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/03/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Unlike orthopedic or visceral surgeons, French military neurosurgeons are not permanently deployed on the conflict zone. Thus, craniocerebral war casualties are often managed by general surgeons in the mobile field surgical team. The objective of the study was to provide the feedback of French military surgeons who operated on craniocerebral injuries during their deployment in a role 2 surgical hospital without a neurosurgeon. MATERIALS AND METHODS A cross-sectional survey was conducted by phone in March 2020, involving every military surgeon currently working in the French Military Training Hospitals, with an experience of cranial surgery without the support of a neurosurgeon during deployment. We strived to obtain contextual, clinical, radiological, and surgical data. RESULTS A total of 33 cranial procedures involving 64 surgeons were reported from 1993 to 2018. A preoperative CT scan was not available in 18 patients (55%). Half of the procedures consisted in debridement of craniocerebral wounds (52%, n = 17), followed by decompressive craniectomies (30%, n = 10), craniotomy with hematoma evacuation (15%, n = 5), and finally one (3%) surgery with exploratory burr holes were performed. The 30-day survival rate was 52% (n = 17) and 50% (n = 10/20) among the patients who sustained severe traumatic brain injury. CONCLUSIONS This survey demonstrates the feasibility and the plus-value of a neurosurgical damage control procedure performed on the field by a surgeon nonspecialized in cranial surgery. The stereotyped neurosurgical techniques used by the in-theater surgeon were learned during a specific predeployment training course. However, the use of a live telemedicine neurosurgical support seems indispensable and could benefit the general surgeon in strained resources setting.
Collapse
Affiliation(s)
- Aurore Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Christophe Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Clément Julien
- Department of Visceral Surgery, Laveran Military Hospital, Marseille 13384, France
| | - Paul Tannyeres
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Florent Anger
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Cédric Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
- French Military Health Service Academy, École du Val-de-Grâce, Paris Cedex 5 75230, France
| |
Collapse
|
4
|
Fawaz R, Fouet M, Brenot G, Bertani A, Lamblin A, Delmas JM. Ethical Issues Regarding Neurosurgical Management of Penetrating Brain Injury in the French Armed Forces. Mil Med 2024; 189:e919-e922. [PMID: 37856219 DOI: 10.1093/milmed/usad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Combat penetrating brain injury (PBI) differs significantly from PBI in civilian environments. Differences include technical factors such as the weapons involved, strained resource environments, and limited medical materials and human resources available. Ethical issues regarding the management of PBI in military settings may occur. This case study examines the case of a 20-year-old member of the French Armed Forces that suffered a penetrating brain injury in a combat situation. The four-quadrant method along with the four principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) was used to analyze this case and to apply ethics to the practice of military medicine. Nowadays, we possess the medical and surgical resources as well as the aeromedical evacuation capability to save the life of a soldier with a penetrating craniocerebral wound. Nonetheless, the functional outcome of this type of wound places military doctors in an ethical dilemma. The line of conduct and clinical protocol established by the French Medical Health Service is to manage all PBIs when the patient's life can be saved and to provide all available financial and social support for the rehabilitation of patients and their family.
Collapse
Affiliation(s)
- Rayan Fawaz
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Mathilde Fouet
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Godefroi Brenot
- Department of Urology, Bégin Military Teaching Hospital, Saint Mandé Cedex 94160, France
| | - Antoine Bertani
- Department of Orthopedics, Edouard Herriot Hospital, Lyon Cedex 69003, France
| | - Antoine Lamblin
- Department of Anesthesiology and Reanimation, Edouard Herriot Hospital, Lyon Cedex 69003, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| |
Collapse
|
5
|
Perrin JM, Monchal T, Texier G, Salou-Regis L, Goudard Y. Concordance of CT imaging and surgical lesions in penetrating abdominal trauma. J Visc Surg 2023; 160:407-416. [PMID: 37481414 DOI: 10.1016/j.jviscsurg.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVE The management of penetrating abdominal wounds has greatly benefited from the development of computed tomography (CT), particularly in stable patients. In this setting, the scanner is the reference examination. Our study aims to evaluate the performance of preoperative CT in the assessment of penetrating abdominal lesions. MATERIAL AND METHODS Between January 1, 2015 and January 1, 2022, 81 patients were hospitalized following penetrating abdominal trauma at the Army Training Hospitals of Sainte-Anne and Laveran. Fifty-one stable patients who had an abdominopelvic CT scan and thereafter underwent abdominal surgery (laparotomy or laparoscopy) were included. Radiological and surgical data were collected from the electronic record and compared by a descriptive analysis (calculation of the sensitivity, specificity, positive and negative predictive value of the CT for the detection of lesions of the various organs) and by a correlation of the CT findings with surgical findings using Kripendorff's alpha coefficient. RESULTS The cohort was largely male (n=45; 88%), with injuries by knife wound in 62.7% of cases (n=32) and gunshot in 35.3% (n=18) of cases. The median age was 36years (25-47). The median index of severity score (ISS) was 17 (10-26). Excellent agreement between predicted and actual findings was obtained for solid organs (α=0.801) with high sensitivity and specificity (81.8% and 96.6%, respectively). The largest discrepancies were observed for the hollow organs (α=26.2%, sensitivity of 53.3% and specificity of 76.2%) and the diaphragm (α=67.3%, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for five patients (9.8%). The failure rate for non-operative treatment was 10% (n=1). CONCLUSION CT detection of solid organ lesions in patients with penetrating abdominal wounds is excellent. However, the detection of hollow organ and diaphragmatic wounds remains a challenge with a risk of over- and underdiagnosis. Laparoscopic exploration should be able to fill in the gaps in the CT findings.
Collapse
Affiliation(s)
- Jean-Mathieu Perrin
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France.
| | - Tristan Monchal
- Visceral Surgery Department, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Gaëtan Texier
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerrannée Infection, Marseille, France; Centre d'épidémiologie et de Santé Publique des Armées (CESPA), Marseille, France
| | - Laure Salou-Regis
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France
| | - Yvain Goudard
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France
| |
Collapse
|
6
|
Pfister G, Aries P, de Lesquen H, Mathieu L. Nine years of surgical activity in the deployed French military role 2 medical treatment facility in Mali. BMJ Mil Health 2023:e002553. [PMID: 37879647 DOI: 10.1136/military-2023-002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION In January 2013, France launched a military operation in Mali, which ended in August 2022. This study aimed to analyse the global activity performed by a surgical team within the role 2 medical treatment facility (MTF) deployed in Gao during this period, in order to adapt medical battlefield support and combat casualty care teaching. METHODS A retrospective study was conducted using the French surgical database OpEX (French Military Health Service) from January 2013 to August 2022. All patients operated on were included. RESULTS During this period, 1298 patients with a median age of 29 (range: 23-38) years were included. Among them, 229 (17.6%) underwent a combat-related trauma surgery (CRTS), 234 (18.0%) underwent a non-CRTS, 167 (12.9%) underwent a non-trauma-related surgery and 668 (51.5%) underwent a scheduled surgery in the context of medical supply to the population.Among the CRTS group, 195 (85.2%) patients underwent an orthopaedic procedure, 73 (31.8%) required a general surgery. Finally, 15 (6.6%) wounded required a specialised surgery. CONCLUSIONS In line with the activity described in the role 2 MTF deployed in other contemporary asymmetric conflicts, this activity is moderate, especially if only combat-related injuries are considered; medical support to the population occupied most of the surgical activity. For CRTS, most of the traumas are limb traumas. Other traumas are composed of various lesions, which are often life-threatening. This fact imposes the presence of an orthopaedic surgeon with the appropriate equipment, as well as a general surgeon with a wide range of skills, in asymmetric conflicts.
