Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
Thoracic surgery, Percy Military teaching hospital, Clamart, France.
Injury. 2024 Sep;55(9):111676. doi: 10.1016/j.injury.2024.111676. Epub 2024 Jun 12.
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.
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.
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).
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.
非压缩性躯干出血（NCTH）是战斗伤员救治中可预防死亡的主要原因。为提高法国军医的准备水平，法国军事卫生局于 2008 年设计了部署手术高级课程（ACDS）。本研究评估了自实施以来战争外科实践中的行为变化。
数据取自 OPEX®登记处，该登记处记录了 2003 年至 2021 年期间所有部署期间的外科活动。所有在阿富汗、马里或乍得部署的法国 2 级或 3 级医疗后送设施（MTF）中因 NCTH 紧急手术治疗的患者均包括在内。记录损伤机制、严重程度和手术程序。比较 ACDS 课程实施前后（对照组）产生的外科护理。
我们纳入了 189 名创伤患者；ACDS 组 99 例，对照组 90 例。大多数损伤与战斗有关（ACDS 组 88%，对照组 82%）。ACDS 组多发伤更多（42%比 27%；p=0.034），e-FAST 详细患者更多（35%比 21%；p=0.044）。两组基本外科创伤护理相似，ACDS 组倾向于减少消化道转流术（n=6 [6%]比 n=12 [13%]；p=0.128），更多使用腹部填塞临时关闭（n=17 [17%]比 n=10 [11%]；p=0.327），较少因出血再次手术（n=0 [0%]比 n=5 [6%]；p=0.046）。
法国战争创伤课程模式成功地使专业外科医生意识到损伤控制手术的基础知识。主要改进是更好地利用术前影像学和更好地管理严重受伤患者。
