Next-generation tourniquet: Recommendations for future capabilities and design requirements.

BACKGROUND: Advances in tourniquet development must meet new military needs for future large-scale combat operations or civilian mass casualty scenarios. This includes the potential use of engineering and automation technologies to provide advanced tourniquet features. A comprehensive set of design capabilities and requirements for an intelligent or smart tourniquet needed to meet the challenges currently does not exist. The goal of this project was to identify key features and capabilities that should be considered for the development of next-generation tourniquets. METHODS: We used a modified Delphi consensus technique to survey a panel of 34 tourniquet subject matter experts to rate various statements and potential design characteristics relevant to tourniquets systems and their use scenarios. Three iterative rounds of surveys were held, followed by virtual working group meetings, to determine importance or agreement with any given statement. We used a tiered consensus system to determine final agreement over key features that were viewed as important or unimportant features or capabilities. This information was used to refine and clarify the necessary tourniquet design features and adjust questions for the following surveys. RESULTS: Key features and capabilities of various were agreed upon by the panelists when consensus was reached. Some tourniquet features that were agreed upon included but are not limited to: Capable of being used longer than 2 hours, applied and monitored by anyone, data displays, semiautomated capabilities with inherent overrides, automated monitoring with notifications and alerts, and provide recommended actions. CONCLUSION: We were able to identify key tourniquet features that will be important for future device development. These consensus results can guide future inventors, researchers, and manufacturers to develop a portfolio of next-generation tourniquets for enhancing the capabilities of a prehospital medical provider. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level V.

Military Standard Testing of Commercially Available Supraglottic Airway Devices for Use in a Military Combat Setting.

INTRODUCTION: Airway obstruction is the second leading cause of death on the battlefield. The harsh conditions of the military combat setting require that devices be able to withstand extreme circumstances. Military standards (MIL-STD) testing is necessary before devices are fielded. We sought to determine the ability of supraglottic airway (SGA) devices to withstand MIL-STD testing. METHODS: We tested 10 SGA models according to nine MIL-STD-810H test methods. We selected these tests by polling five military and civilian emergency-medicine subject matter experts (SMEs), who weighed the relevance of each test. We performed tests on three devices for each model, with operational and visual examinations, to assign a score (1 to 10) for each device after each test. We calculated the final score of each SGA model by averaging the score of each device and multiplying that by the weight for each test, for a possible final score of 2.6 to 26.3. RESULTS: The scores for the SGA models were LMA Classic Airway, 25.9; AuraGain Disposable Laryngeal Mask, 25.5; i-gel Supraglottic Airway, 25.2; Solus Laryngeal Mask Airway, 24.4; LMA Fastrach Airway, 24.4; AuraStraight Disposable Laryngeal Mask, 24.1; King LTS-D Disposable Laryngeal Tube, 22.1; LMA Supreme Airway, 21.0; air-Q Disposable Intubating Laryngeal Airway, 20.1; and Baska Mask Supraglottic Airway, 18.1. The limited (one to three) samples available for testing provide adequate preliminary information but restrict the range of failures that could be discovered. CONCLUSIONS: Lower scoring SGA models may not be optimal for military field use. Models scoring sufficiently close to the top performers (LMA Classic, AuraGain, i-gel, Solus, LMA Fastrach, AuraStraight) may be viable for use in the military setting. The findings of our testing should help guide device procurement appropriate for different battlefield conditions.

Is tactical combat casualty care in terrorist attacks suitable for civilian first responders?