Collapse
Affiliation(s)
- Georges Pfister
- Department of Orthopaedic, Trauma and Reconstrucive Surgery, HIA Percy, Clamart, France
| | - P Aries
- Department of Anesthesia and Surgical Intensive Care, HIA Clermont-Tonnerre, Brest, Bretagne, France
| | - H de Lesquen
- Thoracic and Vascular Surgery, HIA Sainte Anne, Toulon, France
| | - L Mathieu
- Department of Orthopaedic, Trauma and Reconstrucive Surgery, HIA Percy, Clamart, France
| |
Collapse
|
7
|
Fischer J, Barbois S, Quesada JL, Boddaert G, Haen P, Bertani A, Duhamel P, Delmas JM, Lechevallier E, Piolat C, Rongieras F, Tresallet C, Balandraud P, Arvieux C. Early Evaluation of a New French Surgery Course in the Best Practice of Dealing With Major Incidents and Mass Casualty Events. JOURNAL OF SURGICAL EDUCATION 2023; 80:1253-1267. [PMID: 37429782 DOI: 10.1016/j.jsurg.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The main objective of this study is to evaluate the impact of a nationwide 5-month course aimed to prepare surgeons for Major Incidents through the acquisition of key knowledge and competencies. Learners' satisfaction was also measured as a secondary objective. DESIGN This course was evaluated thanks to various teaching efficacy metrics, mainly based on Kirkpatrick's hierarchy in medical education. Gain in knowledge of participants was evaluated by multiple-choice tests. Self-reported confidence was measured with 2 detailed pre and post training questionnaires. SETTING Creation in 2020 of a nationwide, optional and comprehensive Surgical Training in War and Disaster Situation as part of the French surgery residency program. In 2021, data was gathered regarding the impact of the course on participants' knowledge and competencies. PARTICIPANTS The study included 26 students in the 2021 cohort (13 residents and 13 practitioners). RESULTS Mean scores were significantly higher in the post-test compared to the pre-test, showing significant increase in participants' knowledge during the course: 73,3% vs. 47,3% respectively (p ≤ 0.001). Average learners' confidence scores to perform technical procedures showed at least a +1-point increase on the Likert scale for 65% of items tested (p ≤ 0.001). 89% of items showed at least a +1-point increase on the Likert scale when it came to average learners' confidence score on dealing with complicated situations (p ≤ 0.001). Our post-training satisfaction survey showed that 92% of all participants have noticed the impact of the course on their daily practice. CONCLUSION Our study shows that the third level of Kirkpatrick's hierarchy in medical education was reached. This course therefore appears to be meeting the objectives set by the Ministry of Health. Being only 2 years old, it is on the road to gathering momentum and further development.
Collapse
Affiliation(s)
- Juliette Fischer
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
| | - Sandrine Barbois
- Inria, CNRS, Grenoble INP, LJK, University Grenoble Alpes, Grenoble, France; Department Of Digestive and Acute Care Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 university, Lyon, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Academic Hospital, Clamart Cedex, France
| | - Pierre Haen
- Department of Maxillofacial Surgery, Laveran Military and Academic Hospital, Marseille, France
| | - Antoine Bertani
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Patrick Duhamel
- Department of Plastic surgery, Percy Military Academic Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Academic Hospital, Clamart, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, AP-HM, Conception Academic Hospital, Marseille, France
| | - Christian Piolat
- Department of Paediatric surgery, Grenoble Alpes University Hospital, Grenoble , France
| | - Frédéric Rongieras
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, APHP, Avicenne Academic Hospital, Sorbonne Paris Nord University, Bobigny France
| | - Paul Balandraud
- Department of General Surgery, Sainte-Anne Military Academic Hospital, Toulon, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| |
Collapse
|
8
|
Fawaz R, Dagain A, Pons Y, Haen P, Froussart F, Caruhel JB. Head Face and Neck Surgeon Deployment in the New French Role 2: The Damage Control Resuscitation and Surgical Team. Mil Med 2023; 188:e2868-e2873. [PMID: 36308315 DOI: 10.1093/milmed/usac329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION High-intensity conflict is back after decades of asymmetric warfare. With the increase in the incidence of head, face, and neck (HFN) injuries, the French Medical Military Service has decided to deploy HFN surgeons in the new French Role 2: the Damage Control, Resuscitation, and Surgical Team (DCRST). This study aims to provide an overview of HFN French surgeons from their initial training, including the surgical skills required, to their deployment on the DCRST. MATERIALS AND METHODS The DCRST is a tactical mobile medico-surgical structure with several configurations depending on the battlefield, mission, and flux of casualties. It represents the new French paradigm for the management of combat casualties, including HFN injuries. RESULTS The HFN's military surgeon training starts during residency with rotation in the different subspecialties. The HFN surgeon follows a training course called "The French Course for Deployment Surgery" that provides sufficient background to manage polytrauma, including HFN facilities on modern warfare. We have reviewed the main surgical procedures required for an HFN military surgeon. CONCLUSION The systematic deployment of HFN surgeons in Role 2 is a specificity of the French army as well as the HFN surgeon's training.Currently, the feedback from an asymmetric conflict is encouraging. However, it will have to innovate to adapt to modern warfare.
Collapse
Affiliation(s)
- Rayan Fawaz
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon Cedex 83000, France
| | - Yoann Pons
- Department of ENT and Maxillo Facial Surgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Pierre Haen
- Department of Maxillo Facial Surgery, Laveran Military Teaching Hospital, Marseille Cedex 13384, France
| | - Françoise Froussart
- Department of Ophthalmology, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Jean Baptiste Caruhel
- Department of ENT and Maxillo Facial Surgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| |
Collapse
|
9
|
Borg TM, Cavale N, Abu-Sittah G, Ghanem A. Plastic and Maxillofacial Training for War-Zones - A Systematic Review. Craniomaxillofac Trauma Reconstr 2023; 16:154-162. [PMID: 37222978 PMCID: PMC10201192 DOI: 10.1177/19433875221083416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. This study involves a systematic review. Objective To evaluate interventions in place to train Plastic and Maxillofacial surgeons for war-zone environments so that limitations to current training can be addressed. Methods A literature search of Medline and EMBase was performed using terms relevant to Plastic and Maxillofacial surgery training and war-zone environments. Articles that met the inclusion criteria were scored then educational interventions described in included literature were categorised according to their length, delivery style and training environment. Between-group ANOVA was performed to compare training strategies. Results 2055 citations were identified through this literature search. Thirty-three studies were included in this analysis. The highest scoring interventions were over an extended time-frame with an action-oriented training approach, using simulation or actual patients. Core competencies addressed by these strategies included technical and non-technical skills necessary when working in war-zone type settings. Conclusions Surgical rotations in trauma centers and areas of civil strife, together with didactic courses are valuable strategies to train surgeons for war-zones. These opportunities must be readily available globally and be targeted to the surgical needs of the local population, anticipating the types of combat injuries that often occur in these environments.
Collapse
Affiliation(s)
- Tiffanie-Marie Borg
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
- Department of Surgery, Queen’s Hospital, London, UK
| | | | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
| |
Collapse
|
10
|
Arvieux C, Balandraud P, Gaujoux S. Following terrorist attacks, war, natural disasters and other exceptional health emergencies, French surgeons are on the field. J Visc Surg 2023:S1878-7886(23)00082-6. [PMID: 37202266 DOI: 10.1016/j.jviscsurg.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
|
11
|
Wild H, Marfo C, Mock C, Gaarder T, Gyedu A, Wallis L, Makasa E, Hagander L, Reynolds T, Hardcastle T, Jewell T, Stewart B. Operative Trauma Courses: A Scoping Review to Inform the Development of a Trauma Surgery Course for Low-Resource Settings. World J Surg 2023; 47:1662-1683. [PMID: 36988651 DOI: 10.1007/s00268-023-06985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner. METHODS We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000. RESULTS The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics. CONCLUSIONS While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings.
