On connaissait le MALOY T400 mis en avant par la Royal Navy, voici ce que proposent les allemands:

mis e ILA_2024_German_army_presents_use_of_Grille_UAV_for_sanitary_evacuationjpg-0ec08b70.webp

Quant aux Ukrainiens :

http://69citera.hautetfort.com/files/Drone_sav2.pdf

Le quotidien The Economist rapporte dans un article sur ce que la médecine de guerre apprend en terres ukrainiennes, les armées de Kiev utiliseraient de gros drones cargo pour évacuer certains de ses blessés du front.

Comme l'explique le site War on the Rocks, des drones ont été utilisés dès le début de la guerre pour ravitailler troupes et blessés en matériel de soins ou en rations basiques, notamment les combattants retranchés dans l'usine Azovstal à Marioupol.

De son côté, CBC rapportait dès mars 2022 qu'une firme canadienne nommée Draganfly fournissait à Kiev de gros drones-cargos pour des missions similaires de livraison.

Le drone utilisé pourrait être un des drone de la société Malloy déjà testé par les Royal marines, probablement un T400.

JTS Analyzes Search and Rescue After Action Reports to Uncover Deficiencies,
Develops Performance Improvement Metrics

https://prolongedfieldcare.org/2022/03/18/joint-trauma-system-newsletter-update/

The JTS PI and CTS Operations branches published in-depth review of after action reports (AARs) from over 252 search and rescue (SAR) missions from 2018 - 2021. The report is in response to the U.S. Navy SAR’s request that JTS assess its operations. It analyzes the context in which Naval SAR operations oc- curred as well as medical procedures and patient demographics. JTS identified deficiencies in equipment, personnel, and documentation and developed a list of PI metrics. The need for standardization is keenly felt in the field. AAR comments reinforce the need for standardized equipment like cardiac kits, medication kits, and advanced life support tools. For example, SAR crews report they do not have the equipment or skills to perform rapid intubation of patients. The report was unable to conclude whether or not standardized medication kits are available to SAR teams. The report did find skills of attendant medical personal vary considerably across SAR missions. Thirty-one percent of missions were executed by a single EMT-B, while 19% were executed by a single EMP-P, and 17% were executed by two medical attendants. In some cases, both a registered nurse and physician were present, while other times only one was pre- sent.

JTS identified opportunities for improving documentation. Vague or incomplete information in the after action reports makes it more difficult to conduct accurate assessments. Accurate information is critical for mission success. Casualty classification was one area of deficiency. The report found that there is only an 81% overall accuracy in the SAR Rescuer Skill Type
casualty classification. This puts casualty classification high on the list of performance improvement (PI) priorities. Casualty classification includes all the critical information of the patient, most notably the type and severity of injury and location of the patient. It is imperative that patients are accurately classified at the start of the mission, since this determines everything from prioritizing patient care to the medical and logistical resources. A key metric for success is the comparison between the dispatched category and the assessed category of the casualty. Dispatch’s casualty classification should match the classification assessed upon the arrival at the mission destination. Having accurate information upfront is critical for SAR teams to accurately triage the casualty in advance, which dictates urgency, timing, equipment, and all other areas of mission prep. Inconsistent SAR documentation impacts the ability for SAR teams to record accurate information. For example, the DA4700 form has a list of specific mechanisms of injury (MOI), which are tailored towards battlefield en route care and not necessarily applicable to SAR operations. JTS reported roughly one fifth (55 out of 252 cases) of SAR cases recorded the MOI as either “other” or left blank. “Other” or left unchecked ultimately makes the data less useful and harder to interpret. In cases of hypothermia, the patient’s temperature was only recorded in 13% of cases. An emphasis on documentation training may
fill the gaps in SAR documentation.

The situation is further complicated by the fragmented nature of the available guidance for SAR teams. JTS discovered SAR teams rely on guidelines from multiple sources, bringing into question source credibility and guidance consistency.

