EuroTrauma, delays in access to bleeding control. A comparison between a conventional and a hybrid trauma center, both European military trauma centers.

PURPOSE: Comparison of access times to CT and surgical/radiological bleeding control between two European military trauma centers. METHODS: Retrospective and observational study conducted in two military level 1 trauma centers in Toulon (France) and Koblenz (Germany) between 2013 and 2018. Inclusion of severe trauma patients with ISS > 15 with clinical and biological criteria of bleeding. RESULTS: Inclusion of 607 patients (318 in Toulon and 289 in Koblenz). Mean ISS 30. Median access time to CT significantly lower for Koblenz, 14 vs. 30 min; p < 0.001. Median access time to the emergency bleeding control lower in Toulon 84 min vs. 92 (p = 0.114). No impact on mortality at 24 h 9% in Koblenz and 11% in Toulon. Mortality at 28 days identical 17%. CONCLUSION: The organizational innovation at the military hospital in Koblenz saves time in the injury assessment. However, it has no impact on the access time to the scanner and on the mortality at 24 and 28 days. This fight against hemorrhage is a management bundle including delays, transfusion, and team training. CLINICAL TRIAL REGISTRATION: 2,002,878 v 0.

Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study.

BACKGROUND: French military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question. METHOD: Semi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad. RESULTS: All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission's and of treating openly hostile patients were also brought up. Several dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors' duty of care to patients and to the military institution, but this was not the only factor involved. Contextual factors (restricted resources and security constraints) and psychological factors (especially hostility towards the enemy) were also associated with many of the reported dilemmas. CONCLUSION: This is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions.

[2020, Mulhouse, Covid-19: a lesson in history, Europe and resilience]. / 2020, Mulhouse, Covid-19 : une leçon d'histoire, d'Europe, de résilience.

In March 2020, Covid-19, caused by the severe acute respiratory syndrome coronavirus 2, struck the Haut-Rhin region with extreme violence, overwhelming hospitals and requiring the massive opening of new resuscitation beds. The military resuscitation element of the French military health service was deployed for the first time in Mulhouse (68), in eastern France. Alsace-Lorraine, a European crossroads and the birthplace of European institutions, was once again at the heart of history. Perspectives.

[Military nurse: providing care to soldiers on the frontline]. / Infirmier militaire : soigner au plus près des combattants.

Armed forces nurses are selected and trained to intervene on the frontline in the minutes following an injury. Their training and their experience enable them to perform all emergency technical procedures as well as specific procedures performed in war situations. They are prepared to work with personnel from all backgrounds and to integrate pluriprofessional teams with whom they have never previously worked.

[The military intensive care field hospital, a unique experience in the fight against covid-19]. / L'élément militaire de réanimation, une expérience inédite face à la Covid-19.

The militaryintensive care field hospital is a new tool set up by the military medical service as part of Operation Resilience to provide medical support in the regions of France most affected by the SARS-Cov-2 pandemic. Deployed in Mulhouse and Mayotte, this hospital facility is a functional intensive care unit set up to support an existing hospital structure. The caregivers and logistics specialists are all from the military medical service, active personnel or reservists, predominantly nurses. The implementation of this intensive care field hospital in a constrained environment requires an efficient provision of care in accordance with medical guidelines, while protecting the healthcare staff and, notably, the frontline nursing staff.

[E-Training program for sterilization in isolated military operations areas: solution adopted by the French army]. / E-formation à la stérilisation en situation d'isolement: solution retenue par l'armée Française.