Collapse
Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Chris Marfo
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Charles Mock
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Tina Gaarder
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lee Wallis
- World Health Organization, Geneva, Switzerland
| | - Emmanuel Makasa
- Department of Surgery, School of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Timothy Hardcastle
- Nelson R Mandela School of Medicine, Surgery (Trauma), University of KwaZulu-Natal, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, WA, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
| |
Collapse
|
12
|
Learning trauma surgery through cytoreductive surgery. Injury 2023; 54:1330-1333. [PMID: 36792405 DOI: 10.1016/j.injury.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Regarding war surgery (WS), the initial and continuing education of French military gastrointestinal surgeons (FMGIS) is considered flawed and inappropriate. This results from the low incidence of gastrointestinal (GI) trauma, its predominantly non-surgical management, and a daily surgical practice that strongly differs from WS. Conversely, cytoreductive surgery (CRS) of peritoneal metastases has similarities with WS which led us to assess its potential contribution to the initial and continuing education of FMGIS in WS. METHODS We reported the activities of the GI surgery departments of the military teaching hospitals of Percy and Begin. The first one dedicated to traumatology and the second to CRS. We then specifically looked into the surgical procedures conducted by the FMGIS during deployment from January 2004 to December 2014. RESULTS Amongst the 600 severe trauma patients admitted to the Percy trauma center between January 2019 and December 2020, 17 underwent abdominal surgery with a total of 25 procedures performed. During the same period, 61 patients undertook CRS in Begin with an average of 7 surgical processes per patient carried out and a total of 418 abdominal surgical procedures. Outside abdominal packing and nephrectomy (not performed in CRS), the numbers of splenectomy, gastrointestinal / gynecological resections (hysterectomy and/or adnexectomy), or liver resection were higher during CRS compared to abdominal trauma surgery with 10 times less patients (10 vs 1, 43 vs 9, 20 vs 0, 6 vs 0, respectively). CONCLUSION CRS, through its similarities with WS, seemed to be an appropriate tool for the initial and continuing education of FMGIS in WS and, to an extent, of civilian trauma surgeons who could eventually treat terrorist attacks casualties on the national territory.
Collapse
|
13
|
Du WQ, Zhong X, Jiang RQ, Zong ZW, Jia YJ, Ye Z, Zhou XL. Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries. Chin J Traumatol 2023; 26:41-47. [PMID: 36008213 PMCID: PMC9912295 DOI: 10.1016/j.cjtee.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries. METHODS With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches. RESULTS Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury. CONCLUSIONS Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.
Collapse
Affiliation(s)
- Wen-Qiong Du
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Xin Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care & Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Ren-Qing Jiang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Zhao-Wen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care & Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
| | - Yi-Jun Jia
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Zhao Ye
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Xiao-Lin Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| |
Collapse
|
14
|
de Malleray H, Cardinale M, Avaro JP, Meaudre E, Monchal T, Bourgouin S, Vasse M, Balandraud P, de Lesquen H. Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center. Eur J Trauma Emerg Surg 2022; 48:4631-4638. [PMID: 35633378 DOI: 10.1007/s00068-022-01995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate survival after emergency department thoracotomy (EDT) in a physician-staffed emergency medicine system. METHODS This single-center retrospective study included all in extremis trauma patients who underwent EDT between 2013 and 2021 in a military level 1 trauma center. CPR time exceeding 15 minutes for penetrating trauma of 10 minutes for blunt trauma, and identified head injury were the exclusion criteria. RESULTS Thirty patients (73% male, 22/30) with a median age of 42 y/o [27-64], who presented mostly with polytrauma (60%, 18/30), blunt trauma (60%, 18/30), and severe chest trauma with a median AIS of 4 3-5 underwent EDT. Mean prehospital time was 58 min (4-73). On admission, the mean ISS was 41 29-50, and 53% (16/30) of patients had lost all signs of life (SOL) before EDT. On initial work-up, Hb was 9.6 g/dL [7.0-11.1], INR was 2.5 [1.7-3.2], pH was 7.0 [6.8-7.1], and lactate level was 11.1 [7.0-13.1] mmol/L. Survival rates at 24 h and 90 days after penetrating versus blunt trauma were 58 and 41% versus 16 and 6%, respectively. If SOL were present initially, these values were 100 and 80% versus 22 and 11%. CONCLUSION Among in extremis patients supported in a physician-staffed emergency medicine system, implementation of a trauma protocol with EDT resulted in overall survival rates of 33% at 24 h and 20% at 90 days. Best survival was observed for penetrating trauma or in the presence of SOL on admission.
Collapse
Affiliation(s)
| | | | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Eric Meaudre
- ICU, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Tristan Monchal
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Stéphane Bourgouin
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Mathieu Vasse
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Paul Balandraud
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
| |
Collapse
|
15
|
Choufani C, Barbier O, Mathieu L, de L'Escalopier N. Military Orthopedic Surgeons Are Not Just Traumatologists. Mil Med 2021; 187:1376-1380. [PMID: 34591093 DOI: 10.1093/milmed/usab400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 09/18/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Each French military orthopedic surgeon is both an orthopedic surgeon and a trauma surgeon. Their mission is to support the armed forces in France and on deployment. The aim of this study was to describe the type of orthopedic surgery performed for the armed forces in France. Our hypothesis was that scheduled surgery was more common than trauma surgery. METHODS We conducted a retrospective descriptive analysis of the surgical activity for military patients in the orthopedic surgery departments of the four French military platform hospitals. All surgical procedures performed during 2020 were collected. We divided the procedures into the following categories: heavy and light trauma, posttraumatic reconstruction surgery, sports surgery, degenerative surgery, and specialized surgery. Our primary endpoint was the number of procedures performed per category. RESULTS A total of 827 individuals underwent surgery, 91 of whom (11%) were medical returnees from deployment. The surgeries performed for the remaining 736 soldiers present in metropolitan France (89%) consisted of 181 (24.6%) trauma procedures (of which 86.7% were light trauma) and 555 (75.4%) scheduled surgery procedures (of which 60.8% were sports surgery). Among the medical returnees, there were 71 traumatology procedures (78%, of which 87.3% were light traumatology) and 20 procedures corresponding to surgery usually carried out on a scheduled basis (22%, of which 95% were sports surgery). CONCLUSION Military orthopedic surgeons are not just traumatologists; their activity for the armed forces is varied and mainly consists of so-called programmed interventions.
