Analysis during chest compressions in out-of-hospital cardiac arrest patients, a cross/sectional study: The DEFI 2022 study.

AIMS: During out-of-hospital cardiac arrest (OHCA), an automatic external defibrillator (AED) analyzes the cardiac rhythm every two minutes; however, 80% of refibrillations occur within the first minute post-shock. We have implemented an algorithm for Analyzing cardiac rhythm While performing chest Compression (AWC). When AWC detects a shockable rhythm, it shortens the time between analyses to one minute. We investigated the effect of AWC on cardiopulmonary resuscitation quality. METHOD: In this cross-sectional study, we compared patients treated in 2022 with AWC, to a historical cohort from 2017. Inclusion criteria were OHCA patients with a shockable rhythm at the first analysis. Primary endpoint was the chest compression fraction (CCF). Secondary endpoints were cardiac rhythm evolution and survival, including survival analysis of non-prespecified subgroups. RESULTS: In 2017 and 2022, 355 and 377 OHCAs met the inclusion criteria, from which we analyzed the 285 first consecutive cases in each cohort. CCF increased in 2022 compared to 2017 (77% [72-80] vs 72% [67-76]; P < 0.001) and VF recurrences were shocked more promptly (53 s [32-69] vs 117 s [90-132]). Survival did not differ between 2017 and 2022 (adjusted hazard-ratio 0.96 [95% CI, 0.78-1.18]), but was higher in 2022 within the sub-group of OHCAs that occurred in a public place and within a short time from call to AED switch-on (adjusted hazard ratio 0.85[0.76-0.96]). CONCLUSIONS: OHCA patients treated with AWC had higher CCF, shorter time spent in ventricular fibrillation, but no survival difference, except for OHCA that occurred in public places with short intervention time.

Ethical Dilemmas Faced by Military Health Personnel During High-Intensity Conflict: The Crucial Issue of Triage.

Russia's invasion of Ukraine has triggered the biggest conflict in Europe since the Second World War. It has forced countries to prepare for engagement on a massive scale, namely, a high-intensity war between nation states. A potential massive influx of wounded personnel risks saturating logistical supply chains and requires changes to not only medical care but also a paradigm shift. In this context, the principle of distributive justice is key. The aim is to save as many lives as possible through triage, which consists in "doing the greatest good for the greatest number." This idea is fundamental, as an emergency that has passed is no longer an emergency. However, international texts and treaties not only underline that the sole criterion for triage is clinical severity, but they also fail to take into account the patient's status (civilian, friend, and foe). In a high-intensity warfare situation, these texts, and the medical-surgical triage criteria they provide are insufficient, as caregivers may be required to make decisions based on the status of the patient. The need to make such choices could cause psychological suffering among military caregivers, as individuals are recurrently faced with difficult ethical dilemmas. One way to prevent this happening is to provide predeployment training in wartime medical ethics. The latter would include both instruction in international humanitarian law and practical simulations of clinical situations where the person is faced with an ethical dilemma.

Should Soldiers Take Oral Tranexamic Acid Before Going into Battle?

ABSTRACT: Tranexamic acid is an inexpensive antifibrinolytic treatment that reduces morbidity and mortality in civilian and military trauma patients. It must be administered within 3 hours of the injury, and its efficacy is greater the earlier it is given. It is already used preventively in the civilian environment in a number of indications to reduce bleeding and bleeding-related mortality. We wondered about the potential benefits of preventive oral administration of tranexamic acid prior to an assault for military personnel with a potential risk of injury.

Position: A study protocol for the prevention of fall injuries in french special forces selection courses using a body-centered intervention.

INTRODUCTION: The Military Physical and Sports Training program was developed by the French Army in order to train, optimize, and maintain individual readiness. Although the health benefits of sport practice do not need to be demonstrated, such activities can cause acute musculoskeletal injuries that need to be addressed. The prevalence of lower limb injury is rather high in the French military population and, in particular, ranges from 15 to 45% during Special Forces selection courses. Thus, this project aims to investigate the efficiency of a body-centered program designed to enhance body awareness. The program seeks to train the mind to actively pay attention to body information, while the latter is viewed as a protective factor against fall injuries. We assume: (i) that postural control can be improved by enhancing the level of body awareness; and (ii) that greater postural awareness could be beneficial in reducing the risk of fall injuries. The body-centered prevention program is based on the Optimization of the Resources of the Armed Forces (ORAF) intervention, which focuses on mental preparation and recovery, and has been deployed in the French Army for many years. METHOD AND ANALYSES: The study focuses on five French Special Forces selection courses (400 soldiers/ participants). It is divided into two stages (year 1, year 2). The first year is dedicated to data collection from the control group (200 participants), while in the second year the ORAF intervention will be deployed. In both year, participants will be subjected to the same enrollment schedule (Fig 3). The main objective is to evaluate the effectiveness of the ORAF intervention in reducing the rate of fall injuries during military selection, based on a multidisciplinary method that captures demographic, biological, biometric, clinical, and para-clinical measures. TRIAL REGISTRATION: Registration number: IDRCB number 2021-A02108-33, Clinical Trial: NCT05451394.

Burnt by His Cellphone During a Parachute Jump.

