24/10/2023
Chirurgie à l'avant. L'histoire enseigne de petites structures proches des combats
Surgery on the battlefield: Mobile surgical units in the Second World War and the memoirs they produced
Venables KM J Med Biogr. 2023 Aug; 31(3): 202–211.
In the Second World War, there was a flowering of the battlefield surgery pioneered in the Spanish Civil War. There were small, mobile surgical units in all the theatres of the War, working close behind the fighting and deployed flexibly according to the nature of the conflict. With equipment transported by truck, jeep or mule, they operated in tents, bunkers and requisitioned buildings and carried out abdominal, thoracic, head and neck, and limb surgery. Their role was to save life and to ensure that wounded soldiers were stable for casualty evacuation back down the line to a base hospital.
There is a handful of memoirs by British doctors who worked in these units and they make enthralling reading. Casualty evacuation by air replaced the use of mobile surgical units in later wars, throwing into doubt their future relevance in the management of battle wounds. But recent re-evaluations by military planners suggest that their mobility still gives them a place, so the wartime memoirs may have more value than simply as war stories.
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
------------------------------------
Un outil sans nul doute à maîtriser à la lumière des événements ukrainiens
------------------------------------
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
14/11/2022
Plaidoyer AUSSIE pour + de technicité à l'avant
Treatment at point of injury—A proposal for an enhanced combat first aider and health technician skillset
Pilgrim C. et Al. JMVH 2022, oncline first
Management of trauma in the future operating environment might be significantly different from the recent experience in the Middle East Region if it were to occur in the context of hostilities between coalition, including Australian forces and a near-peer or peer-level threat. Specifically, reliance on rotary-wing aeromedical evacuation may be compromised if air superiority is degraded or denied.
Two alternative approaches may be considered in the context of constrained evacuation capability. First, enhanced treatment of the injured soldier on the ground at or near the point of injury by first responders may broaden the window during which a patient may survive on the battlefield awaiting evacuation. Alternatively, moving the surgical resources to the casualty may also improve the chances of survival for an injured soldier. However, this comes at the cost of risking higher-level assets. The first of these approaches is considered here with an exploration of what life-saving interventions (LSI) can be delivered by first responder soldiers. Numerically dropping as a result of tactical combat casualty care principles but persisting as causes of preventable battlefield death, exsanguinating extremity haemorrhage, tension pneumothorax and airway obstruction are areas where future gains may be possible with an expanded skillset deliverable by combat first aiders and health technicians.
Earlier administration of blood products by health technicians to casualties with exsanguinating haemorrhage would align military trauma management principles with the civilian world, where blood products can now be administered en route by trained paramedics. Similarly, there is a shift towards managing tension pneumothorax with finger thoracostomy in preference to needle decompression in the hospital and pre-hospital environment in the civilian sector.
Of much greater complexity, management of non-compressible truncal haemorrhage remains problematic on the battlefield. A highly specialised intervention with significant haemodynamic consequences that nevertheless has been shown to be achievable in both military and civilian contexts is REBOA (resuscitative endovascular balloon occlusion of the aorta). This technique is encumbered with a significant training burden but warrants discussion and is most relevant when evacuation times are expected to fall between 1 and 6 hours. Expanding the skillset deliverable by combat first aiders and health technicians may offset delays in evacuation and maintain battlefield casualty survival in the future operating environment and may be obtained leveraging existing Defence training programs.
16/09/2022
La chirurgie: Encore plus à l'avant
Treatment at Point of Injury. Forward movement of surgical assets to address non compressible truncal haemorrhage
Pilgrim CHC et Al. JMVH 2022, 30: 41-50.
-----------------------------------------------------
C'est la chirurgie qui va sauver les blessés du tronc. Encore faut il que ces blessés soient pris en charge par une équipe chirurgicale. D'où le principe de constituer de petites équipes chirurgicales mettant en oeuvre des techniques choisies et limitées dans un environnement très austère au plus près des combats. C'est le principe du module de chirurgie vitale. Les combats actuels (haute intensité mais avec des effectifs plutôt limités) prônent pour le développement de cette stratégie. Le document présenté est une réflexion australienne en la matière.
-----------------------------------------------------
Contemporary battlefield trauma surgery in the Middle East Region has been characterised by aeromedical evacuation by rotatory wing (RWAME) with relative impunity. Therefore, future health planning needs to consider an environment whereby RWAME movement may be degraded or denied by a near-peer, peer or superior threat. To that end, an exploration of alternative approaches to surgical management of injured personnel is pertinent. Life-saving surgical intervention may be delivered by deploying mobile surgical assets forward rather than
relying on evacuation of casualty rearward. Shortly after the arrival of surgical resources to the point of injury, temporising damage control procedures may begin, removing the delay associated with casualty preparation, package and transfer. Essentially, the concept is to significantly augment Role 1 activities for a time-limited period to increase the evacuation window allowing patients to survive that would otherwise die on the battlefield if rapid evacuation capability was degraded or denied. An exploration of the surgical procedures, anaesthetic considerations and transport logistics associated with these interventions is presented in this paper. Limitations on the concept include tactical training requirement of forward deployed medical staff, definition and description of surgical intervention offered and prerequisite civilian skillset, attendant load list, and considerations of anaesthetic delivery and casualty hold elements.
05/07/2022
Risques biologiques émergents: Etre prêts ?
A Hierarchy of Medical Countermeasures Against Biological Threats
05/04/2021
Combat Urbain: Naplouse