Collapse
Affiliation(s)
- Camille Choufani
- Clinic of Orthopedics and Traumatology, Saint-Anne Military Teaching Hospital, Toulon 83000, France
| | - Olivier Barbier
- Clinic of Orthopedics and Traumatology, Saint-Anne Military Teaching Hospital, Toulon 83000, France.,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | - Laurent Mathieu
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France.,Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France
| | - Nicolas de L'Escalopier
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France
| |
Collapse
|
16
|
Luft A, Pasquier P, Avaro JP. Response to Letter to the Editor "The French Damage Control Resuscitation and Surgical Team in 2021: A Field-Proven Concept". Mil Med 2021; 187:42. [PMID: 34463343 DOI: 10.1093/milmed/usab358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antoine Luft
- French Military Medical Service, Surgeon General Office, Paris Cedex 15 75509, France
| | - Pierre Pasquier
- French Military Medical Service, Percy Military Training Hospital, Clamart 92140, France
| | - Jean-Philippe Avaro
- French Military Medical Service, Sainte Anne Military Training Hospital, Toulon 83000, France
| |
Collapse
|
17
|
Py N, Martinez T, Boyé M, Tourtier JP, Meaudre E, Benbrika W, Ausset S, Pasquier P. The French Pre-Deployment Advanced Course in Anesthesia and Resuscitation: Development and Future Prospects. Mil Med 2021; 186:804-810. [PMID: 33544123 DOI: 10.1093/milmed/usab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military anesthesiologists from the French Military Medical Service (FMMS) are part of the Forward Surgical Teams deployed in overseas military operations. The practice of anesthesia in combat zones requires specific skills that are not taught during the initial curriculum for French civilian anesthesiologist. The Pre-Deployment Advanced Course in Anesthesia and Resuscitation (DACAR) program was developed to prepare military anesthesiologist from the FMMS before their deployment in overseas military operations. METHODS Created in 2013 by the French Military Medical Academy, the DACAR program is divided into two modules and carried out once a year. The DACAR program trains all military anesthesiologist residents at the end of their curricula. Since 2019, a number of Certified Registered Nurse Anesthetists have completed the DACAR program. The DACAR program is organized around the main axes of experience feedback from previous deployments in combat zones as well as didactic learning and practical training using high-fidelity simulation. RESULTS Since 2013, a total of 99 trainees completed the DACAR program during six complete cycles of two modules. The DACAR program has gradually been enriched from 14 courses in 2013 to 28 in 2019. Participants' reported satisfaction rates have increased steadily since 2016, when 88% of courses were rated as "interesting" or "very interesting," and only 4% as "not very interesting." By 2019, those figures had improved to 96% and 2%, respectively. CONCLUSION The DACAR program is a structured and adapted military medical course aimed at completing the curriculum of military anesthesiologists from the FMMS before deployment in overseas military operations. Regular audits and updates ensure that the DACAR training program maintains the highest standards of quality and rigor.
Collapse
Affiliation(s)
- Nicolas Py
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France
| | - Thibault Martinez
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France
| | - Matthieu Boyé
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France
| | - Jean-Pierre Tourtier
- Federation of anesthesiology and intensive care unit, Bégin Military Training Hospital, Saint Mandé 94160, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Eric Meaudre
- Federation of anesthesiology and intensive care unit, Saint-Anne Military Training Hospital, Toulon 83800, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Widad Benbrika
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Sylvain Ausset
- French military medical schools, Bron 69500, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Pierre Pasquier
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| |
Collapse
|
18
|
Boudin L, de Lesquen H, Patient M, Romeo E, Rivière D, Cungi PJ, Savoie PH, Avaro JP, Dagain A, Bladé JS, Balandraud P, Bourgouin S. Role of Cancer Surgery in the Improvement of the Operative Skills of Military Surgeons During Deployment: A Single-Center Study. Mil Med 2021; 186:e469-e473. [PMID: 33135732 DOI: 10.1093/milmed/usaa327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The maintenance of military surgeons' operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons' activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons' operative skills. METHODS Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). RESULTS Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P < 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85-3.14). CONCLUSION This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.
Collapse
Affiliation(s)
- Laurys Boudin
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon 83000, France
| | - Matthieu Patient
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Emilie Romeo
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Damien Rivière
- Head and Neck Surgery Department, Sainte Anne Military Hospital, Toulon 83000, France
| | - Pierre-Julien Cungi
- Department of Anaesthesia and Critical Care, Sainte Anne Military Hospital, Toulon 83000, France
| | - Pierre-Henri Savoie
- Department of Urology, Sainte Anne Military Hospital, Toulon 83000, France.,French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon 83000, France.,French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France
| | - Arnaud Dagain
- French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France.,Department of Neurosurgery, Sainte Anne Military Hospital, Toulon 83000, France
| | - Jean-Sébastien Bladé
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Paul Balandraud
- French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France.,Department of Digestive Surgery, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Stéphane Bourgouin
- Department of Digestive Surgery, Sainte Anne Military Hospital, Toulon 83000, Var, France
| |
Collapse
|
19
|
Sellier A, Beucler N, Desse N, Julien C, Tannyeres P, Bernard C, Joubert C, Dagain A. Evaluation of neurosurgical training of French military surgeons prior to their deployment. Neurochirurgie 2021; 67:454-460. [PMID: 33766563 DOI: 10.1016/j.neuchi.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A specific training course was formalized in 2007 in order to facilitate the management of cranio-encephalic injuries by French military general surgeons during deployment, within the Advanced Course for Deployment Surgery (ACDS). The objective is to evaluate the neurosurgical pre-deployment training course attended by the military surgeons. METHODS From June 2019 to September 2019, we conducted a cross-sectional survey in the form of a digital self-completed questionnaire, addressed to all graduated military surgeons working in the French Military Training Hospitals. The survey included: (1) a knowledge assessment; and (2) a self-assessment of the training course. The participating surgeons were classified into two groups according to their participation (group 1) or not (group 2) in the neurosurgical module. The main outcome was the score received on the knowledge assessment. RESULTS Among the 145 military surgeons currently in service, 76 participated in our study (53%), of which 49 were classified in group 1 (64%) and 27 in group 2 (36%). Group 1 surgeons had a significantly higher score than Group 2 at the knowledge assessment (mean 21.0±7.1 vs. 17.8±6.0, P=0.041). The most successful questions were related to TBI diagnosis and surgical technique, while the least successful questions dealt with "beyond emergency care" and surgical indications. CONCLUSION The French pre-deployment neurosurgical training course provides a strong neurosurgical background, sufficient to perform life-saving procedures in a modern conflict situation. However, neurosurgical specialized advice should be solicited whenever possible to assist the in-theatre surgeon in surgical decisions.
Collapse
Affiliation(s)
- A Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France.
| | - N Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - N Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Julien
- Department of Visceral Surgery, Sainte-Anne Military Hospital, Toulon, France
| | - P Tannyeres
- 9th Army Medical Center, 144th medical unit, French Military Health Service, Canjuers, France
| | - C Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - A Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France; French Military Health Service Academy - École du Val-de-Grâce, Paris, France
| |
Collapse
|
20
|
Boutonnet M, Benbrika W, Facione J, Travers S, Boddaert G, Colas MD, Hornez E, Mathieu L, de Régloix S, Daban JL, Leclerc T, Pasquier P, Ausset S. Traum'cast: an online, open-access educational video podcast series for teaching military trauma care to all healthcare providers. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:438-440. [DOI: 10.1136/bmjstel-2020-000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022]
Abstract
The aim of this paper was to describe the development of ‘Traum’cast’, an ambitious project to create a high-quality, open-access, 12-week video podcast programme providing evidence-based continuing medical education for civilian and military healthcare practitioners dedicated to the management of trauma caused by weapons of war. The management of such patients became a particular public health issue in France following the 2015 terrorist attacks in Paris, which highlighted the need for all healthcare professionals to have appropriate knowledge and training in such situations. In 2016, the French Health General Direction asked the French Military Medical Service (FMMS) to create a task force and to use its unique and considerable experience to produce high-quality educational material on key themes including war injuries, combat casualty care, triage, damage control surgery, transfusion strategies, psychological injury and rehabilitation. The material was produced by FMMS and first broadcast in French and for free, on the official FMMS YouTube channel in September 2020. Traum’cast provides evidence-based continuing medical education for civilian and military healthcare practitioners. Traum’cast is an educational innovation that meets a public health requirement.
