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.

 

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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.

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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.