INTRODUCTION: Prehospital management of intentional mass casualty incidents is a unique challenge to Emergency Medical Services. Tactical Combat Casualty Care (TCCC) and the use of tourniquets for extremity hemorrhage have already proven to reduce mortality on the battlefield. This literature review aims to determine the place of these military concepts in a civilian high-threat prehospital setting. METHODS: The PubMed database was searched for articles published between January 1, 2000, and December 1, 2019, containing descriptions, discussions, or experiences of the application of tourniquets or other TCCC-based interventions in the civilian prehospital setting. Data extraction focused on identifying important common themes in the articles. RESULTS: Of the 286 identified articles, 30 were selected for inclusion. According to the Oxford Centre for Evidence-based Medicine Levels of Evidence, overall level of evidence was low. Most articles were observational, retrospective cohort studies without a nontourniquet control group. Outcome measures and variables were variably reported. Two articles specifically analyzed tourniquet use during high-threat situations, and three described their application by law enforcement personnel. Overall, tourniquets were found to be effective in stopping major limb bleeding. Reported mortality was low and related complications appeared to be infrequent. Only four articles mentioned the application of other TCCC-based maneuvers, such as airway and respiratory management. CONCLUSION: This literature review shows that tourniquets appear to be safe tools associated with few complications and might be effective in controlling major bleeding in civilian limb trauma. For example, during mass casualty incidents, their use could be justified. Training and equipping ambulance and police services to deal with massive bleeding could likewise improve interoperability and victim survival in a civilian high-threat prehospital setting. More qualitative research is needed to further evaluate the effects of hemorrhage control training for first responders on patient outcomes. Literature describing the application of other TCCC-based principles is limited, which makes it difficult to draw conclusions regarding their use in a civilian setting. LEVEL OF EVIDENCE: Systematic review, level III.

A comparison of efficacy, efficiency, and durability in novel tourniquet designs.

BACKGROUND: Exsanguination due to extremity hemorrhage is a major cause of preventable traumatic deaths. Extremity tourniquet use has been shown to be safe and improve survival. The purpose of this study was to compare the efficacy, efficiency, and durability of the Generation 7 Combat Application Tourniquet (CAT; North American Rescue, Greer, SC), the Tactical Mechanical Tourniquet (TMT; Combat Medical Systems, Harrisburg, NC), and the SOF Tactical Tourniquet-Wide (SOFTT-W; Tactical Medical Solutions, Anderson, SC). METHODS: This study was a three-phase randomized, cross-over trial. In successive trials, subjects were timed during the application of each tourniquet to the upper and lower extremity. Following successful lower extremity application, subjects low crawled 25 ft and then were dragged 25 ft, after which effectiveness was reassessed, as defined by the cessation of distal pulses by Doppler ultrasound. RESULTS: In arm application, both the CAT and TMT had significantly less failure rates than the SOFTT-W (5.56%, 19.44%, 58.33%), with the CAT being the fastest tourniquet when compared with TMT and SOFTT-W (37.8 seconds, 65.01 seconds, 63.07 seconds). In leg application, the CAT had significantly less rates of failure when compared with the SOFTT-W, but there was no other significant difference between the tourniquets (27.78%, 44.44%, 61.11%). In addition, the CAT was significantly faster than both the TMT and SOFTT-W when applied to the leg (8.33 seconds, 40.96 seconds, 34.5 seconds). There was no significant difference in tourniquet failure rates between the three tourniquets after subject maneuvers in phase 3 (34.29%, 42.86%, 45.45%). DISCUSSION: The CAT is as effective as the TMT and significantly more effective than the SOFTT-W. In addition, the CAT demonstrated shorter application times than either the TMT or SOFTT-W. However, there was no significant difference between the three tourniquets in their ability to maintain pulselessness after subject maneuvers. LEVEL OF EVIDENCE: Care management, level II.

Military medical research on internal diseases in modern warfare: new concepts, demands, challenges, and opportunities.

Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield. The military medical research on battlefield internal diseases focuses on the pathogenesis, clinical management, and prevention of internal diseases under military war conditions. In both wartime and peacetime, the soldiers suffer from more internal diseases than surgical wounds. With the introduction of high-tech weapons, including chemical, physical, and biological agents, a large number of special internal illnesses and casualties will appear in future wars. The battles often occur in special environments, such as high or low temperatures, plateau or polar areas, and micro- or hyper-gravity. The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare. Therefore, the military medical research on battlefield internal medicine should be based on contemporary military situations, focus on the purpose of treating battlefield internal diseases, and adhere to the actual needs of the troops in peacetime and wartime. We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine. This review highlights new concepts, demands, challenges, and opportunities for the further development of military medical research on battlefield internal medicine.

