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Transfusion. 2019 Apr;59(S2):1459-1466. doi: 10.1111/trf.15262.

Five years of prolonged field care: prehospital challenges during recent French military operations.

Author information

1
2ème Centre Médical des Armées, 12ème Antenne Médicale, French Military Health Service, Villacoublay, France.
2
French Military Health Service, Val de Grâce Military Academy, Paris, Paris, France.
3
French Military Health Service - Operational Headquarters, Paris, France.
4
10ème Centre Médical des Armées, 154ème Antenne Médicale, French Military Health Service, Aubagne, France.
5
French Military Health Service, Percy Military Hospital, Clamart, France.
6
Centre de Transfusion Sanguine des Armées, French Military Health Service, Clamart, France.
7
Emergency Department, Saint Anne Military Hospital, French Military Health Service, Toulon, France.
8
CMIA Saint-Denis, Antenne Médicale de St Pierre, French Military Health Service, La Réunion, France.
9
Paris Fire Brigade Medical Emergency Department, French Military Health Service, Paris, France.
10
French Military Health Service - Ground Forces Headquarters, Tours, France.
11
Medical Corps, US Army, US Army Institute of Surgical Research, Fort Sam Houston, Texas.

Abstract

BACKGROUND:

French military operations in the Sahel conducted since 2013 over more than 5 million square kilometers have challenged the French Military Health Service with specific problems in prolonged field care.

STUDY DESIGN AND METHODS:

To describe these challenges, we retrospectively analyzed the prehospital data from the first 5 years of these operations within a delimited area.

RESULTS:

One hundred eighty-three servicemen of different nationalities were evacuated, mainly as a result of explosions (73.2%) or gunshots (21.9%). Their mean number evacuation was 2.2 (minimum, 1; maximum, 8) per medical evacuation with a direct evacuation from the field to a Role 2 medical treatment facility (MTF) for 62% of them. For the highest-priority casualties (N = 46), the median time [interquartile range] from injury to a Role 2 MTF was 130 minutes [70 minutes to 252 minutes], exceeding 120 minutes in 57% of cases and 240 minutes in 26%. The most frequent out-of-hospital medical interventions were external hemostasis, airway and hemopneumothorax management, hypotensive resuscitation, analgesia, immobilization, and antibiotic administration. Prehospital transfusion (RBCs and/or lyophilized plasma) was started three times in the field, two times during helicopter medical evacuation, and five times in tactical fixed wing medical aircraft. Lyophilized plasma was confirmed to be particularly suitable in these settings. One of the specific issues involved in lengthy prehospital time was the importance to reassess and convert tourniquets prior to Role 2 MTF admission.

CONCLUSION:

Main challenges identified include reducing evacuation times as much as possible, preserving ground deployment of sufficiently trained medics and medical teams, optimization of transfusion strategies, and strengthening specific prolonged field care equipment and training.

PMID:
30980759
DOI:
10.1111/trf.15262
[Indexed for MEDLINE]

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