Collapse
|
21
|
Ballivet de Régloix S, Vico S, Morvan JB, Clément P. Recent changes to the French military forward surgical team. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:311-312. [PMID: 33610501 DOI: 10.1016/j.anorl.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Ballivet de Régloix
- Service d'ORL et de chirurgie cervico-faciale, Hôpital d'Instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - S Vico
- Service d'anesthésie réanimation, Hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-B Morvan
- Service d'ORL et de chirurgie cervico-faciale, Hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - P Clément
- Service d'ORL et de chirurgie cervico-maxillo-faciale, Hôpital d'Instruction des Armées Percy, 2, rue du Lieutenant-Raoul-Batany, 92140 Clamart, France
| |
Collapse
|
22
|
French civilian surgical expertise still inadequately prepared for mass casualties 3 years after major terror attacks in Paris (2015) and Nice (2016). J Trauma Acute Care Surg 2021; 89:S26-S31. [PMID: 32044874 DOI: 10.1097/ta.0000000000002606] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a nonselected population of practicing French surgeons. METHODS A questionnaire was sent between July and December 2017 to French students and practicing surgeons, using the French Surgical Colleges' mailing lists. Items analyzed included education, training, interest and clinical activity in trauma care and damage-control surgery (DCS). RESULTS 622 questionnaires were analyzed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in Level I trauma centers (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of 'interest in trauma care' was 8/10. Factors associated with a higher score were being a resident doctor (p = 0.01), a digestive surgeon (p = 0.0013), in the military (p = 1,71 × 10) and working in TC1 (p = 0.034). The mean "DCS techniques knowledge" score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively, p = 0.0007 and p = 0.001) and in the military (respectively p = 1.74 × 10 and p = 3.94 × 10). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons. CONCLUSION French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate. LEVEL OF EVIDENCE Level III, Study Type Survey.
Collapse
|
23
|
Cant MR, Naumann DN, König TC, Bowley DM. How do deployed general surgeons acquire relevant skill sets and competencies and mitigate skill fade? BMJ Mil Health 2020; 167:209-213. [PMID: 33328277 DOI: 10.1136/bmjmilitary-2020-001641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
There are recognised difficulties internationally with acquisition and retention of skills among deployed military general surgeons. These are compounded by reduced trauma workload in non-deployed roles or during low tempo or limited activity deployments, and the winding-down of combat operations in Iraq and Afghanistan. We summarise the relevant military-run courses, military-civilian collaborations and potential future strategies that have been used to address skill sets and competencies of deployed surgeons. We use examples from the American, British, Danish, French, German and Swedish Armed Forces. There is variation between nations in training, with a combination of didactic lectures, simulation training and trauma placements in civilian settings at home and overseas. Data regarding effectiveness of these techniques are sparse. It is likely that combat surgical skill-set acquisition and maintenance requires a combination of employment at a high-volume trauma centre during a surgeon's non-deployed role, together with military-specific courses and high-fidelity simulation to fill skill gaps. There are multiple newer modalities of training that require further evaluation if they are to prove effective in the future. We aimed to summarise the current methods used internationally to ensure acquisition and retention of vital skill sets for these surgeons.
Collapse
Affiliation(s)
| | - D N Naumann
- Academic Department of Military Surgery and Trauma, Birmingham, UK
| | - T C König
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK.,16 Medical Regiment, Royal Army Medical Corps, Merville Barracks, Colchester, Essex, UK
| | - D M Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
24
|
Luft A, Pasquier P, Soucanye de Landevoisin E, Morel-Stum N, Baillon A, Louis S, Menini W, Sagalle Y, Gintte J, Bouquet A, Avaro JP. The Damage Control Resuscitation and Surgical Team: The New French Paradigm for Management of Combat Casualties. Mil Med 2020; 187:e275-e281. [PMID: 33242064 DOI: 10.1093/milmed/usaa322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/15/2020] [Accepted: 08/20/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The aim of this work was to introduce the new French forward resuscitation and surgical unit. It's also to discuss the choices and waivers granted to fit the tactical context of modern conflicts and the current epidemiology of combat casualties. MATERIALS AND METHODS A multidisciplinary task force of 11 people proceeded to the conception and the creation of a new military resuscitation and surgical unit. The preliminary work included a scoping review of the combat casualties' epidemiology in modern conflicts and an analysis of the recent French medical-surgical treatment facilities lessons learned. In April 2019, a technical-operational evaluation was conducted to confirm all the technical, ergonomic, and organizational choices made during the design phase. RESULTS The multidisciplinary task force resulted in the creation of the Damage Control Resuscitation and Surgical Team (DCRST). The DCRST focused on the resuscitation strategy, including transfusion of blood products, and the life-saving surgical procedures to be performed as close as possible to the point of injury. It was designed for the resuscitation of two patients: the life-saving surgery of two patients and the very short-term intensive care (<12 hours) of four patients at the same time. The DCRST provided sufficient autonomy to provide take care of four T1 and four T2 or T3 casualties per day for 48 hours. It was armed with 23 soldiers. The technical equipment represented 5,300 kg and 27 m3. All the technical medical equipment could be stored in two 20-foot containers. CONCLUSION The DCRST represents a new paradigm in medical support of French military operations. It offers the advantage of two combat casualties' surgical management at the same time, as close as possible to the combat zone. It responds to a 2-fold epidemiological and logistical challenge.
Collapse
Affiliation(s)
- Antoine Luft
- French Military Medical Service - Surgeon General Office, 75509 Paris Cedex 15, France.,French Military Medical Service - Percy Military Training Hospital, 92 140 Clamart, France
| | - Pierre Pasquier
- French Military Medical Service - Percy Military Training Hospital, 92 140 Clamart, France
| | | | - Nelly Morel-Stum
- French Military Medical Service- Military Medical Supply and Health Care Product General Office, 45400 Chanteau, France
| | - Arthur Baillon
- French Military Medical Service - Military Medical Supply and Health Care Product General Office, 45400 Chanteau, France
| | - Serge Louis
- French Military Medical Service - Military Medical Supply and Health Care Product General Office, 45400 Chanteau, France
| | - William Menini
- French Military Medical Service - Sainte Anne military training hospital, 83000 Toulon, France
| | - Yannick Sagalle
- French Military Medical Service - Percy Military Training Hospital, 92 140 Clamart, France
| | - Julie Gintte
- French Military Medical Service - 12th Military Medical Center, 33068 Bordeaux CEDEX, France
| | - Antoine Bouquet
- French Military Medical Service - Surgeon General Office, 60 boulevard du Général Valin CS 21623, 75509 Paris Cedex 15, France
| | - Jean-Philippe Avaro
- French Military Medical Service - Sainte Anne Military Training Hospital, 83000 Toulon, France
| |
Collapse
|
25
|
de Lesquen H, Bergez M, Vuong A, Boufime-Jonqheere A, de l'Escalopier N. Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel. Mil Med 2020; 186:e30-e33. [PMID: 33169148 PMCID: PMC7717289 DOI: 10.1093/milmed/usaa273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.
Collapse
Affiliation(s)
- Henri de Lesquen
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, 8300, Toulon, France
| | - Marie Bergez
- 4th Forward Surgical Team, French Military Health Service, France.,Département d'Anésthésie-Réanimation, Etablissement Hospitalier Civilo Militaire de Metz., 57070 Metz, France
| | - Antoine Vuong
- 183ème Antenne Medical de Mont de Marsan, 12ème Centre Médical des Armées de Bordeaux, 4000 Mont de Marsan, France
| | | | - Nicolas de l'Escalopier
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Orthopedic, Traumatology and Reconstructive Surgery, PERCY Military Teaching Hospital, 92140, Clamart, France
| |
Collapse
|
26
|
Mathieu L, Plang S, de l'Escalopier N, Murison JC, Gaillard C, Bertani A, Rongieras F. Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon. Mil Med Res 2020; 7:51. [PMID: 33099317 PMCID: PMC7585288 DOI: 10.1186/s40779-020-00281-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. METHODS A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). RESULTS Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. CONCLUSIONS Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. TRIAL REGISTRATION Retrospectively registered on January 2019 (n°2019-090 1-001).