Historic Firsts: Aeromedical Evacuation and the Transportation Isolation System.

This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019.

Combat Application Tourniquet fares well in a chemical, biological, radiological or nuclear dress state.

INTRODUCTION: There is a need for a military tourniquet to control catastrophic haemorrhage in a chemical, biological, radiological or nuclear (CBRN) threat environment. No published data exist as to the efficacy of tourniquets while wearing British military CBRN individual protective equipment (IPE). METHODS: 12 volunteers from the counter CBRN instructors' course allowed testing on 24 legs. A Combat Application Tourniquet (C-A-T) was applied to all volunteers at the level of the midthigh. 12 legs were tested while wearing CBRN IPE (both operator and simulated casualty), and the control group of 12 legs was tested while wearing conventional combat dress state (both operator and simulated casualty). The order of leg laterality and dress state were sequenced according to a prerandomised system. Efficacy was measured via use of an ultrasound probe at the popliteal artery. Tourniquets were considered effective if arterial flow was completely occluded on ultrasound imaging. Data were collected on time to successful application, failure of tourniquets and pain scores as rated by the visual analogue scale (1-10). RESULTS: There were no failures of tourniquet application in the CBRN group, and two failures (17%) in the control group. Failures were pain threshold exceeded (n=1) and tourniquet internal strap failure (n=1). The mean application time for the CBRN group was 28.5 s (SD 11.7) and 23.7 s (SD 9.8) for the conventional combat group. There was no statistically significant difference (p=0.27). The median CBRN pain score was 2.0 (IQR 2.0-3.5). The median control pain score was 4.0 (IQR 3-6). This was a statistically significant difference (p=0.002). CONCLUSION: C-A-Ts applied to simulated casualties in CBRN IPE at the midthigh are at least as efficacious as those applied to the midthigh in a conventional combat dress state. The pain experienced was less in CBRN IPE than when in a conventional combat dress state.

Evaluation of the current methods used for assessing dietary intake in military research settings: a scoping review.

INTRODUCTION: It is important to collate the literature that has assessed dietary intake within military settings to establish which methods are commonly used and which are valid so that accurate nutrition recommendations can be made. This scoping review aims to identify which methods are typically used to assess dietary intake in military settings and which of these have been validated. This review also aims to provide a recommendation as to which method(s) should be used in military settings. METHODS: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in PubMed, Web of Science and SPORTDiscus with the most recent search executed on 12th June 2020. Eligible studies had to report original data, assess and quantify dietary intake and have been published in peer-reviewed academic journals. The reporting bias was calculated for each study where possible. RESULTS: Twenty-eight studies used a single method to assess dietary intake and seven studies used a combination of methods. The most commonly used methods were the gold standard food intake/waste method, Food Frequency Questionnaire (FFQ) or a food diary (FD). The only method to date that has been validated in military settings is weighed food records (WFR). CONCLUSIONS: The food intake/waste method or WFR should be used where feasible. Where this is not practical the FFQ or FD should be considered with control measures applied. There is currently not sufficient evidence to state that using multiple methods together improves validity.

Reflecting on success in trauma research: experiences from the SGCNS and SIR studies.

The inclusion of British Service Personnel (SP) lacking capacity into research studies from the point of injury through to medium-term rehabilitation had not previously been undertaken until work to support operations in Afghanistan (2001-2014). The Surgeon General's Casualty Nutrition Study and the Steroids and Immunity from Injury through to Rehabilitation Study sought to address the nutrition, endocrine and immune responses in a military patient cohort. A fundamental part of research is to feedback to patients, their relatives and ward staff on data collection and outcomes, and how future research may be improved to better support both injured SP and trauma patients in the UK. This paper will provide an experiential view on the delivery, operations and infrastructure requirements that should be considered when developing military research at a role-3 facility, before, during and after a study.

