Casualty care implications of large-scale combat operations
Mason H. Remondelli MH et Al. J Trauma Acute Care Surg. 2023 Aug; 95(2 ): S180–S184.

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Cet article met en exergue la nécessité de repenser en profondeur l'organisation de la chaîne santé , la place prépondérante de la transfusion sanguine et l'intérêt de petites équipes chirurgicales mobiles intervenant "enterrées" au plus près des combats

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Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review

Jarrassier A. et Al Anaesth Crit Care Pain Med. 2024 Jul 30;43(5):101409.

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Un point de situation particulièrement intéressant qui met en avant la nécessité de prendre en compte les spécificités de cette guerre à haute intensité: De nouvelles modalités lésionnelles notamment par les armes thermo-bariques, les difficultés de l'établissement d'une chaîne maîtrisée de prise en charge des blessés avec la réapparition du train comme vecteur d'évacuation, bien souvent la nécessité de porter la chirurgie au plus près des combats en s'appuyant sur les hôpitaux d'infrastructures, la difficulté de l'approvisionnement notamment en dérivés sanguins, la réapparition de la discussion sur le garrot, la nécessité de disposer d'équipes parfaitement formées et entraînées pour intervenir dans de telles conditions, la place tout à fait particulière et prééminente des anesthésistes-réanimateurs dans de telles situations.

Une bonne partie de ces constatations avaient été faites notamment lors de la crise COVID (histoire de l'EMR SSA de Mulhouse puis dans les DOM). Oui mais elles ont été oubliées noyées dans le quotidien.

Background

The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis.

Methods

A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures.

Results

Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25–63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation.

Conclusion

This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.

The “Survival Chain” Medical Support to Military Operations on the Future Battlefield

Gurney MJ et Al. JFQ 112, 1st Quarter 2024

Un plaidoyer pour plus de technicité, de savoir faire , d'agilité bref une professionnalisation encore plus grande des équipes santé vers le trauma et la réanimation.

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An Analysis of 13 Years of Prehospital Combat Casualty Care: Implications for Maintaining a Ready Medical Force
Schauer SG et Al. Prehosp Emerg Care. 2022 May-Jun;26(3):370-379.

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Des choses simples dans un contexte où les medevac étaient très rapides, ce qui n'est plus le cas. Poser des garrots est toujours nécessaires MAIS ne suffit plus. Les gestes sophistiqués de réanimation doivent absolument être maîtrisées. Cela passe par une autre vision, que celle actuelle, de la médicalisation de l'avant.

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Background:

Most potentially preventable deaths occur in the prehospital setting before reaching a military treatment facility with surgical capabilities. Thus, optimizing the care we deliver in the prehospital combat setting represents a ripe target for reducing mortality. We sought to analyze prehospital data within the Department of Defense Trauma Registry (DODTR).

Materials and methods:

We requested all encounters with any prehospital activity (e.g., interventions, transportation, vital signs) documented within the DODTR from January 2007 to March 2020 along with all hospital-based data that was available. We excluded from our search casualties that had no prehospital activity documented.

Results:

There were 28,950 encounters that met inclusion criteria. Of these, 25,897 (89.5%) were adults and 3053 were children (10.5%). There was a steady decline in the number of casualties encountered with the most notable decline occurring in 2014. U.S. military casualties comprised the largest proportion (n = 10,182) of subjects followed by host nation civilians (n = 9637). The median age was 24 years (interquartile range/IQR 21-29).

Most were battle injuries (78.6%) and part of Operation ENDURING FREEDOM (61.8%) and Operation IRAQI FREEDOM (24.4%). Most sustained injuries from explosives (52.1%) followed by firearms (28.1%), with serious injury to the extremities (24.9%) occurring most frequently. The median injury severity score was 9 (IQR 4-16) with most surviving to discharge (95.0%). A minority had a documented medic or combat lifesaver (27.9%) in their chain of care, nor did they pass through an aid station (3.0%). Air evacuation predominated (77.9%).

Conclusions:

Within our dataset, the deployed U.S. military medical system provided prehospital medical care to at least 28,950 combat casualties consisting mostly of U.S. military personnel and host nation civilian care. There was a rapid decline in combat casualty volumes since 2014, however, on a per-encounter basis there was no apparent drop in procedural volume.

Une évidence. Et dans le système français le modèle de cet infirmier est un IADE

ACNPs in the U.S. Army-Medical Force Multipliers for Large-Scale Combat Operations

Robert L Grabowski R et Al. Mil Med. 2024 Feb 27;189(3-4):74-79.