Collapse
Affiliation(s)
- Laurent Mathieu
- Department of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France. .,Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 75005, Paris, France.
| | - Soryapong Plang
- Department of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
| | - Nicolas de l'Escalopier
- Department of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
| | - James Charles Murison
- Department of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
| | - Christophe Gaillard
- Department of Orthopedics and Trauma Surgery, Edouard Herriot Hospital, 69003, Lyon, France
| | - Antoine Bertani
- Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 75005, Paris, France.,Department of Orthopedics and Trauma Surgery, Edouard Herriot Hospital, 69003, Lyon, France
| | - Frédéric Rongieras
- Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 75005, Paris, France.,Department of Orthopedics and Trauma Surgery, Edouard Herriot Hospital, 69003, Lyon, France
| |
Collapse
|
27
|
de Carbonnières A, Moritz C, Destan C, Daban JL, Boddaert G, Bonnet S, Hornez E. A decade in the battlefield (2004-2014): A French military perspective on the high mortality associated with non-exclusively orthopedic or brain combat injuries. Injury 2020; 51:2046-2050. [PMID: 32451146 DOI: 10.1016/j.injury.2020.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND During the last few decades, French armed forces have regularly deployed in asymmetric conflicts. Surgical support for casualties of these conflicts occurs in NATO role 2 and 3 medical treatment facilities (MTF); definitive surgical care occurs in France following a strategic medical evacuation. The aim of this study was to describe the combat injury profile of these soldiers who presented with either non-exclusively orthopedic and/or brain injuries. METHODS This descriptive study is a retrospective analysis of the surgical management of French casualties performed in role 2 or 3 MTF in Afghanistan, Mali, Niger, Djibouti and the Central African Republic between January 2004 and December 2014. RESULTS One hundred patients were included. Forty had fragment wounds. The most severe lesions were of the head, neck or thorax. The average injury severity score (ISS) was 34.9 (IC 95% 29.8-40). 17 damage control procedures were performed. Thirty patients died with a mean ISS of 61 (IC 95% 56-67); 5 deaths were considered as preventable. The most frequent surgical procedures in the MTF were digestive (n=31) and thoracic surgery (n=19). Thirty patients needed second-look surgery in France; eleven had severe complications. No patient died following medical evacuation to France. CONCLUSIONS Results from this study indicated that the mortality following non-exclusively brain or orthopedic injuries remains high in modern asymmetric conflicts. Level of Evidence IV.
Collapse
Affiliation(s)
- Anne de Carbonnières
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Céline Moritz
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Clément Destan
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Jean-Louis Daban
- Critical care department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - Guillaume Boddaert
- Thoracic surgery, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France; French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France
| | - Stéphane Bonnet
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France.; French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France
| | - Emmanuel Hornez
- Digestive surgery department, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France.; French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France..
| |
Collapse
|
28
|
Choufani C, Demoures T, de l'Escalopier N, Chapon MP, Barbier O, Mathieu L. Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad. Eur J Trauma Emerg Surg 2020; 48:593-599. [PMID: 32857239 DOI: 10.1007/s00068-020-01471-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/21/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. METHODS A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application. RESULTS Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage. CONCLUSIONS This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures.
Collapse
Affiliation(s)
- Camille Choufani
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France.
| | - Thomas Demoures
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France
| | - Nicolas de l'Escalopier
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
| | - Marie-Pauline Chapon
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France
| | - Olivier Barbier
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France
- French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Laurent Mathieu
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
- French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005, Paris, France
| |
Collapse
|
29
|
Choufani C, Barbier O, Demoures T, Mathieu L, Rigal S. Evaluation of a fellowship abroad as part of the initial training of the French military surgeon. BMJ Mil Health 2020; 167:168-171. [PMID: 32015183 DOI: 10.1136/jramc-2019-001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment. METHODS This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment. RESULTS Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10. CONCLUSION A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.
Collapse
Affiliation(s)
- Camille Choufani
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - O Barbier
- Orthopedic and Traumatology, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - T Demoures
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - L Mathieu
- Department of Orthopaedic, Trauma and Reconstructive Surgery, HIA Percy, Clamart, France
| | - S Rigal
- Department of Traumatology and Orthopedics, HIA Percy, Clamart, France
| |
Collapse
|
30
|
Joubert C, Cungi PJ, Esnault P, Sellier A, de Lesquen H, Avaro JP, Bordes J, Dagain A. Surgical management of spine injuries in severe polytrauma patients: a retrospective study. Br J Neurosurg 2019; 34:370-380. [PMID: 31771363 DOI: 10.1080/02688697.2019.1692787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Optimal surgical management of spinal injuries as part of life-threatening multiple traumas remains challenging. We provide insights into the surgical management of spinal injuries in polytrauma patients. Methods: All patients from our polytrauma care network who both met at least one positive Vittel criteria and an injury severity score (ISS) >15 at admission and who underwent surgery for a spinal injury were included retrospectively. Demographic data, clinical data demonstrating the severity of the trauma and imaging defining the spinal and extraspinal number and types of injuries were collected.Results: Between January 2012 and December 2016, 302 (22.2%) patients suffered from spinal injury (143 total injuries) and 83 (6.1%) met the inclusion criteria. Mean ISS was 36.2 (16-75). Only 48 (33.6%) injuries led to neurological impairment involving the thoracic (n = 23, 16.1%) and lower cervical (n = 15, 10.5%) spine. The most frequent association of injuries involved the thoracic spine (n = 42). 106 spinal surgeries were performed. The 3-month mortality rate was 2.4%.Conclusions: We present data collected on admission and in the early postoperative period referring to injury severity, the priority of injuries, and development of multi-organ failure. We revealed trends to guide the surgical support of spinal lesions in polytrauma patients.
Collapse
Affiliation(s)
- C Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - P-J Cungi
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France
| | - P Esnault
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France
| | - A Sellier
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - H de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon, France
| | - J-P Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| | - J Bordes
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| | - A Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| |
Collapse
|
31
|
Swiech A, de Rocquigny G, Martinez T, Loarer G, Vico S, Planchon J, Le Goff A, Bertho K, Derkenne C, Travers S, Malgras B, Martinaud C, Carfantan C, Gaudry S, Boutonnet M, Pasquier P. Terrorist threat: Creating a nationwide damage control training program for non-trauma care providers. Anaesth Crit Care Pain Med 2019; 39:59-64. [PMID: 31614243 DOI: 10.1016/j.accpm.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The current terrorist threat challenges nations to train numerous non-trauma care providers with different backgrounds in damage control (DC) strategies. The purpose of this work was to propose a specific DC training program. METHODS A Task Force of 16 civilian and military physicians met for a 24-hour session, to propose the construction of a DC training program for non-specialised caregivers. RESULTS Existing DC training programs are heterogeneous, mainly theoretical and almost only for physicians. A program entitled Damage Control for Terrorist Attack Victims (DC-TAV) was then proposed. Identified training targets were care providers from prehospital and hospital staffs, with no experience in trauma care. The training objectives were the improvement of individual and collective skills in managing terrorist attacks casualties. The tools selected for training concerned e-learning on a dedicated digital teaching platform (including a core section of four modules with types and mechanisms of injury, basic DC techniques, triage, organisation of emergency medical response and two complementary modules for doctors with DC resuscitation including remote transfusion and DC surgery), hands-on workshops with procedural simulation and full-scale simulation exercises, technical (tourniquets, haemostatic gauzes, needle thoracostomy, chest tube drainage, management of airway, coniotomy) and non-technical (leadership, communication, coordination and triage, decision-making, appropriate use of resources) skills. Finally, an evaluation of the DC-TAV program was planned. CONCLUSIONS The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
Collapse
Affiliation(s)
- Astrée Swiech
- Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France.
