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Sellier A, Beucler N, Joubert C, Julien C, Tannyeres P, Anger F, Bernard C, Desse N, Dagain A. Emergency Cranial Surgeries Without the Support of a Neurosurgeon: Experience of the French Military Surgeons. Mil Med 2024; 189:598-605. [PMID: 35906867 DOI: 10.1093/milmed/usac227] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/03/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Unlike orthopedic or visceral surgeons, French military neurosurgeons are not permanently deployed on the conflict zone. Thus, craniocerebral war casualties are often managed by general surgeons in the mobile field surgical team. The objective of the study was to provide the feedback of French military surgeons who operated on craniocerebral injuries during their deployment in a role 2 surgical hospital without a neurosurgeon. MATERIALS AND METHODS A cross-sectional survey was conducted by phone in March 2020, involving every military surgeon currently working in the French Military Training Hospitals, with an experience of cranial surgery without the support of a neurosurgeon during deployment. We strived to obtain contextual, clinical, radiological, and surgical data. RESULTS A total of 33 cranial procedures involving 64 surgeons were reported from 1993 to 2018. A preoperative CT scan was not available in 18 patients (55%). Half of the procedures consisted in debridement of craniocerebral wounds (52%, n = 17), followed by decompressive craniectomies (30%, n = 10), craniotomy with hematoma evacuation (15%, n = 5), and finally one (3%) surgery with exploratory burr holes were performed. The 30-day survival rate was 52% (n = 17) and 50% (n = 10/20) among the patients who sustained severe traumatic brain injury. CONCLUSIONS This survey demonstrates the feasibility and the plus-value of a neurosurgical damage control procedure performed on the field by a surgeon nonspecialized in cranial surgery. The stereotyped neurosurgical techniques used by the in-theater surgeon were learned during a specific predeployment training course. However, the use of a live telemedicine neurosurgical support seems indispensable and could benefit the general surgeon in strained resources setting.
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Affiliation(s)
- Aurore Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Christophe Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Clément Julien
- Department of Visceral Surgery, Laveran Military Hospital, Marseille 13384, France
| | - Paul Tannyeres
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Florent Anger
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Cédric Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
- French Military Health Service Academy, École du Val-de-Grâce, Paris Cedex 5 75230, France
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Borg TM, Cavale N, Abu-Sittah G, Ghanem A. Plastic and Maxillofacial Training for War-Zones - A Systematic Review. Craniomaxillofac Trauma Reconstr 2023; 16:154-162. [PMID: 37222978 PMCID: PMC10201192 DOI: 10.1177/19433875221083416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. This study involves a systematic review. Objective To evaluate interventions in place to train Plastic and Maxillofacial surgeons for war-zone environments so that limitations to current training can be addressed. Methods A literature search of Medline and EMBase was performed using terms relevant to Plastic and Maxillofacial surgery training and war-zone environments. Articles that met the inclusion criteria were scored then educational interventions described in included literature were categorised according to their length, delivery style and training environment. Between-group ANOVA was performed to compare training strategies. Results 2055 citations were identified through this literature search. Thirty-three studies were included in this analysis. The highest scoring interventions were over an extended time-frame with an action-oriented training approach, using simulation or actual patients. Core competencies addressed by these strategies included technical and non-technical skills necessary when working in war-zone type settings. Conclusions Surgical rotations in trauma centers and areas of civil strife, together with didactic courses are valuable strategies to train surgeons for war-zones. These opportunities must be readily available globally and be targeted to the surgical needs of the local population, anticipating the types of combat injuries that often occur in these environments.
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Affiliation(s)
- Tiffanie-Marie Borg
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
- Department of Surgery, Queen’s Hospital, London, UK
| | | | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
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Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries. Chin J Traumatol 2022; 25:193-200. [PMID: 35331606 PMCID: PMC9252934 DOI: 10.1016/j.cjtee.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. METHODS The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. RESULTS The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training. CONCLUSION The platform established in this study was useful for CDCS training.
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Haverkamp FJC, van Leest TAJ, Muhrbeck M, Hoencamp R, Wladis A, Tan ECTH. Self-perceived preparedness and training needs of healthcare personnel on humanitarian mission: a pre- and post-deployment survey. World J Emerg Surg 2022; 17:14. [PMID: 35248111 PMCID: PMC8898429 DOI: 10.1186/s13017-022-00417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Humanitarian healthcare workers are indispensable for treating weapon-wounded patients in armed conflict, and the international humanitarian community should ensure adequate preparedness for this task. This study aims to assess deployed humanitarian healthcare workers’ self-perceived preparedness, training requirements and mental support needs. Methods Medical professionals deployed with the International Committee of the Red Cross (ICRC) between October 2018 and June 2020 were invited to participate in this longitudinal questionnaire. Two separate questionnaires were conducted pre- and post-deployment to assess respondents’ self-perceived preparedness, preparation efforts, deployment experiences and deployment influence on personal and professional development. Results Response rates for the pre- and post-deployment questionnaires were 52.5% (114/217) and 26.7% (58/217), respectively. Eighty-five respondents (85/114; 74.6%) reported feeling sufficiently prepared to treat adult trauma patients, reflected by predeployment ratings of 3 or higher on a scale from 1 (low) to 5 (high). Significantly lower ratings were found among nurses compared to physicians. Work experience in a high-volume trauma centre before deployment was associated with a greater feeling of preparedness (mean rank 46.98 vs. 36.89; p = 0.045). Topics most frequently requested to be included in future training were neurosurgery, maxillofacial surgery, reconstructive surgery, ultrasound, tropical diseases, triage, burns and newborn noncommunicable disease management. Moreover, 51.7% (30/58) of the respondents regarded the availability of a mental health professional during deployment as helpful to deal with stress. Conclusion Overall, deployed ICRC medical personnel felt sufficiently prepared for their missions, although nurses reported lower preparedness levels than physicians. Recommendations were made concerning topics to be covered in future training and additional preparation strategies to gain relevant clinical experience. Future preparatory efforts should focus on all medical professions, and their training needs should be continuously monitored to ensure the alignment of preparation strategies with preparation needs. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00417-z.
