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01/05/2019

TCCC: Quoi de réalisé en réalité ?

 Prehospital Interventions Performed in Afghanistan Between November 2009 and March 2014.

Lairet J et l Mil Med. 2019 Mar 1;184(Supplement_1):133-137. doi: 10.1093/milmed/usy311.

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Le bilan des gestes réalisés par les US en afghanistan. Ces chiffres montrent l'importance tant de l'acquisition de pratiques gestuelles que et surtout du  maintien des avoirs faire. La gestion des voies aériennes et les gestes de décompression thoracique représentent un enjeu majeur de performance bien plus importan que la maîtrise par quelques uns de techniques d'occlusion endovasculaire préhospitalière.

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OBJECTIVE: Care provided to a casualty in the prehospital combat setting can influence subsequent medical interactions and impact patient outcomes; therefore, we aimed to describe the incidence of specific prehospital interventions (lifesaving interventions (LSIs)) performed during the resuscitation and transport of combat casualties.

METHODS: We performed a prospective observational, IRB approved study between November 2009 and March 2014. Casualties were enrolled as they were cared for at nine U.S. military medical facilities in Afghanistan. Data were collected using a standardized collection form. Determination if a prehospital intervention was performed correctly, performed incorrectly, or was necessary but was not performed (missed LSIs) was made by the receiving facility's medical provider.

RESULTS: Two thousand one hundred and six patients met inclusion criteria. The mean age was 25 years and 98% were male. The most common mechanism of injury was explosion 57%. There were 236 airway interventions attempted, 183 chest procedures, 1,673 hemorrhage control, 1,698 vascular access, and 1,066 hypothermia preventions implemented.

Incorrectly Performed Interventions Comparison of First 1,003 Patients to Second 1,103 Patients

  Overall Data  Interima (n = 1,003)  Post-Interim (1,103)  p-Valueb 
Airway Interventions  8.9%  8.6%  9.0%  0.9165 
Chest Procedures  5.5%  6.7%  5.2%  0.6726 
Vascular Access  4.1%  8.0%  2.9%  <0.0001 
Hypothermia Prevention  0.6%  0.7%  0.5%  0.6860 
Hemorrhage Control  2.1%  2.2%  2%  0.8643 

 

Missed LSIs 
  Number of Missed LSIs  Total Number of Interventions + Missed Opportunities  Percentage of Missed LSIs 
Airway interventions  56  292  19.2 
Chest procedures  24  207  11.6 
Vascular access  160  1,858  8.6 
Hypothermia prevention  63  1,129  5.6 
Hemorrhage control  57  1,730  3.3 
 
 

 

 

There were 142 incorrectly performed interventions and 360 were missed.

 

CONCLUSIONS: In our study, the most commonly performed prehospital LSI in a combat setting were for vascular access and hemorrhage control. The most common incorrectly performed and missed interventions were airway interventions and chest procedures respectively.

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