| | - Gaël de Rocquigny
- Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France; École du Val-de-Grâce, 75005 Paris, France.
| | - Thibault Martinez
- Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France.
| | - Gwion Loarer
- Direction centrale du service de santé des armées, Paris, France.
| | - Sylvain Vico
- Hôpital d'instruction des armées Sainte-Anne, Toulon, France.
| | - Jérôme Planchon
- Hôpital d'instruction des armées Bégin, Saint-Mandé, France.
| | | | - Kilian Bertho
- Brigade des sapeurs pompiers de Paris, Paris, France.
| | | | - Stéphane Travers
- École du Val-de-Grâce, 75005 Paris, France; 12°, antenne médicale, Villacoublay, France.
| | - Brice Malgras
- École du Val-de-Grâce, 75005 Paris, France; Hôpital d'instruction des armées Bégin, Saint-Mandé, France.
| | - Christophe Martinaud
- École du Val-de-Grâce, 75005 Paris, France; Centre de transfusion sanguine des armées, Clamart, France.
| | | | | | - Mathieu Boutonnet
- Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France.
| | - Pierre Pasquier
- Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France; École du Val-de-Grâce, 75005 Paris, France.
| |
Collapse
|
32
|
Dupre HL, Brocq FX, Chueca M, Loriau J. Damage control surgery: From training to practice. J Visc Surg 2019; 156:368-369. [PMID: 31229449 DOI: 10.1016/j.jviscsurg.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- H-L Dupre
- Service d'Anesthésie-Réanimation, Hôpital d'instruction des Armées Saint Anne, boulevard St Anne, 83200 Toulon, France.
| | - F-X Brocq
- Service d'expertise des personnels naviguant, Hôpital d'instruction des Armées Saint Anne, boulevard St Anne, 83200 Toulon, France.
| | - M Chueca
- Service de Transfusion sanguine des Armées, Hôpital d'instruction des Armées Percy, France.
| | - J Loriau
- Service de chirurgie digestive, Groupe Hospitalier Paris St Joseph, 75014 Paris, France; 2(e) centre médical des Armées Versailles, 78100 St Germain en Laye, France.
| |
Collapse
|
33
|
Coventry CA, Holland AJA, Read DJ, Ivers RQ. Australasian general surgical training and emergency medical teams: a review. ANZ J Surg 2019; 89:815-820. [PMID: 31066168 DOI: 10.1111/ans.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
Emergency medical teams (EMTs) have provided surgical care in sudden-onset disasters in low- and middle-income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high-income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden-onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.
Collapse
Affiliation(s)
- Charles A Coventry
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
34
|
Malgras B, Aoun O, Pauleau G, Boddaert G, Hornez E, Dulou R, Delmas JM, Haen P, Laversanne S, Crambert A, Balandraud P. Deployment of the Surgical Life-saving Module (SLM) in 2017: Lessons learned in setting up and training operational surgical units. Injury 2019; 50:1133-1137. [PMID: 30851979 DOI: 10.1016/j.injury.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/13/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The military operations carried out by the French armed forces, occasionally require the use of the Surgical Life-saving Module (SLM), to ensure the surgical support of its soldiers. Due to its extreme mobility and capacity of fast deployment, SLM is particularly useful in small-scale military operations, such as Special Forces missions. In 2017, the French SLM was for the first time used to ensure surgical support of allied forces, which were lacking forward surgical capabilities. MATERIALS AND METHODS the SLM is a mobile, heliborne, airborne, surgical structure with parachuting capability onto land or sea, therefore essentially focused on life-saving procedures, also known as "damage control" surgery. Due to the need for mobility and rapid implementation, the SLM is limited to a maximum of 5 interventions or, in terms of injuries, to 1 or 2 seriously injured patients. RESULTS Over a period of 2 months, 5 medical teams were successively deployed with the SLM. A total of 157 casualties were treated. The most common injuries were caused by shrapnel 561%), followed by firearms (36%), and blunt trauma (2.5%). Injuries included the limbs (56%), thorax (18%), abdomen (13%), head (11%), and neck (2%). The average ISS was 8.5 (1-25) with 26 patients presenting with an ISS greater than or equal to 15. The average NISS was 10.8 (1-75) with 34 casualties having an NISS equal to or greater than 15. The surgical procedures were broken down as follows: 126 dressings, 16 laparotomies, 7 thoracotomies, 12 isolated thoracic drains (without thoracotomy), 1 cervicotomy, 12 amputations, 7 limb splints, 2 limb fasciotomies, 2 external fixators and 1 femoral fracture traction. CONCLUSIONS The numerous SLM deployments in larger operations highlighted its ability to adapt both in terms of equipment and personnel. Continuous management of equipment logistics, robust personnel training, and appropriate organization of the evacuation procedures, were the key elements for optimizing combat casualty care. As a consequence, the SLM appears to be an operational surgical unit of choice during deployments.
Collapse
Affiliation(s)
- Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France.
| | - Olivier Aoun
- 5th Armed Forces Medical Center, Strasbourg, France
| | - Ghislain Pauleau
- Department of Gastrointestinal Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Guillaume Boddaert
- Department of Gastrointestinal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Emmanuel Hornez
- Department of Gastrointestinal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Renaud Dulou
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Haen
- Departmet of Maxillofacial Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Sophie Laversanne
- Departmet of Maxillofacial Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Anna Crambert
- Department of Otorhinolaryngology, Percy Military Teaching Hospital, Clamart, France
| | - Paul Balandraud
- Department of Gastrointestinal Surgery, Saint-Anne Military Teaching Hospital, Toulon, France
| |
Collapse
|
35
|
Re: Neurosurgical activity by deployed military non-neurosurgeons: Is predeployment training enough? J Trauma Acute Care Surg 2018; 85:1130-1131. [PMID: 30462624 DOI: 10.1097/ta.0000000000002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Turégano Fuentes F, Pérez Díaz D. Teaching courses in the management of visceral trauma. Cir Esp 2018; 96:606-611. [PMID: 30554595 DOI: 10.1016/j.ciresp.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
Several changes introduced in the management of trauma during the last two decades have considerably decreased the practical exposure to bleeding trauma patients by residents and young surgeons. Hemorrhage still represents the second cause of death from trauma worldwide, and the surgical maneuvers required for its control must be learned and practised in specific courses. These courses address the "second hour" of trauma, beyond ATLS©, and also emphasize the decision-making process, communication among team members, and discussion of clinical scenarios. The significant progress made in simulation technologies and virtual reality systems have yet to replace living tissue models to train surgeons in the rapid control of active bleeding, although that replacement is probably not far away.