The lack of training is at the root of the deficiencies. Additionally, actual mission engagements do not provide for redundancy which would lead to proficiency, proving that personnel training is of paramount importance. For instance, in one exercise, Special Operations assets had to be utilized for Casualty Evacuation (CASEVAC) purposes because the CASEVAC plan proved insufficient during the course of the exercise. The AARs recommended regular testing and evaluation of CASEVAC plans.

Response to the JTS SAR report has been positive and supportive. LCDR Paul Roszko, Director of Emergency Medical Services, Navy Medical Forces, called the report “excellent” and viewed the findings as an opportunity to improve trauma training across the Services. The report prompted Rosko to question why there is not standardized casualty cards or simulations. He would like to take real-life cases and turn them into vignettes or simulations for squadron training. JTS does include an example of a SAR casualty vignette as a tool to improve SAR training. “The data is clear that the SAR community does a lot more than just treat trauma patients,” said Rozko. “Perhaps identifying a few common medical cases or other types of commonly encountered injuries and specifying what our "standard of care" reference point is would allow the JTS PI team to provide more feedback on the quality of care provided.”

SOFINS 2019: A quoi pourrait servir un drone pour le soutien médical du combattant ?

Clic sur l'image pour accéder au document

The potential use of unmanned aircraft systems (drones) in mountain search and rescue operations.

Karaca Y et al 2018 Apr;36(4):583-588.

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Gagner du temps dans la localisation des victimes, c'est ce que pourrait apporter l'utilisation de drone. L'application opérationnelle pour la prise en charge de blessés de guerre comporte des contraintes différentes mais à n'en pas douter le train est en marche.

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Objective: This study explores the potential use of drones in searching for and locating victims and of motorized transportation of search and rescue providers in a mountain environment using a simulation model.

Methods: This prospective randomized simulation study was performed in order to compare two different search and rescue techniques in searching for an unconscious victim on snow-covered ground. In the control arm, the Classical Line Search Technique (CLT) was used, in which the search is performed on foot and the victim is reached on foot. In the intervention arm, the Drone-snowmobile Technique (DST) was used, the search being performed by drone and the victim reached by snowmobile. The primary outcome of the study was the comparison of the two search and rescue techniques in terms of first human contact time.

Results: Twenty search and rescue operations were conducted in this study. Median time to arrival at the mannequin was 57.3 min for CLT, compared to 8.9 min for DST. The median value of the total searched area was 88,322.0 m2 for CLT and 228,613.0 m2 for DST. The median area searched per minute was 1489.6 m2 for CLT and 32,979.9 m2 for DST (p b 0.01 for all comparisons).

Operation	Recherche classique			Recherche par drone
Operation	First human contact (min)	Total searched area (m ²)	Searched area for a minute (m ²/min)	First human contact (min)	Total searched area (m ²)	Searched area for a minute (m ²/min)
1	39.0	66,408	1702.8	7.7	168,395	28,065.8
2	53.1	78,209	1475.6	8.2	217,624	33,225.1
3	67.1	88,664	1323.3	8.5	239,602	35,080.8
4	95.0	120,891	1272.5	11.2	310,981	32,734.8
5	50.2	85,861	1717.2	5.6	192,224	49,162.1
6	95.2	104,479	1099.8	13.1	346,268	30,294.7
7	54.0	98,385	1821.9	7.4	144,480	25,302.9
8	61.1	77,378	1268.5	4.2	138,945	54,488.2
9	59.1	87,980	1503.7	9.7	266,722	33,340.3
10	56.1	99,375	1774.6	12.9	313,525	27,968.3
Median (25–75%)	57.3 ^a (52.3–74.0)	88,322.0 ^b (78,001.3–100,651.0)	1489.7 ^c (1271.5–1731.6)	8.4 ^a (6.9–11.6)	228,613.0 ^b (162,416.0–311,617.0)	32,979.9 ^c (28,041.4–8601.1)

Conclusions: In conclusion, a wider area can be searched faster by drone using DST compared to the classical technique, and the victim can be located faster and reached earlier with rescuers transported by snowmobile

Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study

Maddry JK et Al. 2018 Jun 30;5(1):22. doi: 10.1186/s40779-018-0169-2.