Practice parameters for the use of actigraphy in the military operational context: the Walter Reed Army Institute of Research Operational Research Kit-Actigraphy (WORK-A).

BACKGROUND: The Walter Reed Army Institute of Research (WRAIR) Operational Research Kit-Actigraphy (WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States Army Reserve Officers' Training Corps (ROTC) cadets (n = 286) during a month-long capstone pre-commissioning training exercise. METHODS: The sleep of ROTC cadets (n = 286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets (n = 140). RESULTS: Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep (all P ≤ 0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime (22:21 ± 1:30 vs. 22:13 ± 0:40, P = 0.21) and waketime (04:30 ± 2:17 vs. 04:31 ± 0:47, P = 0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed (TIB) for major sleep intervals (352 ± 29 min) and self-report nightly sleep duration (337 ± 57 min, P = 0.006) than that between the WORK-A major TIB and Actiware TIB (177 ± 42, P ≤ 0.001). CONCLUSIONS: Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.

Maintaining a high inspired oxygen fraction with the Elisée 350 turbine transport ventilator connected to two portable oxygen concentrators in an austere environment.

BACKGROUND: Management of critically ill patients requiring mechanical ventilation in austere environments or during disaster response is a logistic challenge. Availability of oxygen cylinders for mechanically ventilated patient may be difficult in such a context. A solution to ventilate patients requiring high fraction of inspired oxygen (FiO2) is to use a ventilator able to be supplied by a low-pressure oxygen source connected with two oxygen concentrators (OCs). We tested the Elisée 350 (ResMedBella Vista, Australia) ventilator paired with two Newlife Intensity 10 (Airsep, Ball Ground, Georgia) OCs and evaluated the delivered FiO2 across a range of minute volumes and combinations of ventilator settings. METHODS: The ventilators were attached to a test lung, OC flow was adjusted with a Certifier FA ventilator test systems from 2 to 10 L/min and injected into the oxygen inlet port of the Elisée 350. The FiO2 was measured by the analyzer integrated in the ventilator, controlled by the ventilator test system. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered FiO2. RESULTS: The Elisée 350 ventilator is a turbine ventilator able to deliver high FiO2 when functioning with two OCs. However, modifications of the ventilator settings such as an increase in minute ventilation affect delivered FiO2 even if oxygen flow is constant on the OC. CONCLUSION: The ability of two OCs to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders to ventilate patients requiring an FiO2 of ≥80% in austere place or during disaster response. LEVEL OF EVIDENCE: Feasibility study on test bench, level V.

The Light Role CCP: A Blueprint for Far Forward Medical Support to Contemporary Operations.

November 2018 saw the deployment of a medical team with a remit to provide far forward medical support to UK, Coalition and indigenous forces. The delivery of this capability demanded a solution unique within the UK Defence Medical Services. The 'light role' casualty collection points provided emergency medical care to 475 casualties over a 4-month period. The success of the deployment was dependant on the ability to remain light and agile which brought with it logistical considerations. The clinical caseload was predominantly secondary blast injury and gunshot wound (GSW). The positioning of a Role 1 facility close to the front line of troops enabled early Damage Control Resuscitation including the delivery of blood products. MEDEVAC to Role 2 was enabled by indigenous forces. The unique situation demanded bespoke solutions for documentation and blood warming. The lessons learnt during the deployment may form a blueprint for future contingency operations.

Medical data collection on UK Military Exercise Saif Sareea 3: the EpiNATO-2 surveillance system.