Operations in the Middle East have slowed, and near-peer tensions escalate. The U.S. Military has directed its attention from combating insurgencies toward preparedness for large-scale combat operations (LSCOs). The threat of LSCO demands a dramatic shift in strategy and resource and has raised questions about how the military will pivot from the counter-insurgency operations of the previous two decades. Innovation and change are needed to adequately receive, treat, hold, and transport the high volume of anticipated casualties in LSCO. Review of the current deployed medical structure has identified needs to increase emergency medical capabilities near the point of injury, increase patient holding capacity (particularly in critical care) in field hospitals and expeditionary medical facilities, and address likely delayed and prolonged medical evacuation. To address these new challenges, the authors offer recommendations for the addition of Acute Care Nurse Practitioners (ACNPs) to the U.S. Army Medical Department. ACNPs are advanced practice providers, specialized in acute and critical care. ACNPs are a potential medical force multiplier not currently utilized in the U.S. Army. If adapted, ACNPs could contribute significantly to meeting the demands of LSCO medical needs via multiple roles. Recommendations are provided by the authors, such as utilizing the ACNP within the Forward Resuscitative Surgical Detachment, Field Hospital intensive care unit, aeromedical evacuation, and/or Prolonged Care Augmentation Detachment. With support from the U.S. Army Nurse Corp and Army Medical Department, ACNPs could be integrated into the Army healthcare model, emulating the civilian standard of care for every soldier deployed. Furthermore, use of ACNPs in theater could advance deployed medical capabilities and help conserve the fighting force of the U.S. Military and its partners.

4A after access: a new mnemonic to aid timely administration of IV/IO treatment in trauma patients

Campbell K et Al. BMJ Mil Health. 2023 Sep 11:e002463.

Administration of medication is a well-established part of prehospital trauma care. Guidance varies on the types of recommended medications and when they should be administered. Mnemonics have become commonplace in prehospital medicine to facilitate recall and retention. However, there is no comprehensive aid for the administration of medication in trauma patients. We propose a new mnemonic for the delivery of relevant intravenous or intraosseous medications in trauma patients. A ‘4A after Access’ approach should enhance memory recall for the efficient provision of patient care. These 4As are: antifibrinolysis, analgesia, antiemesis and antibiotics. This mnemonic is designed to be used as an optional aide memoire in conjunction with existing treatment algorithms in the military prehospital setting.

A Decade of Firearm Injuries: Have We Improved ?
Sarah A Hatfield SA et Al. J Trauma Acute Care Surg. 2024 Jan 16.doi: 10.1097/TA.0000000000004249.

Background:

Firearm injuries are a growing public health issue, with marked increases coinciding with the coronavirus disease 2019 (COVID-19) pandemic. This study evaluates temporal trends over the past decade, hypothesizing that despite a growing number of injuries, mortality would be unaffected. In addition, the study characterizes the types of centers affected disproportionately by the reported firearm injury surge in 2020.

Methods:

Patients aged 18 years and older with firearm injuries from 2011-2020 were identified retrospectively using the National Trauma Data Bank (NTDB®). Trauma centers not operating for the entirety of the study period were excluded to allow for temporal comparisons. Joinpoint regression and risk-standardized mortality ratios (SMR) were used to evaluate injury counts and adjusted mortality over time. Subgroup analysis was performed to describe centers with the largest increases in firearm injuries in 2020.

Results:

A total of 238,674 patients, treated at 420 unique trauma centers, met inclusion criteria. Firearm injuries increased by 31.1% in 2020, compared to an annual percent change of 2.4% from 2011-2019 (p = 0.01). Subset analysis of centers with the largest changes in firearm injuries in 2020 found that they were more often level I centers, with higher historic trauma volumes and percentages of firearm injuries (p < 0.001). Unadjusted mortality decreased by 0.9% from 2011-2020, but after controlling for demographics, injury characteristics and physiology, there was no difference in adjusted mortality over the same time period. However, among patients with injury severity scores ≥25, adjusted mortality improved compared to 2011 (SMR of 0.950 in 2020, 95% CI 0.916 - 0.986).

Conclusions:

Firearm injuries pose an increasing burden to trauma systems, with level I and high-volume centers seeing the largest growth in 2020. Despite increasing numbers of firearm injuries, mortality has remained unchanged over the past decade.