BACKGROUND:

In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI).

METHODS:

We completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI (AMP+NCTI), traumatic amputation only (AMP), and neither AMP nor NCTI (Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher's exact tests, Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.

RESULTS:

We reviewed 1267 records, of which 669 had an injury severity score (ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries (n=104, AMP only), 10.8% sustained amputation and NCTI (n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI (n=493, Non-AMP/NCTI). AMP+NCTI had the highest mortality (16.7%) with transport time greater than 60 min. While the

AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.

CONCLUSIONS:

A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.

En Route Resuscitation – Utilization of CCATT to Transport and Stabilize Critically Injured and Unstable Casualties

Maddry JK et Al Mil Med. 2018 Dec 7. doi: 10.1093/milmed/usy371.

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Une démarche qui prône l'emploi de spécialistes ayant une pratique régulière et avancée de la réanimation et de l'anesthésie du traumatisé pour le transport des blessés de guerre. Elle doit être rapprochée du concept des MERT-Enhanced UK.

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Introduction:

The U.S. Air Force utilizes specialized Critical Care Air Transport Teams (CCATT) for transporting “stabilized” patients. Given the drawdown of military forces from various areas of operation, recent
CCATT operations have increasingly involved the evacuation of unstable and incompletely resuscitated patients from far forward, austere locations. This brief report describes unique cases representative of the evolving CCATT mission and provides future direction for changes in doctrine and educational requirements in preparation for en route combat casualty care. Methods and Materials: This case series describes three patients who required significant resuscitation during CCATT transport from austere locations between April and November 2017. Approval for this project was received from the US Air Force 59th Medical Wing Institutional Review Board as non-research.

Results:

Case 1:

CCATT was dispatched to transport patient 1 who was reported to have a head injury after a fall. Upon evaluation of the patient onboard the aircraft, it was discovered that the patient was in cardiac arrest. Cardiopulmonary resuscitation was performed during tactical takeoff with frequent combat maneuvers. The patient developed a palpable pulse after three rounds of CPR, three doses of epinephrine, and one unit of packed red blood cells. Point of care laboratory analysis demonstrated a profoundly elevated lactate level. Cyanide poisoning was a concern but there was no antidote available in the available equipment set. After delivery to a medical facility, blood samples were positive for cyanide. Over the next 2 weeks, the patient improved and was discharged home, neurologically intact.

Case 2:

Patient 2 sustained complex blast injuries and bilateral lower extremity amputations. He required early transport for continuous renal replacement therapy (CRRT). The patient received 200 units of blood products in the 24 hours prior to transport and developed renal failure, pulmonary edema, and elevated ICP. During the 7 hour flight, Patient 2 received frequent adjustments of vasopressor medications, multiple Dakins solution soaks and flushes, and 1 unit of fresh frozen plasma. He mained alive 2 months later.

Case 3:

The team was notified to collect an urgent patient with a blast lung injury and bilateral lower extremity amputations. The ground team encountered difficulty ventilating the patient. Patient 3 arrived in the back of a pickup truck accompanied by medics and being bag valve mask ventilated with a pulse oximetry reading of 65%. He was secured to the floor of the aircraft which departed within 5 minutes of arrival. An ultrasound of the lungs showed no pneumothorax. By the end of the flight, the patient’s oxygen saturation had risen to 95% and he was delivered to the emergency department in stable condition. He later passed away in the operating room due to severe blast lung and cardiac contusion.

Conclusion: This brief report demonstrates the need of CCATT in the transport of unstable patients from forward deployed locations. The Air Force has adapted and is continuing to adapt CCATT training, equipment, onboard diagnostics and therapies, and team members’ clinical skills to meet en route care combat casualty needs.

A Descriptive Analysis of Causalities Undergoing CASEVAC from the Point-of-Injury in the Department of Defense Trauma Registry

Schauer SG et Al. Mil Med. 2019 Feb 22. pii: usz015. doi: 10.1093/milmed/usz015.

