19/01/2023
Le drone: Incontournable !
Drones reduce the treatment-free interval in search and rescue operations with telemedical support – A randomized control trial
Van Veelen MJ et Al. https://doi.org/10.1016/j.ajem.2023.01.020
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Un outil sans nul doute à maîtriser à la lumière des événements ukrainiens
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Introduction
Response to medical incidents in mountainous areas is delayed due to the remote and challenging terrain. Drones could assist in a quicker search for patients and can facilitate earlier treatment through delivery of medical equipment. We aim to assess the effects of drone deployment in search and rescue (SAR) operations in challenging terrain. We hypothesize that drones can reduce the search time and treatment-free interval of patients through initiation of telemedicine in a single mission.
Methods
In this randomized control trial with a cross-over design two methods of searching for and initiating treatment of a patient were compared. The primary outcome was a comparison of the times for locating a patient through visual contact and starting treatment on-site between the drone assisted intervention arm and the conventional ground rescue control arm. A linear mixed model (LMM) was used to evaluate the effect of using a drone on search and start of treatment times.
Results
Twenty-four SAR missions, performed by six SAR teams each with four team members, were analyzed. The mean time to locate the patient was 14.6 min (95% CI 11.3–17.9) in the drone assisted intervention arm and 20.6 min (95% CI 17.3–23.9) in the control arm. The mean time to start treatment was 15.7 min (95% CI 12.4–19.0) in the drone assisted arm and 22.4 min (95% CI 19.1–25.7) in the control arm ( p < 0.01 for both comparisons).
Conclusion
Drone deployment in SAR operations leads to a reduction in search time and treatment-free interval of patients in challenging terrain, which could improve outcomes in patients suffering from traumatic injuries, the most commonly occurring incident requiring mountain rescue deployment.
| Tags : drone
23/10/2022
Drone: Pour quoi faire ?
SOFINS 2019: A quoi pourrait servir un drone pour le soutien médical du combattant ?
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| Tags : drone
05/07/2022
Risques biologiques émergents: Etre prêts ?
A Hierarchy of Medical Countermeasures Against Biological Threats
08/06/2022
Trauma Prehospitalier: Aides
| Tags : traumatologie
14/03/2021
Hydrazine: Qu'est ce que c'est ?
The Toxicity, Pathophysiology, and Treatment of Acute Hydrazine Propellant Exposure: A Systematic Review
Nguyen HN et Al. Mil Med. 2021 Feb 26;186(3-4):e319-e326.
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L'hydrazine est employé comme combustible dans les fusées et dans les F16 américains en tant que combustible alimentant une unité de puissance de secours. Et cela n'est pas sans conséquence lors d'une intervention auprès d'un tel type d'aéronef.
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Introduction:
Hydrazines are highly toxic inorganic liquids that are used as propellants in military and aviation industries, such as the U.S. Air Force F-16 Emergency Power Unit and SpaceX SuperDraco Rockets. The most commonly used derivatives include hydrazine, monomethylhydrazine, and 1,1-dimethylhydrazine (unsymmetrical dimethylhydrazine). Industrial workers in close contact with hydrazines during routine maintenance tasks can be exposed to levels well above the National Institute for Occupational Safety and Health relative exposure limits.
Materials and methods: A systematic review was performed using PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration Technical Server, and Defense Technical Information Center, and data related to hydrazine exposures were searched from inception to April 2020. Publications or reports addressing hydrazine toxicity, pathophysiology, and treatment of hydrazine fuel exposure were selected.
Results: Acute toxic exposures to hydrazine and its derivatives are rare. There are few case reports of acute toxic exposure in humans, and data are largely based on animal studies. The initial search identified 741 articles, manuscripts, and government reports. After screening for eligibility, 51 were included in this review. Eight articles reported acute exposures to hydrazine propellant in humans, and an additional 14 articles reported relevant animal data.
Conclusions: Exposure to small amounts of hydrazine and its derivatives can cause significant soft tissue injury, pulmonary injury, seizures, coma, and death. Neurologic presentations can vary based on exposure compound and dose. Decontamination is critical as treatment is mainly supportive. High-dose intravenous pyridoxine has been suggested as treatment for hydrazine-related neurologic toxicity, but this recommendation is based on limited human data. Despite recent research efforts to generate less toxic alternatives to hydrazine fuel, it will likely continue to have a role in military and aviation industries. Aerospace and military physicians should be aware of the toxicity associated with hydrazine exposure and be prepared to treat hydrazine toxicity in at-risk populations.
10/01/2020
Plaie du coeur: Un retex brestois
Un cas clinique peu fréquent mais classique de plaie du coeur par balle où tous les grands principes du sauvetage au combat se retrouvent.
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03/01/2020
Les brûlures
Le blessé de guerre
Secours en milieu périilleux
Le blessé par attentat terroriste
13/09/2019
Médecine et parachutisme dans les armées
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12/09/2019
Ophtalmologie de guerre
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16/04/2019
FST, chirurgie et USAparticulièrement innovant
Où comment faire évoluer la chirurgie de guerre par la mise en place d'un écosystème spécifique
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TCCC: Un écosystème spécifique
Un regard sur l'émergence des nouvelles modalités de prise en charge des blessés de guerre avec pour point d'orgue l'innovation conduite et la construction d'un écosystème complet autour de la prise en charge du blessé de guerre. Une démarche à comprendre et à bien méditer.
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19/03/2019
ATLS 9ème Edition
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13/12/2018
Rétrospective sur les missions du SSA
A lire pour avoir une image actualisée du SSA. Certes peine à la peine mais, fidèle à ses traditions, n'a manifestement pas chômé ses dernières années
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09/12/2018
Tuerie massive: Les 30 premières min.
3 Echo: concept of operations for early care and evacuation of victims of mass violence
This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance.
This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.
07/12/2018
K comme Killer ?
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K comme Killer ? Peut être pas, mais en tous cas plus fréquent que l'on croit.
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OBJECTIVE:
Fixed facilities and rapid global evacuation ensured that delayed complications of trauma, such as hyperkalemia, occurred late in the evacuation chain where renal replacement therapies were available. However, future conflicts or humanitarian disasters may involve prolonged evacuation times. We sought to quantify one potential risk of delayed evacuation by assessing hyperkalemia in combat casualties.
METHODS:
Retrospective study of military members admitted to intensive care units in Iraq and Afghanistan from February 1, 2002, to February 1, 2011. This study was approved by the U.S. Army Medical Research and Materiel Command Institutional Review Board. Demographics, injury severity score, burn injury, mechanism of injury, vital signs, creatinine, and potassium were collected. Logistic regression models were used to identify incidence and risk factors for hyperkalemia.
RESULTS:
Of 6,011 patient records, 1,472 had sufficient data to be included for analysis. Hyperkalemia occurred in 5.8% of patients. Those with hyperkalemia had higher injury severity scores, higher shock index, were more likely to have acute kidney injury, and were more likely to die. On multivariate analysis, acute kidney injury and shock index were significantly associated with the development of hyperkalemia. In a subgroup of patients with data on creatine kinase, rhabdomyolysis was associated with hyperkalemia in the univariate model, but was not significant after adjustment.
CONCLUSION:
Hyperkalemia occurred in 5.8% of patients in our cohort of critically injured combat casualties. The development of hyperkalemia was independently associated with acute kidney injury and shock index. In future conflicts, with prolonged evacuation times, mitigation strategies should be developed to treat hyperkalemia in casualties before arrival at definitive care.
01/11/2018
Combat urbain: Problématique
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08/10/2018
Military Medicine: Numéro spécial 2018
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