Collapse
Affiliation(s)
| | - Dolores Pérez Díaz
- Sección de Cirugía de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España
| |
Collapse
|
37
|
Barbier O, Racle M. Has Current French Training for Military Orthopedic Surgeons Deployed in External Operations Been Appropriately Adapted? Mil Med 2018; 183:e411-e415. [DOI: 10.1093/milmed/usy013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/09/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Barbier
- Orthopaedic Department, Begin Military Teaching Hospital, 69, avenue de Paris, Saint-Mandé, France
| | - Maelle Racle
- 1st Military Medical Center, Medical Unit of Vincennes, Cours des Maréchaux, Paris Cedex, France
| |
Collapse
|
38
|
|
39
|
Breeze J, Blanch R, Baden J, Monaghan AM, Evriviades D, Harrisson SE, Roberts S, Gibson A, MacKenzie N, Baxter D, Gibbons AJ, Heppell S, Combes JG, Rickard RF. Skill sets required for the management of military head, face and neck trauma: a multidisciplinary consensus statement. J ROY ARMY MED CORPS 2018; 164:133-138. [DOI: 10.1136/jramc-2017-000881] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
IntroductionThe evolution of medical practice is resulting in increasing subspecialisation, with head, face and neck (HFN) trauma in a civilian environment usually managed by a combination of surgical specialties working as a team. However, the full combination of HFN specialties commonly available in the NHS may not be available in future UK military-led operations, necessitating the identification of a group of skill sets that could be delivered by one or more deployed surgeons.MethodA systematic review was undertaken to identify those surgical procedures performed to treat acute military head, face, neck and eye trauma. A multidisciplinary consensus group was convened following this with military HFN trauma expertise to define those procedures commonly required to conduct deployed, in-theatre HFN surgical combat trauma management.ResultsHead, face, neck and eye damage control surgical procedures were identified as comprising surgical cricothyroidotomy, cervico-facial haemorrhage control and decompression of orbital haemorrhage through lateral canthotomy. Acute in-theatre surgical skills required within 24 hours consist of wound debridement, surgical tracheostomy, decompressive craniectomy, intracranial pressure monitor placement, temporary facial fracture stabilisation for airway management or haemorrhage control and primary globe repair. Delayed in-theatre procedures required within 5 days prior to predicted evacuation encompass facial fracture fixation, delayed lateral canthotomy, evisceration, enucleation and eyelid repair.ConclusionsThe identification of those skill sets required for deployment is in keeping with the General Medical Council’s current drive towards credentialing consultants, by which a consultant surgeon’s capabilities in particular practice areas would be defined. Limited opportunities currently exist for trainees and consultants to gain experience in the management of traumatic head, face, neck and eye injuries seen in a kinetic combat environment. Predeployment training requires that the surgical techniques described in this paper are covered and should form the curriculum of future military-specific surgical fellowships. Relevant continued professional development will be necessary to maintain required clinical competency.
Collapse
|
40
|
Cai YL, Ju JT, Liu WB, Zhang J. Military Trauma and Surgical Procedures in Conflict Area: A Review for the Utilization of Forward Surgical Team. Mil Med 2017. [DOI: 10.1093/milmed/usx048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yi-Ling Cai
- Faculty of Navy Medicine, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China
| | - Jin-Tao Ju
- Faculty of Navy Medicine, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China
| | - Wen-Bao Liu
- Faculty of Navy Medicine, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, China
| | - Jian Zhang
- Department of General Surgery, Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China
| |
Collapse
|
41
|
Bonnet S, Gaujoux S. War in civilian life: what we should all know. J Visc Surg 2017; 154 Suppl 1:S1-S2. [PMID: 28941566 DOI: 10.1016/j.jviscsurg.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Bonnet
- Service de chirurgie viscérale et générale, hôpital d'instruction des Armées-Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.
| | - S Gaujoux
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014, Paris, France; Université Paris Descartes, 75006 Paris, France
| |
Collapse
|
42
|
Beranger F, Lesquen HD, Aoun O, Roqueplo C, Meyrat L, Natale C, Avaro JP. Management of war-related vascular wounds in French role 3 hospital during the Afghan campaign. Injury 2017. [PMID: 28622832 DOI: 10.1016/j.injury.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the management of war-related vascular injuries in the Kabul French military hospital. METHODS From January 2009 to April 2013, in the Kabul French military hospital, we prospectively included all patients presenting with war-related vascular injuries. We collected the following data: site, type, and mechanism of vascular injury, associated trauma, type of vascular repair, amputation rate and complications. RESULTS Out of the 922 soldiers admitted for emergency surgical care, we recorded 45 (5%) patients presenting with vascular injuries: 30 (67%) gunshot-related, 11 (24%) explosive device-related, and 4 (9%) due to road traffic accident. The majority of injuries (93%) involved limbs. Vascular injuries were associated with fractures in 71% of cases. Twelve (26.7%) had an early amputation performed before evacuation. Twenty (44.4%) patients underwent fasciotomy and three (6.6%) sustained a compartment syndrome. CONCLUSIONS This was the first French reported series of war-related vascular injuries during the last decade's major conflicts. The majority of injuries occurred in the limbs. Autologous vein graft remains the treatment of choice for arterial repair. Functional severity of these injuries justifies specific training for military surgeons.
Collapse
Affiliation(s)
- Fabien Beranger
- Department of Vascular and Thoracic Surgery, Sainte-Anne Military Teaching Hospital, Toulon, 83 800, France.
| | - Henri De Lesquen
- Department of Vascular and Thoracic Surgery, Sainte-Anne Military Teaching Hospital, Toulon, 83 800, France
| | - Olivier Aoun
- Strasbourg Armed Forces Medical Center, Strasbourg, 67000, France
| | - Cédric Roqueplo
- Strasbourg Armed Forces Medical Center, Strasbourg, 67000, France
| | - Léon Meyrat
- Department of Vascular and Thoracic Surgery, Sainte-Anne Military Teaching Hospital, Toulon, 83 800, France
| | - Claudia Natale
- Department of Vascular and Thoracic Surgery, Sainte-Anne Military Teaching Hospital, Toulon, 83 800, France
| | - Jean-Philippe Avaro
- Department of Vascular and Thoracic Surgery, Sainte-Anne Military Teaching Hospital, Toulon, 83 800, France
| |
Collapse
|
43
|
Maintaining clinical competencies of military surgeons at the beginning of the 21st century: the French paradigm. J Trauma Acute Care Surg 2017; 83:562-563. [PMID: 28609382 DOI: 10.1097/ta.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Back DA, Waldmann K, Hauer T, Huschitt N, Bowyer MW, Wesemann U, Lieber A, Willy C. Concept and evaluation of the German War Surgery Course - Einsatzchirurgie-Kurs der Bundeswehr. J ROY ARMY MED CORPS 2016; 163:206-210. [PMID: 27909067 DOI: 10.1136/jramc-2016-000706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgeons must be prepared to care for severe and complex life-threatening injuries rarely seen in the civilian setting. Typical civilian training and practice do not provide adequate exposure to the broad set of surgical skills required. The German Bundeswehr Medical Service has developed and refined the War Surgery Course (WSC) to meet this training gap. This article describes the recent experience with this readiness curriculum. METHODS Run annually since 1998, WSC consists nowadays of 5 days with 20 theoretical modules. Four sessions with standardised practical skills training use a live tissue porcine model, and the recently added cadaver-based Advanced Surgical Skills for Exposure in Trauma course. Sixteen military surgeons who participated in the WSC in January 2016 completed a survey of their self-rated readiness for 114 predefined emergency skills before and after completion, and provided an overall evaluation of the course. RESULTS Self-assessed readiness improved significantly over baseline for all areas covered in both the practical skills and theoretical knowledge portions of the WSC curriculum. Additionally, all participants rated the course as important and universally recommended it to other military surgeons preparing for missions. CONCLUSIONS The WSC course format was well received and perceived by learners as a valuable readiness platform. Ongoing evaluation of this course will enable data-driven evolution to ensure a maximum learning benefit for participants. With the increasing multinational nature of modern military missions, surgeons' training should follow international standards. Continuing evolution of military surgical training courses should further encourage the sharing and adoption of best educational practices.
Collapse
Affiliation(s)
- David A Back
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.,Dieter Scheffner Center for Medical Education and Educational Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Waldmann
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - T Hauer
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - N Huschitt
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - M W Bowyer
- Division of Trauma and Combat Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - U Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - A Lieber
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.,Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - C Willy
- Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| |
Collapse
|