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Ce travail porte sur l'analyse des blessés pris en charge du point de blessure jusqu'au premier échelon chirurgical par des moyens non dédiés spécifiquement. Si les lésions des membres sont les pljus fréquentes, les lésions les plus graves intéressent le thorax. La survie est importantes. Les auteurs pointent cependant du doigt les difficultés d'interprétation de leurs registres et le recours à des moyens non santé armés par du personnel médical, notamment pour les opérations spéciales. A noter la présence de données concernant les opérations en irak et en syrie.

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Introduction

The recent conflicts in Iraq and Afghanistan entail an asymmetric battlefield without clearly defined forward lines of troops as seen in previous wars. Accordingly, the United States military medical services have increasingly adopted casualty evacuation (CASEVAC) platforms. We describe CASEVAC events reported within the Department of Defense Trauma Registry (DODTR).

Materials and Methods

This is a secondary analysis of previously published data from two datasets spanning from 2007 through 2017. We isolated casualties within our dataset that had a documented evacuation method from the point-of-injury other than dedicated medical evacuation platforms (e.g., MEDEVAC, etc.).

Results

During OPERATION IRAQI FREEDOM, three casualties underwent CASEVAC. The median age was 30 and all were male. Most sustained injuries from explosives (67%) and the median composite injury scores were low (10). The most frequent seriously injured body region was the thorax (67%). All survived to hospital discharge. During operations in Afghanistan (OPERATION ENDURING FREEDOM, OPERATION FREEDOMS SENTINEL, OPERATION NEW DAWN), 248 casualties underwent CASEVAC. The median age was 28 and most (96%) were male. Most sustained injuries from explosives (58%) and the median injury score was low (9). The most frequent seriously injured body region was the extremities (24%). Most (97%) survived to hospital discharge. During OPERATION INHERENT RESOLVE, 247 casualties underwent CASEVAC. The median age was 21 and most (96%) were male. The majority sustained injuries from explosives (61%) and the median injury score was low (9). The most frequent seriously injury body region was the extremities (27%). Most survived to hospital discharge (94%).

Conclusions

In our dataset, CASEVAC events most frequently involved US military personnel service members with most surviving to hospital discharge. Developing new terminology that distinguishes different types of CASEVAC would allow for more accurate future analyses of casualty evacuation and outcomes – such as those transports that are truly in a non-medical versus the various medical platforms that do not fall with into the confines of the MEDEVAC platforms.

A Review of Casualties Transported to Role 2 Medical Treatment Facilities in Afghanistan.

Kotwal RS et Al. Mil Med. 2018 Mar 1;183(suppl_1):134-145

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Ce document met en évidence tout l'apport d'une chaine coordonnée de prise en charge du traumatisé par des équipes entraînées appliquant une stratégie médico-chirurgicale moderne.

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Critically injured trauma patients benefit from timely transport and care. Accordingly, the provision of rapid transport and effective treatment capabilities in appropriately close proximity to the point of injury will optimize time and survival. Pre-transport tactical combat casualty care, rapid transport with en route casualty care, and advanced damage control resuscitation and surgery delivered early by small, mobile, forward-positioned Role 2 medical treatment facilities have potential to reduce morbidity and mortality from trauma. This retrospective review and descriptive analysis of trauma patients transported from Role 1 entities to Role 2 facilities in Afghanistan from 2008 to 2014 found casualties to be diverse in affiliation and delivered by various types and modes of transport. Air medical evacuation provided transport for most patients, while the shortest transport time was seen with air casualty evacuation. Although relatively little data were collected for air casualty evacuation, this rapid mode of transport remains an operationally important method of transport on the battlefield. For prehospital care provided before and during transport, continued leadership and training emphasis should be placed on the administration and documentation of tactical combat casualty care as delivered by both medical and non-medical first responders.

Survey of Casualty Evacuation Missions Conducted by the 160th Special Operations Aviation Regiment During the Afghanistan Conflict.