BACKGROUND: Many current cell phone (mobile phone, smartphone) batteries are lithium-ion. These batteries can overheat and catch fire under certain conditions. If it happens during a flight or air activity, this might compromise aviation safety. We report a case of a man whose phone caught fire during a parachute jump.CASE REPORT: The individual, a member of Police Special Forces, is required to regularly perform parachute jumps. During the incident flight, the man had a cell phone in a pocket that ignited during the jump. He was able to land and then extract the phone with burns requiring acute medical care and later a skin graft.DISCUSSION: This is a cautionary tale of lithium-ion batteries in flight. Many other situations could also occur with these batteries. There is little medical documentation of the risk of fire with lithium-ion batteries causing injuries during flight operations. To reduce the risk of fire, the devices should be powered down and phones should not be worn directly touching the skin. Damaged devices are more prone to overheating.des Robert V, Saint-Jean L, Corcostegui S-P, Romary E, and Derkenne C. Burnt by his cellphone during a parachute jump. Aerosp Med Hum Perform. 2023; 94(10):792-795.

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study.

BACKGROUND: Prehospital transfusion is a way of improving the management of hemorrhagic shock. In France, prehospital transfusion is struggling to develop, both because of logistical difficulties and particularly restrictive legislation. To comply with this, we propose to store the blood products (BPs) in ground ambulances with refrigerated boxes allowing remote continuous monitoring of storage conditions, called "NelumBox" (Tec4med Lifescience GmbH). To open them, the ambulance's team needs a code that is only given by the Transfusion Center if the request meets all required regulatory criteria. STUDY DESIGN AND METHODS: We conducted a prospective simulation-based feasibility study using dummy BPs. Two ambulances were equipped. Simulations were triggered unexpectedly, including during on-call hours. The ability to quickly access the BPs was the main judgment criterion. The quality of hemovigilance during these simulations was also examined. RESULTS: Twenty-two simulations were performed. The ambulance's team was able to access the BPs in 100% of cases. The average waiting time for receiving the unlocking code was 5 min 27 s (SD = 2 min 12 s, MAX = 12 min 00 s). The transfusion traceability was compliant with regulations in 100% of cases. The transfusion center was able to remotely monitor BPs storage conditions for the entire duration of their stockage in the NelumBox. DISCUSSION: The present procedure is efficient, repeatable, and fast. It guarantees a strict transfusion safety without slowdown a severe trauma management, while complying with French regulations.

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.

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.

Level of Onboard Care for Critical Patients: Analysis of the French Armed Forces Air Medical Evacuations From the Sahel Since 2013.

OBJECTIVE: Since 2013, the French Armed Forces have been engaged in the Sahel. The aim of our work was to study the characteristics of severe patients evacuated according to the composition of the air medical staff (ie, an anesthesiologist/intensive care physician [AICP] or an emergency physician [EP]). METHODS: This was a retrospective cohort analysis including all French service members repatriated from the Sahel with a speedy evacuation priority between 2013 and 2019. RESULTS: A total of 191 patients were evacuated. The causes were trauma for 103 patients and disease for 88. Trauma patients included war injuries (n = 58) and nonbattle injuries (n = 44). For disease patients, the main pathologies were cardiovascular (n = 17), infectious (n = 17), neurologic (n = 15), and gastrointestinal (n = 12). Highly dependent patients were significantly (P < .001) more likely to be managed by an AICP (n = 41) than an EP (n = 5). Moderately dependent patients managed by an AICP (n = 51) were more frequently unstable hemodynamically (n = 5 vs. n = 0, P < .05) and referred to an intensive care unit (n = 24 vs. n = 2, P < .001) than those managed by an EP (n = 41). There were no deaths in flight. CONCLUSION: Greater use of EPs, especially for transporting stabilized patients, would provide more personnel trained in long-distance air transport.

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.

Aeromedical Evacuations Within the French Armed Forces: Analysis of 2,129 Patients.

INTRODUCTION: The doctrine of medical support during French military operations is based on a triptych: forward medical stabilization, forward damage control surgery, and early strategic aeromedical evacuation (Strategic-AE). The aim of this study was to describe the last piece, the evacuation process of the French Strategic-AE. METHODS: We conducted a retrospective cohort analysis using patient records from 2015 to 2017. All French service members requiring an air evacuation from a foreign country to a homeland medical facility were included. Data collected included age, medical diagnosis, priority categorization, boarding location, distance from Paris, type of plane and flight, medical team composition, timeline, and dispatch at arrival. RESULTS: We analyzed 2,129 patients evacuated from 71 countries, most from Africa (1,256), the Middle East (382), and South America (175). Most patients (1,958) were not severely injured, although some considered priority (103) or urgent (68). Diagnoses included disease (48.6%), nonbattle injuries (43%), battle stress (5.3%), and battle injuries (3%). 246 Strategic-AE used medical teams in flight, 136 of them in a dedicated Falcon aircraft. The main etiologies for those evacuations were battle injuries (24%), cardiovascular (15.4%), infections (8%), and neurologic (7.3%). The median time of management for urgent patients was about 16 hours but longer for priority patients (26 hours). Once in France, 1,146 patients were admitted to a surgery department and 96 to an intensive care unit. CONCLUSION: This is the first study to analyze the French Strategic-AE system, which is doctrinally unique when compared to its North Atlantic Treaty Organization allies. North Atlantic Treaty Organization allies favor care in the theatre in place of the French early Strategic-AE. However, in the event of a high intensity conflict, a combination of these two doctrines could be useful.