•In a Role 2+, scanner changed patients’ therapeutic management.•In a Role 2+, scanner made it possible to clarify the diagnosis.•In a Role 2+, scanner relevance appears to be mainly for the ...visceral, cranio-cerebral and rachidial pathologies.•In a Role 2+, scanner operational impact has yet to be demonstrated.
According to the NATO classification, the difference between Role 2 and Role 2+ is the presence of extra diagnostic and therapeutic means, including the deployment of a scanner. The aim of this study is to analyze the impact of this deployment at the front, in the Gao French Role 2 (Mali). Our main hypothesis is that the presence of a scanner at the front improves the servicemen's diagnostic and therapeutic management abilities. Secondly that scanner holds strategic relevance by limiting the repatriation of servicemen on medical grounds.
A prospective analytical observational study was conducted over 6 months within Gao's Role 2. All the French military patients who received a scanner were involved. The collected data was epidemiological, clinical and radiological in nature, and included the results from the scanner and data regarding the operational impact (repatriation). The principal judgment criterion was the rate of modification of the therapeutic decision. The secondary criterion was the modification of the repatriation decision on medical grounds.
Of the 45 patients examined, in 14 cases (31.1%), performing a scanner changed patients’ therapeutic management in relation to the management, which would have been conducted in the scanner's absence. For 12 of these patients (85.7%), the indication of the scanner concerned visceral or cranium-spine pathologies. For 33 patients (73.3%), the scanner enabled diagnosis via the elimination of an organic injury or a severity criterion. The repatriation decision remained unchanged for many patients.
The scanner appears to be a significant factor in the initial therapeutic decision. Scanning made it possible to clarify the diagnosis and to better adapt the initial therapeutic decision. In contrast, the operational impact was null. The literature highlights the relevance of scanner in surgical abstention (limiting unnecessary operative procedures), and for the visceral, cranium-cerebral and spine pathologies in an emergency.
The scanner, a heavy logistic unit deployed within a forward surgical unit, holds therapeutic relevance for French servicemen's management with an important medical service provided for the therapeutic choices, although its operational impact has yet to be demonstrated.
Understanding patients' length of stay at far-forward Role 2 surgical units may help to determine support needs, stabilization requirements, predeployment training, and necessity of increased care ...capability before or during transport to a higher level of care. The objectives of this study were to (1) evaluate the amount of time patients spent at Role 2 and (2) determine the factors associated with trauma patients' length of stay at Role 2.
We conducted a secondary data analysis of the Joint Trauma System Role 2 Database. Logistic regression was used to determine factors associated with extended length of stay at Role 2.
There were 7,912 study patients, and the overall median (interquartile range) amount of time patients spent at Role 2 was 2.5 (1.2-5.5) hours. The adjusted odds ratio (aOR) of extended stay for civilian/other forces and non-US military patients were 1.2 (95% confidence interval CI, 1.0-1.4) and 1.4 (95% CI, 1.2-1.7) times higher as compared with US military patients, respectively. The aOR of extended stay were higher for patients who received blood transfusions (aOR, 1.4; 95% CI, 1.2-1.6), surgical procedures (aOR, 1.6; 95% CI, 1.4-1.8), or did not use a tourniquet (aOR, 1.2; 95% CI, 1.0-1.5). As compared with those injured by an explosion, the adjusted odds of extended stay were 1.2 (95% CI, 1.0-1.4) times higher for patients injured by another mechanism. The odds of extended stay were lower (aOR, 0.3; 95% CI, 0.2-0.5) for patients who died and higher (aOR, 1.4; 95% CI, 1.2-1.6) for transferred patients as compared with patients who returned to duty.
In this study, interventions, patient affiliation, discharge status, and injury mechanism were associated with length of stay at Role 2. Our study results will help inform training and current Role 2 logistic and personnel support needs.
Prognostic, level III.
Abstract Introduction On January 11th 2013, France launched Operation Serval in Mali following Resolution 2085 of the Security Council of the United Nations. Between January and March 2013, more than ...4000 French soldiers were deployed to support the Malian National Army and the African Armed Forces. Methods All of the patients who had surgery during Operation Serval were entered into a computerised database. Patients’ demographic data (age, sex, status) and types of performed surgical procedures (specialties, injury mechanisms) were recorded. Results 268 patients were operated on in Gao's Role 2 with a total of 296 surgeries. Among those operated on, 40% were Malian civilians, 24% were French soldiers, and 36% were soldiers of the International Coalition Forces. The majority of the surgeries were orthopaedic, and visceral surgeries were common as well, representing 43% of the total surgeries. Specialised surgical procedures including neurosurgery, thoracic, and vascular surgery were also performed. Forty percent of the surgeries were scheduled. War-related traumatic surgeries represented 22% of the surgical procedures, with non-war related surgeries and non-trauma emergency surgeries making up the rest. Conclusion this analysis confirms the specific characteristic of asymmetric warfare that it results in a relatively reduced number of war-related casualties. Forward surgical teams have to deal with a wide range of injuries requiring several surgical specialties. Surgeries dedicated to medical aid provided to the population also represented an important part of the surgical activity. Because of the diversity and the technicality of the surgical procedures in Role 2, surgeons had to be trained in war surgery covering all of the surgical specialties, while they maintained their specific skills. In France in 2007, the French Military Health Service Academy (École du Val-de-Grâce, Paris, France) offered an advanced course in surgery for deployment in combat zones, with a special focus on damage control surgeries and the management of mass casualties incidents.