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Transferable military medical lessons from the Russo-Ukraine war

Hodgetts TJ, et al. BMJ Mil Health 2023;0:1–4

The first year of the war in Ukraine has presented critical lessons for the UK’s Defence Medical Services (DMS) regarding its preparedness to support the nation for warfighting at scale. There are tactical, clinical, and strategic challenges that must be addressed. The war has exposed the limitations of international humanitarian law and the laws of armed conflict in protecting forward field hospitals from deliberate targeting. The DMS may need to employ measures such as disguise, deception, and dispersal to provide care in a contested environment. The historical trend of disinvestment in military medical capability between major conflicts, known as the "Walker Dip," represents a clinical risk that must be mitigated. Even if this is achieved, clinical outcomes during large-scale warfighting are likely to be worse that those the nation has come to expect during more low-intensity conflicts. Effective civilian-military collaboration will be paramount to manage casualties at scale. Both novel and reversionary modes of transportation may be required, such as the mass movement of casualties by train. The need for a sufficient and capable medical workforce, amid global shortages and post-COVID burnout, calls for further investment. The DMS requires innovation and adaptability to harness the ability to adopt external ideas, translate successful innovations and address complex challenges. By addressing tactical vulnerabilities, enhancing clinical preparedness, fostering civilian-military collaboration, and embracing innovation, the DMS will be better equipped to support the UK and allied armed forces in future warfighting at scale.

Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade
Renberg M et Al. Scand J Trauma Resusc Emerg Med. 2023 Nov 24;31(1):85

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On sait cet exercice difficile même entre des mains expérimentées. Cet article le confirme. N'oublions pas; ce qui compte en premier c'est d'oxygéner. Avant de procéder à une intubation, bien évaluer l'état hémodynamique car une induction et une mise sous respirateur peuvent l'altérer, voire être responsable d'un arrêt cardiaque.

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Background:

Prehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED).

Methods:

This was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI.

Result:

Of 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p < 0.001) than TI in the ED, even when adjusted for ISS (OR 2.88 [CI 1.64, 5.14, p < 0.001]). Hemodynamic collapse (≤ 40 mmHg) and low GCS score (≤ 8) were the characteristics most associated with prehospital TI. Traumatic cardiac arrests (TCAs) occurred in 154 (18.9%) patients, of whom 77 (50%) were intubated prehospitally and 56 (36.4%) were intubated in the ED. A subgroup analysis excluding TCA showed that patients with prehospital TI did not have a higher mortality rate than those with ED TI, OR 2.07 (CI 0.93, 4.51, p = 0.068), with OR 1.39 (0.56, 3.26, p = 0.5) when adjusted for ISS.

Conclusion:

Prehospital TI was associated with a higher mortality rate than those with ED TI, which was specifically related to TCA; intubation did not affect mortality in patients without cardiac arrest. Mortality was high when airway management was needed, regardless of cardiac arrest, thereby emphasizing the challenges posed when anesthesia is needed. Several interventions, including whole blood transfusions, the implementation of second-tier EMS units and measures to shorten scene times, have been initiated in Sweden to counteract these challenges. Sweden.

A Gray Future: The Role of the Anesthesiologist in Hybrid Warfare
Granholm F et Al. Anesthesiology. 2023 Nov 1;139(5):563-567.

During the last few decades, the increasing use of asymmetric and multimodal tactics by terrorists has led anesthesiologists worldwide to analyze and discuss their role in mass casualty scenarios in more depth. Now anesthesiologists must address the new situation of hybrid threats and hybrid warfare. This will have a direct impact on anesthesiology and intensive care, and in the end, the health and well-being of critical patients of all ages. To be able to respond to a hybrid threat efficiently and effectively, it is imperative that anesthesiologists play an early and integral role in mitigation and response planning.

Medical support for future large-scale combat operations

Tien H. et Al. https://doi.org/10.3138/jmvfh-2022-0006

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C'est un plaidoyer pour plus des équipes beaucoup plus techniques à l'avant, de petite taille et mobiles.

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Introduction: Medical teams were extremely successful in saving lives during the war in Afghanistan. However, this war was a counterinsurgency (COIN) operation where Allied forces enjoyed air superiority and complete unhampered communications. A future war against a peer adversary may present differently. A narrative review was conducted to make recommendations about how medical support to large-scale combat operations may need to be modified from current doctrine, which was developed for COIN operations. Methods: This narrative review examined the evolution of pre-hospital (tactical combat casualty care [TCCC]) and hospital (NATO echelons of care) doctrine underlying medical support to land operations developed during operations in Afghanistan and Iraq. It analyzed the outcomes of several battles from the current Russo-Ukrainian conflict and considered the implications of how medical support should be provided to large-scale combat operations. Results: Military planners should expect that timely medical evacuation to surgical care cannot be assumed in a peer-to-peer war, as air superiority and reliable communications cannot be assured. As well, modern munitions are likely to cause substantially more casualties than previous COIN operations, with a higher proportion of burns and primary blast injuries. Discussion: Canadian Forces Health Services should actively review its TCCC guidelines and doctrine for providing medical support to land operations. As air superiority and constant communication cannot be assured during peer-to-peer large-scale combat operations, there may be a need to focus on prolonged tactical field care and smaller, more mobile surgical teams.

