Has Current French Training for Military Orthopedic Surgeons Deployed in External Operations Been Appropriately Adapted?

INTRODUCTION: The current evolution of surgical practices is increasingly trending toward hyper-specialization. For military surgeons, their practice in France does not differ from their civilian counterparts. In contrast, in external operations, they have to deal with specific war injuries in austere conditions. They are also required to take care of local populations. Therefore, specific training is necessary, and the French Military Health Service Academy (Ecole du Val-de-Grâce) Paris has set up a specific training called Advanced Course for Deployment Surgery (ACDS) in 2007. The aim of this study is to assess the relevance of this teaching regarding pathologies encountered during current conflicts. MATERIALS AND METHODS: The activity of deploying orthopedic surgeons during the three recent major external operations (Afghanistan, Mali, and Central African Republic) has been retrospectively recorded in terms of global volume, types of trauma, status of patients who had been operated on, and indications. These data have been compared with teaching during the ACDS. RESULTS: Our study found a high variability in terms of operating volume, types of trauma, patients' statuses, and types of operations performed depending on the operation theaters. The volume of surgical activity carried out within Role 3 is much more important than that in Role 2 with more than half of the surgeries performed as scheduled surgery to the benefit of the local population. Within advanced Role 2 surgical structures deployed in Mali and Central Africa, more than 70% of the activity was performed as emergencies. Surgical indications were varied, ranging from emergency surgery to limb reconstructive surgery. A lot of non-orthopedic procedures such as vascular repairs and decompressive craniotomies were also performed. All of the encountered pathologies were taught during ACDS. DISCUSSION: The large variety and technical nature of the performed operations requires the training of highly qualified military orthopedic surgeons with both experience in war surgery and management of after-effects and complications. Orthopedists are also required to carry out procedures dealing with neurosurgery, general, and/or vascular surgery on missions. These data highlight the complexity of military surgeons' training along with the hyper-specialization of the civilian medical world. For more than 10 yr, French military surgeons have benefited from a training program called ACDS to meet these objectives. This initial training seems to be appropriated adapted in view of the managed pathologies.

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.