AI Article Synopsis

  • - The French Military Health Service established the Advanced Course for Deployment Surgery (ACDS) in 2008 to improve surgeons' skills in handling Non-Compressible Torso Hemorrhage (NCTH), a leading cause of preventable death in combat scenarios.
  • - A study comparing surgical practices before and after ACDS showed that post-course patients had more severe injuries and demonstrated improved techniques, such as increased use of temporary abdominal packing and reduced re-operations for bleeding.
  • - Overall, the ACDS effectively enhanced the readiness and performance of military surgeons, leading to better management of trauma cases, particularly through improved imaging and surgical techniques.

Article Abstract

Background: Non-Compressible Torso Hemorrhage (NCTH) is the leading cause of preventable death in combat casualty care. To enhance the French military surgeons' preparedness, the French Military Health Service designed the Advanced Course for Deployment Surgery (ACDS) in 2008. This study evaluates behavioral changes in war surgery practice since its implementation.

Methods: Data were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2003 to 2021. All patients treated in French Role 2 or 3 Medical Treatment Facilities (MTFs) deployed in Afghanistan, Mali, or Chad requiring emergency surgery for NCTH were included. The mechanism of injury, severity, and surgical procedures were noted. Surgical care produced before (Control group) and after the implementation of the ACDS course (ACDS group) were compared.

Results: We included 189 trauma patients; 99 in the ACDS group and 90 in the Control group. Most injuries were combat-related (88 % of the ACDS and 82 % of the Control group). The ACDS group had more polytrauma (42% vs. 27 %; p= 0.034) and more e-FAST detailed patients (35% vs. 21 %; p= 0.044). Basics in surgical trauma care were similar between both groups, with a tendency in the ACDS group toward less digestive diversion (n= 6 [6 %] vs. n= 12 [13 %]; p= 0.128), more temporary closure with abdominal packing (n= 17 [17 %] vs. n= 10 [11 %]; p= 0.327), and less re-operation for bleeding (n= 0 [0 %] vs. n= 5 [6 %]; p= 0.046).

Conclusion: The French model of war trauma course succeeded in keeping specialized surgeons aware of the basics of damage control surgery. The main improvements were better use of preoperative imaging and better management of seriously injured patients.

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Source
http://dx.doi.org/10.1016/j.injury.2024.111676DOI Listing

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