Perspectives on the management of non-compressible torso hemorrhage: A narrative review

Leclerc S et Al. Journal of Military, Veteran and Family Health 8(s2) 2022: 73-36

Hemorrhage is one of the leading causes of death after trauma. A significant proportion of these fatalities could be prevented with appropriate bleeding control. This is more easily achieved with direct pressure in compressible areas such as the extremities or major joints. However, bleeding in the chest, abdomen, or pelvis cannot be as easily controlled without advanced procedures that are only available in hospitals. This article describes several technologies to control bleeding in the chest, abdomen, and pelvis that are potentially applicable in combat and pre-hospital settings. However, a review of existing studies quickly shows that convincing clinical evidence is lacking to support most pre-existing technologies, and the majority of studies are in the investigational stage. A universal, effective, and life-saving solution has not yet been identified. Accordingly, research in this area should continue to focus on both refining existing technologies and developing new approaches.

More than 50% of combat casualty deaths on the battlefield occur minutes to hours after a person has been wounded. Approximately 25% of those fatalities could potentially be prevented if rapid hemorrhage control or temporization were feasible. Despite several technologies to temporize non-compressible torso hemorrhage (NCTH), an ideal device and method have not yet been developed, particularly for Role 1 military medical treatment facilities and civilian pre-hospital settings. This article summarizes the devices and adjunct methods currently available to temporize NCTH when surgical and interventional radiology control are not readily accessible. New technologies under investigation are also discussed.

Comparison of Airway Control Methods and Ventilation Success With an Automatic Resuscitator

Rodriguez D. et Al. J Spec Oper Med. 2012; 12(2):65-70.

Mechanical ventilation in an austere environment is difficult owing to logistics, training, and environmental conditions. We evaluated the ability of professional caregivers to provide ventilatory support to a simulated patient using the Simplified Automated Ventilator (SAVe) with a mask hand attended ventilation, mask with single strap unattended ventilation, and supraglottic airway (King LT) ventilation.

All three methods were performed using a SAVe with a set tidal volume of 600 mL and respiratory rate of 10 breaths per minute. The simulator consisted of a head and upper torso with anatomically correct upper airway structures, trachea, esophagus, and lung that also measured the delivered tidal volume, respiratory rate, inspiratory flow, and airway pressures. Volunteers used each airway control method to provide ventilation for 10 minutes in random order. Success of each technique was judged as a mean delivered tidal volume of > 500 mL. The major finding of this study was that medical professionals using the SAVe resuscitator and the manufacturer-supplied face mask with single head strap failed to ventilate the airway model in every case

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.

10.1177_09677720211012190-fig1.jpg

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.

A prospective assessment of the medic autologous blood transfusion skills for field transfusion preparation

Steven G Schauer SG et Al. Transfusion. 2023 Mar 27. doi: 10.1111/trf.17325.

Background: Data demonstrate benefit from blood product administration near point-of-injury (POI). Fresh whole blood transfusion from a pre-screened donor provides a source of blood at the POI when resources are constrained. We captured transfusion skills data for medics performing autologous blood transfusion training.

Methods: We conducted a prospective, observational study of medics with varying levels of experience. Inexperienced medics were those with minimal or no reported experience learning the autologous transfusion procedures, versus reported experience among special operations medics. When available, medics were debriefed after the procedure for qualitative feedback. We followed them up to 7 days for adverse events.

Results: The median number of attempts for inexperienced and experienced medics was 1 versus 1 (interquartile range 1-1 for both, p=0.260). The inexperienced medics had a slower median time to needle venipuncture access for donation of 7.3 versus 1.5 minutes, needle removal after clamping time of 0.3 versus 0.2 minutes, time to bag preparation of 1.9 versus 1.0 minutes, time to IV access for reinfusion of 6.0 versus 3.0 minutes, time to transfusion completion of 17.3 versus 11.0 minutes, and time to IV removal of 0.9 versus 0.3 minutes (all p<0.05). We noted one administrative safety event in which allogeneic transfusion occurred. No major adverse events occurred. Qualitative data saturated around the need for quarterly training.