French Army Health Service provides medical support for armed forces deployed on external missions.In order to ensure the same health care quality in the theatre and in the metropolis, the Military Health Service provides sterilization of reusable medical devices by its own means. Army pharmacists carrying out an on-site mission comes from different domains: medical biology laboratory, research, medical supplies, hospital pharmacy or yet pharmaceutical laboratory for some reservists. Training program for sterilization in isolated military operations areas is therefore necessary in order to ensure knowledge uniformity. Our study is organized in two parts: determination of the needs and of the adapted training modalities, then implementation of training itself. This training should be accessible to a geographically dispersed public whose levels of expertise in sterilization are disparate. The module «Préparation opérationnelle à la stérilisation en Opération Extérieure¼ carried out allows to update and standardize the knowledge of the deployed pharmacists. It is composed of 11 sub-modules covering the different aspects of sterilization during external missions. Assessment using multiple-choice questions (MCQ) is necessary to check the level of knowledge and to understanding at the end of the training. A 75% good response rate is requested to validate the training. Training content has been approved by the National referents for sterilization and it is already available on the e-learning platform of the École du Val de Grâce.

Articulação entre o serviço de saúde militar e os demais serviços públicos de saúde no controle da HIV/SIDA: o caso do hospital militar de maputo

Esta pesquisa faz uma análise da coordenação de ações entre o Serviço de Saúde Militar (SSM), mais especificamente o Hospital Militar de Maputo (HMM), e os demais serviços públicos do Sistema Nacional de Saúde de Moçambique (SNS) que operam na mesma cidade, particularmente em relação à atenção às Pessoas Vivendo com HIV/SIDA (PVHS). O termo articulação se refere neste trabalho à coordenação entre os diferentes atores/prestadores públicos de serviços de saúde, civis e militares, da cidade de Maputo nessa matéria, de forma a verificar se estão sincronizados e direcionados para o alcance de objetivos comuns. A exemplo do que ocorre em outros países, o SNS moçambicano possui um Serviço de Saúde Militar (SSM), que funciona como um subsistema, com unidades assistenciais operando em todas as províncias e que atende às necessidades de saúde dos militares e seus dependentes, assim como da população civil, em determinadas condições. O Hospital Militar de Maputo (HMM) subordina-se ao Ministério da Defesa Nacional (MDN). Entretanto, como uma das unidades sanitárias da cidade de Maputo, está integrado aos serviços públicos de saúde desta urbe, prestando assistência a usuários com agravos de várias ordens, inclusive portadores de HIV/SIDA. Há um Memorando de Entendimento entre o MDN e o Ministério da Saúde (MISAU), formalizada em 2005, voltado para a assistência à saúde das populações civis no SSM. . Porém, estudos sobre a descrição e análise dessa articulação com os demaisserviços públicos de saúde de Maputo, em relação ao HIV e outras doenças, e sobre osmecanismos que a operacionalizam, ainda são escassos. No HMM funciona um Laboratóriode Análises Clínicas que realiza exames de pacientes de diferentes proveniências, paradiversas patologias, e serve de referência para os exames de contagem de células T-CD4 dedoentes oriundos de alguns Centros de Saúde da Cidade de Maputo, no âmbito dacoordenação entre o MISAU e o MDN...

This study examines coordination of care between the Military Health Service (Serviço de Saúde Militar, SSM), more specifically Maputo Military Hospital (Hospital Militar de Maputo, HMM), and the other services of Mozambique’s National Health System (Sistema Nacional de Saúde, SNS) operating in the same city, particularly as regards care for people living with HIV/AIDS. In this paper, the term articulation is used to refer to the work of coordinating, in this connection, among civil and military public health service actors and providers in the city of Maputo, so as to assure that they are synchronised and directed to attaining common goals. As occurs in other countries, Mozambique’s SNS has an SSM, operating as a subsystem with care facilities in all the provinces, attending to the needs of military personnel and their dependents and, in certain circumstances, the civil population. The HMM is subordinated to the Ministry of National Defence (Ministério da Defesa Nacional, MDN). However, as one of several health facilities in Maputo city, is it integrated with the city’s public health services and provides care to users with conditions of various orders, including those with HIV/AIDS. A Memorandum of Understanding signed in 2005 between the MDN and the Ministry of Health (Ministério da Saúde, MISAU) addresses provision of health care by the SSM for civil populations. s. However, studies describing andanalysing this articulation with Maputo’s other public health services on HIV and otherdiseases, and the mechanisms by which it is operationalised, are still scarce. The HMM has aclinical laboratory which conducts testing of patients from various sources and for variouspathologies, serving as a referral centre for T-CD4 cell count testing of patients from some ofMaputo’s health centres, under the coordination between the MISAU and MDN...