Military medical research has affirmed that early administration of blood products and timely treatment save lives. The US Navy's Expeditionary Resuscitative Surgical System (ERSS) is a Role 2 Light ...Maneuver team that functions close to the point of injury, administering blood products and providing damage-control resuscitation and surgery. However, information is lacking on the logistical constraints regarding provisions for and the stability of blood products in austere environments.
ERSS conducted a study on the United States Central Command (USCENTCOM) area of responsibility. Expired but properly stored units of stored whole blood (SWB) were subjected to five different storage conditions, including combinations of passive and active refrigeration. The SWB was monitored continuously, including for external ambient temperatures. The time for the SWB to rise above the threshold temperature was recorded.
The main outcome of the study was the time for the SWB to rise above the recommended storage temperature. Average ambient temperature during the experiment involving conditions 1 through 4 was 25.6°C (78.08°F). Average ambient temperature during the experiment involving condition 5 was 34.8°C (94.64°F). Blood temperature reached the 6°C (42.8°F) threshold within 90 minutes in conditions 1 and 2, which included control and chemically activated ice packs in the thermal insulated chamber (TIC). Condition 2 included prechilling the TIC in a standard refrigerator to 4°C (39.2°F), which kept the units of SWB below the threshold temperature for 490 minutes (approximately 8 hours). Condition 4 entailed prechilling the TIC in a standard freezer to 0.4°C (32.72°F), thus keeping the units of SWB below threshold for 2,160 minutes (i.e., 36 hours). Condition 5 consisted of prechilling the TIC to 3.9°C (39.02°F) in the combat blood refrigerator, which kept the SWB units below the threshold for 780 minutes (i.e., 13 hours), despite a higher average ambient temperature of almost +10°C (50°F).
Combining active and passive refrigeration methods will increase the time before SWB rises above the threshold temperature. We demonstrate an adaptable approach of preserving blood product temperature despite refrigeration power failure in austere settings, thereby maintaining mission readiness to increase the survival of potential casualties.
Abstract
Introduction
The combat experience during the re-entry stages of Operation Inherent Resolve was distinct from other recent operations, but there is no published literature regarding these ...“initial entry operations” experiences among forward surgical teams (FSTs) deployed to Role 2 facilities A descriptive analysis of patients treated by FSTs may provide valuable information for Role 2 surgical teams preparing to deploy in support of initial entry operations. The purpose of this analysis was to describe injury mechanism, wounding patterns and interventions performed by a small FST in the re-entry phase in Iraq.
Materials and Methods
From July 17, 2015 to January 31, 2016, a split surgical team with two surgeons and an ER physician documented care for all patients treated by their FST located in Iraq. Given their austere environment, FSTs have limited holding capacity, blood supply, and ability to triage and perform advanced procedures. Patients, who arrived to the Role 2 in asystole, were ineligible for the study. The patient population was Iraqi Security Forces as well as Iraqi civilians. No follow-up data were obtained. Using descriptive statistics, we described the basic demographics, health status, blood utilization, injury severity, and injury pattern of the patient population.
Results
The final study population included 300 Iraqi casualties. The majority of patients (96%) were discharged alive. Many patients were 16 years or older (96%), male (96%), Iraqi soldiers (86%), and injured during battle (96%). Over one-third of patients (35%) had a form of metabolic acidosis, 7% were hypothermic, and 18% were in shock at admission. The median amount of blood products used was 6 (interquartile ranges (IQR) = 2–12) units, while the median red blood cells:fresh frozen plasma ratio was 1.2:1. Six or more units of blood were given to 67 (22%) patients. The top three diagnoses were laceration (n = 197, 21%), penetrating injury (n = 185, 19%), and fracture (n = 174, 18%). A high number of injuries occurred in the extremities/pelvis and buttocks (n = 360, 38%) and in the abdomen and pelvic contents (n = 145, 15%). Over a quarter of patients (26%) had critical injuries (i.e., military injury severity score ≥25).
Conclusions
Given the Role 2 configuration, these results demonstrate FSTs must be capable of managing critically ill patients with markedly limited resources. This management will include general operations in both adult and pediatric patients, resuscitation with a limited blood supply, and patient assessment with minimal to no diagnostic tools. This analysis can inform resident training, pre-deployment training, as well as sustainment training for surgeons after residency.
The Role 2 Afloat (R2A) is the Royal Navy (RN)'s Damage Control Resuscitation (DCR), including Damage Control Surgery, capability at sea. There are currently three operating department practitioners ...(ODP) in the deployed team. This article describes the role of the ODP in this team and the training which is required to fulfil this role.
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