Use of prehospital transfusion by French emergency medical services: A national survey.

BACKGROUND: Major bleeding is the leading cause of preventable mortality among trauma patients. Several studies have recently shown that prehospital plasma transfusion improves the outcomes of severely injured patients. Although no consensus has been reached, prehospital transfusion is regularly considered to reduce avoidable mortality. The objective was to assess the status of prehospital transfusion practices in France. STUDY DESIGN AND METHODS: A national survey among the 378 advance life support emergency teams (SMURs) in metropolitan France was conducted from December 15, 2020 to October 31, 2021. A questionnaire was distributed by e-mail to the physicians in charge of SMURs. The questions addressed the transfusion modalities, labile blood products (LBPs) used, and limitations encountered in implementing transfusion. RESULTS: The response rate was 48%, and 82% of the respondents performed prehospital transfusions. A designated pack was used by 44% of the respondents. The LBPs used were packed red blood cells (100%), of which 95% were group 0 RH:-1, fresh frozen plasma (27%), lyophilized plasma (7%), and platelets (1%). The LBPs were transported in isothermal boxes (97%) without temperature monitoring in 52% of the cases. Nontransfused LBPs were discarded in 43% of the cases. Reported limitations in implementing transfusion were the delivery time (45%), loss of LBPs (32%), and lack of evidence (46%). DISCUSSION: Prehospital transfusion was developed in France but access to plasma remains difficult. Protocols allowing the reutilization of LBPs and improving conservation could limit the waste of a rare resource. Implementing the use of lyophilized plasma could facilitate prehospital transfusion. Future studies will need to specify the role of each LBP in the prehospital setting.

Effect of the implementation of a checklist in the prehospital management of a traumatised patient.

BACKGROUND: In October 2021, French acute care societies jointly published cognitive aids to standardise practices and limit cognitive biases to ensure greater safety in management of severe trauma patients. The aim of the study was to evaluate the impact of a checklist on emergency physicians' adherence to the recommendations. METHODS: This prospective before-and-after study study took place in a French mobile emergency and resuscitation service. All adults trauma patients referred to hospital were included. A checklist on trauma management inspired by the MARCHE acronym was produced. During phase I, the checklist was performed within 24 h after the end of the intervention. During phase II, the checklist was performed during the patient's transport to hospital, thus allowing potentially omitted procedures to be performed initially. The use of the checklist was systematically evaluated using an anonymous questionnaire among doctors and nurses. In phase II, doctors and nurses who did not perform checklist were systematically asked to answer a specific online questionnaire. The primary outcome was the overall omission rate of checklist items during each phase of the study. RESULTS: One hundred and sixteen patients were included, 53 in phase I and 63 in phase II. Eleven patients did not have a checklist in phase II. The overall omission rate of checklist items was significantly lower with checklist (17%) than without (25%) (p = 0.02). This trend increased in proportion to severity with an omission rate of 30% without checklist versus 15% with checklist (p = 0.03) for patients with an ISS ≥ 25. A majority of doctors and nurses who used the checklist considered that it should be made compulsory (82% and 67% respectively). Paradoxically, only 55% of doctors who did not perform the checklist thought it was useful, while the omission rate was significantly higher (17% with checklist compared with 59% without checklist, p < 0.01). CONCLUSION: This work shows a significant reduction in the number of omissions on the actions carried out during the management of a trauma patient in prehospital settings, allowing better adherence to the recommendations. Its benefit is increased in severely traumatised patients.

Phosphorus Burn Management with Multimodal Analgesia.

We report the case of a patient suffering from a chemical burn caused by white phosphorus, for whom initial management required decontamination using multimodal analgesia. This case report should be familiar to other military emergency physicians and Tactical Emergency Medical Support for two reasons: 1) A phosphorus burn occurs from a chemical agent rarely encountered, with minimal research available in the medical literature, despite the use of this weapon in the recent Ukrainian conflict, and 2) We discuss the use of multimodal analgesia, combining loco-regional anesthesia (LRA) and an intranasal pathway, which can be used in a remote and austere environment.

Mass Casualty Incident: Do Tactical Tag Bracelets Improve Triage Performance by First Responders? A Randomized Controlled Mass Casualty Incident Simulation and Response of A French Gendarmerie Elite Unit.

INTRODUCTION: Tactical triage replaces primary triage in the exclusion zone in mass murder or terrorist events to prioritize victims requiring life-saving interventions (LSIs) and/or rapid extraction in an environment with a lack of resources and under active threat. French gendarmerie tactical unit medical teams use triage bracelets during mass casualty incidents (MCIs). This study assessed the value of these bracelets in the tactical triage performance of nonhealthcare combat rescue operators in an MCI simulation. OBJECTIVES: To compare triage performance with and without the use of bracelets based on categorization accuracy, LSIs, and time to end triage. MATERIALS AND METHODS: Two groups of operators were randomly assigned to participate in an MCI simulation alone (10 simulated patients) with (intervention group) or without (control) bracelets. The primary outcome was triage performance assessed by the mass casualty triage performance assessment tools. The results were measured based on the LSI required, triage category, and time of completion of the task. Secondary outcomes were operator-perceived stress and self-efficacy. RESULTS: Eleven operators (intervention group n = 5, control group n = 6) participated. Triage performance, based on a maximum score of 90, was better for the intervention group [72.200 (SD = 10.330) vs. 57.000 (SD = 12.961), P = .045]. Self-efficacy was increased after the simulation in the intervention group [45.00 47.2 (SD = 4.147) vs. 50.400 (SD = 5.505), P = .034)]. CONCLUSIONS: This is the first study to show the best triage performance among nonhealthcare combat rescuers using triage bracelets in an MCI simulation. The small sample size did not allow for external validity of the results. The initially calculated number of participants (N = 12) was not reached for operational reasons. The use of bracelets may have a place in the medico-organizational act of tactical triage during MCIs in exclusion zones. Further studies should be conducted to assess the value of triage bracelets by other first responders, including physician-nurse teams.

Correction to: Intranasal sufentanil given in the emergency department triage zone for severe acute traumatic pain-a randomized double­blind controlled trail: comment.

In the original publication, the doses of sufentanil were incorrectly published.