Redman TT et Al. J Spec Oper Med. Summer 2018;18(2):79-85

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Une vision des techniques mises en oeuvre en préhospitalier par des équipes américaines en afghanistan. Les pratiques gestuelles mies en oeuvre sur le terrain et en cours d'évacuation sont décrites. Ces dernières doivent être maîtrisées, ce qui est un vrai challenge en terme de formation et d'implication des équipes

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BACKGROUND:

Historically, documentation of prehospital combat casualty care has been relatively nonexistent. Without documentation, performance improvement of prehospital care and evacuation through data collection, consolidation, and scientific analyses cannot be adequately accomplished. During recent conflicts, prehospital documentation has received increased attention for point-of-injury care as well as for care provided en route on medical evacuation platforms. However, documentation on casualty evacuation (CASEVAC) platforms is still lacking. Thus, a CASEVAC dataset was developed and maintained by the 160th Special Operations Aviation Regiment (SOAR), a nonmedical, rotary-wing aviation unit, to evaluate and review CASEVAC missions conducted by their organization.

METHODS:

A retrospective review and descriptive analysis were performed on data from all documented CASEVAC missions conducted in Afghanistan by the 160th SOAR from January 2008 to May 2015. Documentation of care was originally performed in a narrative after-action review (AAR) format. Unclassified, nonpersonally identifiable data were extracted and transferred from these AARs into a database for detailed analysis. Data points included demographics, flight time, provider number and type, injury and outcome details, and medical interventions provided by ground forces and CASEVAC personnel.

RESULTS:

There were 227 patients transported during 129 CASEVAC missions conducted by the 160th SOAR. Three patients had unavailable data, four had unknown injuries or illnesses, and eight were military working dogs. Remaining were 207 trauma casualties (96%) and five medical patients (2%). The mean and median times of flight from the injury scene to hospital arrival were less than 20 minutes. Of trauma casualties, most were male US and coalition forces (n = 178; 86%). From this population, injuries to the extremities (n = 139; 67%) were seen most commonly. The primary mechanisms of injury were gunshot wound (n = 89; 43%) and blast injury (n = 82; 40%). The survival rate was 85% (n = 176) for those who incurred trauma. Of those who did not survive, most died before reaching surgical care (26 of 31; 84%).

CONCLUSION:

Performance improvement efforts directed toward prehospital combat casualty care can ameliorate survival on the battlefield. Because documentation of care is essential for conducting performance improvement, medical and nonmedical units must dedicate time and efforts accordingly. Capturing and analyzing data from combat missions can help refine tactics, techniques, and procedures and more accurately define wartime personnel, training, and equipment requirements. This study is an example of how performance improvement can be initiated by a nonmedical unit conducting CASEVAC missions.

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L'Allemagne dispose à présent de la capacité d'évacuation aéromédicale à bord d'un A400M. Le premier kit « Intensive care aeromedical evacuation » (ICAE) a été mis en service ce 1er août, avec un délai d'alerte à 12 heures. Au total, la Luftwaffe disposera à terme de quatre kits, intégrable aux A400M en quatre heures, pour prendre en charge le rapatriement de blessés - aussi bien allemands qu'européens, voire des autres pays membres de l'OTAN.

Le kit ICAE permettra de prendre en charge jusqu'à six blessés allongés avec oxygénothérapie et appareils de réanimation, dont deux en unité de soins intensifs, deux blessés de catégorie intermédiaire et deux blessés plus légers. L'équipe médicale est quant à elle composée de 11 personnels, de différentes spécialités. (source).

Speed is not everything: Identifying patients who may benefit from helicopter transport despite faster ground transport.

Chen X et Al. J Trauma Acute Care Surg. 2018 Apr;84(4):549-557

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Ne pas perdre de temps est bien. Mais il ne faut pas oublier également que la réalisation de gestes avancés de réanimation est aussi utile en préhospitalier. Ceci milite pour la constitution d'équipes dont l'expertise en matière de gestion des voies aériennes/Trauma thoracique-Crânien est le métier. Cette question se pose tout particulièrement pour les vecteurs d'EVASAN à voilure tournante.

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