INTRODUCTION: Epidemiological data from military exercises are important to identify trends in medical presentations and treatment requirements to aid planning for future operations. UK Military exercises use the EpiNATO-2 surveillance system for this purpose, however it has some limitations in the spectrum of data it can collect. An enhanced reporting system titled EpiNATO-2 PLUS was developed and introduced in all LAND (Army) Role 1 Medical Treatment Facilities (MTFs) as part of Exercise Saif Sareea 3 (SS3). It was assessed as part of a Quality Improvement Project for its utility in terms of spectrum and validity of data capture. METHOD: Epidemiological data were collected over a 2-month period from medical consultations in Camp Shafa during SS3 by EpiNATO-2 or EpiNATO-2 PLUS. This involved categorisation of symptoms into a coding system which represents a spectrum of clinical presentations, as well as collecting data on the effect of medical issues on personnel productivity. Halfway through the collection period, an EpiNATO-2 PLUS education session and Summary Guide were introduced. Data were audited for the period before and after these introductions. RESULTS: Of the 1163 consultations conducted in the 2-month period, the use of EpiNATO-2 PLUS captured an additional 169 patient contacts not collected by EpiNATO-2. The provision of a summary guide and teaching session decreased coding errors in the second audit period from 12.9% to 6.8% for EpiNATO-2 and from 19.4% to 6.6% for EpiNATO-2 PLUS, respectively. CONCLUSIONS: The use of EpiNATO-2 PLUS collected a broader spectrum of medical activity in the Role 1 MTF, by capturing an additional 10% of the clinical workload compared with EpiNATO-2. The increase in coding accuracy correlates with the introduction of the education session and EpiNATO-2 PLUS Summary Guide. It is recommended that EpiNATO-2 PLUS is used in future deployments.

Medical equipment trends during the UK military exercise SAIF SAREEA 3 in Oman.

INTRODUCTION: Ex SAIF SAREEA 3 was a joint British-Omani military exercise involving approximately 5500 British personnel deployed to Oman over a 6-month period. Role 1 medical care was provided by medical treatment facilities (MTFs) deployed with medical equipment as per the UK 300 medical module. METHOD: Retrospective analysis was undertaken of prospectively collected equipment usage data from two Role 1 MTFs in Duqm (MTF 1) and Muaskar Al Murtafa (MTF 2) camps over a period of 6-8 weeks. Data were analysed alongside routinely collected epidemiological data (EPINATO) during the deployment. Equipment used in addition to the module was also recorded. RESULTS: MTF 1 used 50 out of the 179 different items from the module over the 8-week period. MTF 2 used 45 out of the 179 different items from their module over the 6-week period. The most commonly used items across the sites were non-sterile examination gloves, plastic aprons, tympanic thermometer probe covers, disinfectant wipes and self-adhesive plasters. Extramodular items (blunt fill needle, water pump sprayer, Jelonet gauze and stool specimen pot) accounted for 5% of all equipment used in MTF 1. CONCLUSION: The study showed that the 300 module accommodates 95% of Role 1 patients' needs but highlights the requirement for dedicated equipment for the treatment of heat casualties if deemed likely and blunt fill/filter needles for the administration of parenteral medication. Commanders must perform a thorough medical estimate and risk assessment prior to deployment to ensure that the 300 medical module is likely to provide the necessary equipment and supplement the module if required.

Prescribing in the prehospital environment: a review of the pharmaceutical Module 501 on UK Military Exercise SAIF SAREEA 3. Can such analysis assist with the scaling of healthcare assets?