Conclusions: Inexperienced medics have longer procedure times when training autologous whole blood transfusion skills. This data will help establish training measures of performance for skills optimization when learning this procedure.

Blunt and Penetrating Airway Trauma

Duggan LV et Al.. Emerg Med Clin North Am. 2023 Feb;41(1S):e1-e15.

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C'est une chose compliquée, pas simple surtout en condition de combat et qui justifie la maîtrise d'un abord chirurgical du cou. Ce document est, je trouve, excellent.

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Airway injury, be that penetrating or blunt, is a high-stakes high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injury vary in injury patterns requiring prepracticed skills and protocols coordinating care between specialties. Variables including patient cooperation, coexisting injuries, cardiorespiratory stability, care location (remote vs tertiary care center), and anticipated course of airway injury (eg, oxygenating well and comfortable vs increasing subcutaneous emphysema) all play a role in determining airway if and when airway management is required. Direct airway trauma is relatively infrequent, but its presence should be accompanied by in-person or virtual otolaryngology support.

Russia's Hybrid Warfare in Ukraine Threatens Both Healthcare & Health Protections Provided by International Law
Baker MS et Al., Ann Glob Health. 2023 Jan 23;89(1):3.

Hybrid Warfare is on display because of the unjustified Russian invasion of Ukraine. This is characterized by numerous crimes against civilians as seen vividly during the occupation of the town of Bucha where rape, torture, murder, and looting seem to reflect Russian military policy, leadership, and command guidance. Of particular concern is the threat to hospitals and health care as well as vital life support. Numerous hospitals have been damaged and destroyed. Hospitals are not tactical military targets and targeting health care facilities and personnel ignores traditional jus in bello and ignores numerous conventions established to stabilize the global order. The Russian-proclaimed "special operation" in Ukraine has been characterized by barbarian warfare in which the Russian military uses weapons against the civilian population and civilian infrastructure. The aggressors have embarked on a purposeful terror campaign through infrastructure attacks, which are of little military value except to demoralize the nation's people. This is evident with Russian missile and drone attacks on electric, water, and health care in Ukraine. Warfare now and in the future may be increasingly aimed at demoralizing civilian populations and reducing the will of the people and their government to resist. The Ukrainian invasion clearly shows that this use of hybrid warfare should be met with a strong reaction of the international community at the earliest possible stage, especially the supposedly peace-loving neutral countries, or else the future is expanded unlawful and barbaric military conflict.

Hybrid warfare and counter-terrorism medicine

Derrick Tin D et Al.. Eur J Trauma Emerg Surg. 2023 Feb 10;1-5.

Introduction:
March 9, 2022. An airstrike by Russian forces destroying a maternity hospital in Mariupol, Ukraine. The image of a severely injured pregnant woman covered in blood being stretchered away against the backdrop of destroyed buildings. Mutterings of the use of chemical weapons. This paper is a primer for healthcare personnel and health systems on hybrid warfare and counter-terrorism medicine.

Discussion:
While recent events and images arising from conflicts around the world represent a cruel hallmark in today's history, attacks against healthcare facilities and innocent civilians are not new and continue to be perpetrated around the world. In war, the Geneva Convention protects civilians and healthcare institutions from harm but when war crimes are being committed and civilians knowingly targeted, parallels from a healthcare perspective can be drawn with terrorism events. Increasingly, civilian institutions and in particular the healthcare sector, are drawn into such conflicts and understanding the health system impact of hybrid warfare and other asymmetrical attack methods is of great importance.

Conclusion:
The field of Counter-Terrorism Medicine (CTM) explores the healthcare impacts of intentional, man-made attacks and much recent research and discussions around this topic are extremely relevant and applicable not just to the ongoing hybrid war in Ukraine, but to today's threat climate all around us.

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

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Un outil sans nul doute à maîtriser à la lumière des événements ukrainiens

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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).

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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.

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18/02/2024

27/01/2024

01/12/2023

28/11/2023

25/11/2023

20/11/2023

12/11/2023

Medical support for future large-scale combat operations

Perspectives on the management of non-compressible torso hemorrhage: A narrative review

09/11/2023

24/10/2023

Surgery on the battlefield: Mobile surgical units in the Second World War and the memoirs they produced

03/04/2023

01/04/2023

16/02/2023

19/01/2023

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Introduction

Methods

Results

Conclusion