The application status of Chinese herbal medicine in military health service in China.

Military medicine has had a long history in China since the emergence of the war. Chinese medicine, especially Chinese herbs, was widely used in China as well as other Asian countries for the prevention and treatment of diseases in the military for hundreds of years. However, the use of Chinese medicine in military health service has never been well studied. In this article, we briefly summarize the application status of Chinese herbal medicine in military health service in China, putting particular emphasis on special military environment, in an attempt to build a bridge between Chinese medicine and military health service and promote the quality of health service for the military and maintain world peace.

The application status of Chinese herbal medicine in military health service in China / 中国结合医学杂志

Military medicine has had a long history in China since the emergence of the war. Chinese medicine, especially Chinese herbs, was widely used in China as well as other Asian countries for the prevention and treatment of diseases in the military for hundreds of years. However, the use of Chinese medicine in military health service has never been well studied. In this article, we briefly summarize the application status of Chinese herbal medicine in military health service in China, putting particular emphasis on special military environment, in an attempt to build a bridge between Chinese medicine and military health service and promote the quality of health service for the military and maintain world peace.

Development and comparison of domestic and foreign military health service command management systems / 军事医学

According to the property of military health service positioning , armed forces all over the world invariably put military health service into combat team ranks .They want to strengthen the ties between the health system and the military system by adjusting the health command and management system in order to meet the needs of multi -level and multi-directional wartime support in the future .This paper summarizes the development of foreign ( the US.Germany and Russian Federation) and our military health command and management system , and make a detailed comparison .It may be a practical and valuable research for the current military health reform .

Research on mechanism and application of optimal disposition of military health service forces / 第二军医大学学报

Based on the theoretical difficulties and application of rapid decision-making in mechanism of optimal disposition of military health service forces, we established the logic model of optimal disposition factors of military health service forces and optimal decision-making using literature reviewing, expert consulting, and systemic analysis; we also established the optimal disposition model of military health service forces using linear programming, autoregressive integrated moving average and back propagation neural network model, and system dynamics, which reveals the intrinsic characteristics and laws of the optimal disposition of military health service forces. We prepared the supporting system and operational box for optimal disposition of the military health forces using the geographic information system, database system, software engineering, and decision support systems, which provide not only a theoretic model for optimal disposition of military health service forces, information software, and equipment tool, and also theoretical evidence for the rapid decision-making in military health resource planning for diversified military actions. Our study has expanded the research area of evidence-informed decision-making in military health forces.

Current status and development of evidence-informed decision-making in military health service / 第二军医大学学报

Evidence-informed military health decision-making is an important way to upgrade the commanding of military health service in multiple military actions; it is also a methodology to ensure systematic, scientific, and continuous strategic military health service. This article, based on the definition of evidence informed military health policy-making, analyzes the major ways of evidence-informed decision-making home and abroad, introduces the current situation of evidence-informed health policy-making of PLA, and makes a perspective analysis about the development of evidence-informed decision-making in military health service.

Study on Health Service Rescue Vest of Armed Police Forces / 医疗卫生装备

Objective To evaluate the performance of a kind of military health service rescue vest. Methods The author studied the structure analysis, basic performance experiments and ergonomics tests. Results The vest was scientifically designed, easy to use, in line with the ergonomics and can fulfill the requirements of military health service secure in different environment. Conclusion The secure vest can fulfill medical first aid at scene and military health service rescue. It can be used for soldiers.