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01/05/2015

Medevac tactique:Médicalisation utile pour 30% des blessés

En-Route Care Capability From Point of Injury Impacts Mortality After Severe Wartime Injury

Morrison JJ et AL. Ann Surg 2013;257: 330–334

 

Il est difficile de se faire une idée de l'efficience de nos organisations de relève des blessés de guerre. En effet les 2/3 de ses derniers sont peu graves et ne nécessitent pas de pratiques avancées. Le conflit afghan a permis de confirmer la pertinence d'un certain nombre de faits: Une stratégie de conditionnement basé sur l'analyse des causes évitables de décès, l'importance de la mise en place d'un réseau structuré de prise en charge préhospitalière et hospitalière. Ce document confirme que la médicalisation avancée améliore la probabilité de survie des  blessés de gravité intermédiaire qui représentent tout de même près du  1/3 des cas rencontrés et qui justifient nos organisations. Ceci confirme que la maîtrise de pratiques de base de réanimation préhospitalière devrait donc être l'un des piliers de l'organisation des évacuations médicales tactiques. 

 

OBJECTIVE:

The objective of this study is to characterize modern point-of-injury (POI) en-route care platforms and to compare mortality among casualties evacuated with conventional military retrieval (CMR) methods to those evacuated with an advanced medical retrieval (AMR) capability.

BACKGROUND:

Following a decade of war in Afghanistan, the impact of en-route care capabilities from the POI on mortality is unknown.

METHODS:

Casualties evacuated from POI to one level III facility in Afghanistan (July 2008-March 2012) were identified from UK and US trauma registries. Groups comprised those evacuated by a medically qualified provider-led, AMR and those by a medic-led CMR capability. Outcomes were compared per incremental Injury Severity Score (ISS) bins.

RESULTS:

Most casualties (n = 1054; 61.2%) were in the low-ISS (1-15) bracket in which there was no difference in en-route care time or mortality between AMR and CMR. Casualties in the mid-ISS bracket (16-50) (n = 583; 33.4%) experienced the same median en-route care time (minutes) on AMR and CMR platforms [78 (58) vs 75 (93); P = 0.542] although those on AMR had shorter time to operation [110 (95) vs 117 (126); P < 0.001]. In this mid-ISS bracket, mortality was lower in the AMR than in the CMR group (12.2% vs 18.2%; P = 0.035). In the high-ISS category (51-75) (n = 75; 4.6%), time to operation was lower in the AMR than the CMR group (66 ± 77 vs 113 ± 122; P = 0.013) but there was no difference in mortality.

CONCLUSIONS:

This study characterizes en-route care capabilities from POI in modern combat. Conventional platforms are effective in most casualties with low injury severity. However, a definable injury severity exists for which evacuation with an AMR capability is associated with improved survival.

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