French Military Operations: What are the Prehospital Challenges?

Research Paper Title

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

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.

Methods

To describe these challenges, we retrospectively analysed 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, immobilisation, and antibiotic administration.

Prehospital transfusion (RBCs and/or lyophilised plasma) was started three times in the field, two times during helicopter medical evacuation, and five times in tactical fixed wing medical aircraft.

Lyophilised 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.

Conclusions

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

Reference

Travers, S., Carfantan, C., Luft, A., Aigle, L., Pasquier, P., Martinaud, C., Renard, A., Dubourg, O., Derkenne, C., Kedzierewicz, R., Franchin, M., Bay, C., Cap, A.P. & Ausset, S. (2019) Five years of prolonged field care: prehospital challenges during recent French military operations. Transfusion. 59(S2), pp.1459-1466. doi: 10.1111/trf.15262.

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