INTRODUCTION: Module 501 provides core medications which are fundamental to the capability of a prehospital treatment team (PHTT). The quantities of each medication in the module inventory undergo regular review, but these do not correspond to a population at risk (PAR) figure or deployment length for which they intend to be used. This article proposes how the quantities of Module 501 drugs can be scaled for a given deployment, in this example using statistics taken from static PHTTs on Exercise Saif Sareea 3 (SS3). METHODS: The statistics were gathered using a custom-built search of electronic records from the Deployed Defence Medical Information Capability Programme in addition to written record-keeping, which were aligned to the weekly PAR at each PHTT location throughout their full operational capability periods. A quotient was then derived for each module item using a formula. RESULTS: Among the 10 most commonly prescribed drugs were four analgesics and three antimicrobials. 42 of the 110 studied drugs were not prescribed during SS3. DISCUSSION: The data from SS3 reflect the typical scope of disease encountered in the deployed land setting. Employing these data, the use of a formula to estimate the drug quantities needed to sustain a Strike Armoured Infantry Brigade over a 28-day period is demonstrated. RECOMMENDATIONS: Further study of Module 501 across varied deployment environments would be valuable in evolving this approach to medicinal scaling if proven effective for the warm desert climate. It could then be applied to other modules to further inform future Strike medical planning. LIMITATIONS: Several considerations when drawing deductions from the data are mentioned, including the inaccuracy of predictor variables taken from the EpiNATO-2 reports. CONCLUSION: The proposed formula provides an evidence-based framework for scaling drug quantities for a deployment planning. This may improve patient safety and confer logistical, storage and fiscal benefits.

Developing the Prototype Embedded Health Engagement Team.

Small, well prepared, culturally competent, and embedded health engagement teams (EHET) tailored to work within a partner health system, rather than outside of it, will achieve greater mutual benefit, desired military objectives, and better health outcomes for the United States Department of Defence and its partners. EHETs have significant advantages over traditional methods of choice for health security cooperation and humanitarian assistance missions. These advantages include enhanced capability and capacity building, greater trust through intentional cultural expertise, a ready platform for enduring relationships, enhanced host nation legitimacy, and flexibility to target specific issues with greater fidelity. We must first define a prototype EHET, compare the concept against prior units that have executed health engagement, and test it prospectively in employment. The U.S. military and the civilian business world each have extensive experience in employing small teams that the health community can emulate. The ideal EHET should have the following nine characteristics: 12 people or fewer, skillsets for the tasks, global health knowledge, be multidisciplinary, a balance of experience, local language capability, geopolitical and cultural competence, targeted preparation for specific security and health objectives, and joint representation. This paper will explore these components of the prototype EHET as it will be tested in our research project.

Use of drones in clinical microbiology and infectious diseases: current status, challenges and barriers.

BACKGROUND: Drones or unmanned aerial vehicles are autonomous or remotely controlled multipurpose aerial vehicles driven by aerodynamic forces and capable of carrying a payload. Whereas initially used exclusively for military purposes, the use of drones has gradually spread into other areas. Given their great flexibility and favourable costs, the use of drones has also been piloted in various healthcare settings. OBJECTIVES: We briefly summarize current knowledge regarding the use of drones in healthcare, focusing on infectious diseases and/or microbiology when applicable. SOURCES: Information was sought through PubMed and extracted from peer-reviewed literature published between January 2010 and August 2019 and from reliable online news sources. The search terms 'drones', 'unmanned aerial vehicles', 'microbiology' and 'medicine' were used. CONTENT: Peer-reviewed literature on the use of drones in healthcare has steadily increased in recent years. Drones have been successfully evaluated in various pilot programmes and are already implemented in some settings for transporting samples and delivering blood, vaccines, medicines, organs, life-saving medical supplies and equipment. In addition, a promising proof-of-concept 'lab-on-a-drone' was recently presented, as well as several pilot studies showing the benefits of drone use in surveillance and epidemiology of infectious diseases. IMPLICATIONS: The potential for drone use in clinical microbiology, infectious diseases and epidemiology is vast. Drones may help to increase access to healthcare for individuals that might otherwise not benefit from appropriate care due to remoteness and lack of infrastructure or funds. However, factors such as national airspace legislation and legal medical issues, differences in topography and climates, cost-effectiveness, and community attitudes and acceptance in different cultures and societies currently impede the widespread use of drones. Significant cost savings compared with ground transportation, speed and convenience of delivery, and the booming drone sector will probably drive drone implementation in various areas of medicine in the next 5 years.

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents.

INTRODUCTION: To evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies. METHODS: A prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a 'clinical diagnostic probability' (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an 'ultrasound diagnostic probability' (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy). RESULTS: Forty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0-5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%). CONCLUSION: POCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.