Tourniquet Training Program Assessed by a New Performance Score.

IntroductionApplication of a tourniquet is the cornerstone in management of combat-related extremity hemorrhages. Continuous and appropriate training is required to use tourniquets correctly.HypothesisThe aim of this study was to analyze the impact of a refresher training session, conducted directly in the theater of military operations, on the performance of tourniquet use. METHODS: During their deployment (October 2015-April 2016) in the Central African Republic, a first simulation session evaluated soldiers from two combats platoons for the application of the SOFFT (Special Operation Forces Tactical Tourniquet; Tactical Medical Solutions; Anderson, South California USA) tourniquet. After randomization, a R (+) group underwent a refresher training session, while a R (-) group did not. Two months later, a second simulation session was conducted for both groups: R (+) and R (-). A dedicated score (one to seven points), including delay and effectiveness, evaluated the soldiers' performance for tourniquet application. RESULTS: Twenty-six subjects were included in the R (+) group and 24 in the R (-) group. Between the two assessments, the score improved for 61.5% of subjects of the R (+) group and 37.5% subjects of the R (-) group (P=.09). More particularly, the performance score increased from 4.2 (SD=1.4) to 5.5 (SD=0.9; P=.002) in subjects of the R (+) group whose last training for tourniquet application was over six months prior. CONCLUSION: A refresher tourniquet training session, conducted directly in a combat zone, is especially effective for soldiers whose last training session was over six months prior. A dedicated score can assess appropriately the performance of tourniquet training. MartinezT, DuronS, SchaalJV, BaudoinY, BarbierO, DabanJL, BoutonnetM, AussetS, PasquierP. Tourniquet training program assessed by a new performance score. Prehosp Disaster Med. 2018;33(5):519-525.

Dynamic Insights on Surgical Activity in a New Modern Warfare: The French Role 2 in Bangui, Central African Republic.

INTRODUCTION: In December 2013, France deployed more than 2,000 soldiers in Central African Republic with two main missions, to restore security and to improve the humanitarian situation. The objectives of this article were to analyze the surgical activity of forward surgical teams in Central African Republic over 2 years and to discuss features of training for deployed surgeons. MATERIALS AND METHODS: From December 5, 2013, to September 30, 2015, we retrospectively reviewed the electronic surgical database. Surgical activity was described as patient status, type of lesion, surgical procedures performed, and anatomic regions involved. RESULTS: During this study period, 431 surgical procedures were performed on 401 patients; 66% of the patients were civilians, 26% French soldiers, and 11% foreign soldiers. Surgical procedures were divided into 34% orthopedic activity and 66% general surgery activity. Orthopedic activity was mainly performed during the first months of the operation Sangaris, whereas general surgery occurred after summer 2014 with a return to peacetime. CONCLUSIONS: Our study demonstrated original and dynamic insights into the nature of surgical activity throughout the operation with mainly orthopedic surgery during the initial deployment for management of combat casualties and general surgery later, dedicated to elective surgery for local citizens. These data should enhance staffing, training, and deployment of future surgical teams in combat settings with continuous training programs to maintain specific competences, especially in cases of low surgical activity, such as virtual learning or e-learning that could be developed in the future.

[Hospital care for war casualties: forward surgery]. / Le choix tactique de gestes incomplets mais rapides, efficaces et salvateurs.

Hospital care for war casualties: forward surgery. War casualties in today's conflicts are often multiple injuries although fatal injuries of the trunk is limited by the use of ballistic protection. The initial surgery procedures (forward surgery) are based on a genuine therapeutic strategy in the context of war and meets the three priorities that are life saving, save the organ or member, and preserve function. The initial surgical treatment is performed on the theater of operations. Procedures are simple, rapid but incomplete. Damage control surgery is used for trunk, vascular lesions or lesions of the members. The definitive treatment will be done once the patient resuscitated, stabilized and sometimes after evacuation.

Prise en charge hospitalière des blessés de guerre : la chirurgie de l'avant. Les blessés de guerre dans les conflits actuels sont souvent des polytraumatisés bien que les lésions mortelles du tronc soient limitées par l'utilisation de protections balistiques. La prise en charge chirurgicale initiale ou chirurgie de l'avant de ces patients blessés nécessite une véritable stratégie thérapeutique en contexte de guerre et répond aux trois priorités que sont sauver la vie, sauver l'organe ou le membre et préserver la fonction. Le traitement chirurgical initial est réalisé sur le théâtre d'opérations. Il consiste à effectuer des gestes initiaux simples, rapides, mais incomplets, principe même du damage control aussi bien pour les lésions du tronc que pour les lésions vasculaires ou des membres. Le traitement définitif sera réalisé une fois le patient réanimé, stabilisé et parfois après son évacuation.

Concomitant Vascular War Trauma Saturating a French Forward Surgical Team Deployed to Support the Victims of the Syrian War (2013). Interest of the Vascular Damage Control.

Vascular injuries from war require an emergency treatment whose objective is to quickly obtain hemostasis and the restoration of arterial flow. In this context of heavy trauma and limited means, damage control surgery is recommended and is based on the use of temporary vascular shunts (TVSs). We report the management of the simultaneous arrival of 2 vascular injuries of war in a field hospital. Patient 1 presented a ballistic trauma of the elbow with a section of the humeral artery (Gustillo IIIC). A TVS was set up during the external fixation of the elbow. Final revascularization was carried out and aponevrotomies of the forearm were performed. Patient 2 had a riddled knee with an open fracture of the femur, an avulsion of the popliteal artery, and a hemorrhagic shock. A strategy of damage control surgery was carried out with placing an arterial and venous shunt. Aponevrotomies of the leg were carried out before casting. For the traumatisms of the arteries of the members, the use of shunts is reserved for the lesions of the proximal vessels. Many vascular shunts available have the same performances to restore the arterial flow and prevent secondary thrombosis. The time before the final revascularization depends on the clinical condition of the patient. The value of anticoagulation in these cases was not shown.

Enterolith ileus due to jejunal diverticulosis.

Jejunal diverticulosis is a rare malformation that is often asymptomatic. Complications might be similar to those occurring in large-bowel diverticula but also include a much more particular event: intestinal obstruction due to migration and impaction of enterolith formed inside diverticula. This is a very uncommon entity; diagnosis and management are thus often delayed. Mostly surgical exploration is necessary because obstruction symptoms are unresponsive to medical treatment. The authors report a new case of enterolith ileus in a 74-year-old man, due to jejunal diverticulosis, and its successful surgical management in emergency. Only 39 similar cases have ever been reported in the literature.