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Choufani C, Barbier O, Mathieu L, de L'Escalopier N. Military Orthopedic Surgeons Are Not Just Traumatologists. Mil Med 2021; 187:1376-1380. [PMID: 34591093 DOI: 10.1093/milmed/usab400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 09/18/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Each French military orthopedic surgeon is both an orthopedic surgeon and a trauma surgeon. Their mission is to support the armed forces in France and on deployment. The aim of this study was to describe the type of orthopedic surgery performed for the armed forces in France. Our hypothesis was that scheduled surgery was more common than trauma surgery. METHODS We conducted a retrospective descriptive analysis of the surgical activity for military patients in the orthopedic surgery departments of the four French military platform hospitals. All surgical procedures performed during 2020 were collected. We divided the procedures into the following categories: heavy and light trauma, posttraumatic reconstruction surgery, sports surgery, degenerative surgery, and specialized surgery. Our primary endpoint was the number of procedures performed per category. RESULTS A total of 827 individuals underwent surgery, 91 of whom (11%) were medical returnees from deployment. The surgeries performed for the remaining 736 soldiers present in metropolitan France (89%) consisted of 181 (24.6%) trauma procedures (of which 86.7% were light trauma) and 555 (75.4%) scheduled surgery procedures (of which 60.8% were sports surgery). Among the medical returnees, there were 71 traumatology procedures (78%, of which 87.3% were light traumatology) and 20 procedures corresponding to surgery usually carried out on a scheduled basis (22%, of which 95% were sports surgery). CONCLUSION Military orthopedic surgeons are not just traumatologists; their activity for the armed forces is varied and mainly consists of so-called programmed interventions.
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Affiliation(s)
- Camille Choufani
- Clinic of Orthopedics and Traumatology, Saint-Anne Military Teaching Hospital, Toulon 83000, France
| | - Olivier Barbier
- Clinic of Orthopedics and Traumatology, Saint-Anne Military Teaching Hospital, Toulon 83000, France.,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | - Laurent Mathieu
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France.,Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France
| | - Nicolas de L'Escalopier
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France
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Py N, Martinez T, Boyé M, Tourtier JP, Meaudre E, Benbrika W, Ausset S, Pasquier P. The French Pre-Deployment Advanced Course in Anesthesia and Resuscitation: Development and Future Prospects. Mil Med 2021; 186:804-810. [PMID: 33544123 DOI: 10.1093/milmed/usab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military anesthesiologists from the French Military Medical Service (FMMS) are part of the Forward Surgical Teams deployed in overseas military operations. The practice of anesthesia in combat zones requires specific skills that are not taught during the initial curriculum for French civilian anesthesiologist. The Pre-Deployment Advanced Course in Anesthesia and Resuscitation (DACAR) program was developed to prepare military anesthesiologist from the FMMS before their deployment in overseas military operations. METHODS Created in 2013 by the French Military Medical Academy, the DACAR program is divided into two modules and carried out once a year. The DACAR program trains all military anesthesiologist residents at the end of their curricula. Since 2019, a number of Certified Registered Nurse Anesthetists have completed the DACAR program. The DACAR program is organized around the main axes of experience feedback from previous deployments in combat zones as well as didactic learning and practical training using high-fidelity simulation. RESULTS Since 2013, a total of 99 trainees completed the DACAR program during six complete cycles of two modules. The DACAR program has gradually been enriched from 14 courses in 2013 to 28 in 2019. Participants' reported satisfaction rates have increased steadily since 2016, when 88% of courses were rated as "interesting" or "very interesting," and only 4% as "not very interesting." By 2019, those figures had improved to 96% and 2%, respectively. CONCLUSION The DACAR program is a structured and adapted military medical course aimed at completing the curriculum of military anesthesiologists from the FMMS before deployment in overseas military operations. Regular audits and updates ensure that the DACAR training program maintains the highest standards of quality and rigor.
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Affiliation(s)
- Nicolas Py
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France
| | - Thibault Martinez
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France
| | - Matthieu Boyé
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France
| | - Jean-Pierre Tourtier
- Federation of anesthesiology and intensive care unit, Bégin Military Training Hospital, Saint Mandé 94160, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Eric Meaudre
- Federation of anesthesiology and intensive care unit, Saint-Anne Military Training Hospital, Toulon 83800, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Widad Benbrika
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Sylvain Ausset
- French military medical schools, Bron 69500, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
| | - Pierre Pasquier
- Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart 92140, France.,École du Val-de-Grâce, French military medical academy, Paris 75005, France
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Sellier A, Beucler N, Desse N, Julien C, Tannyeres P, Bernard C, Joubert C, Dagain A. Evaluation of neurosurgical training of French military surgeons prior to their deployment. Neurochirurgie 2021; 67:454-460. [PMID: 33766563 DOI: 10.1016/j.neuchi.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A specific training course was formalized in 2007 in order to facilitate the management of cranio-encephalic injuries by French military general surgeons during deployment, within the Advanced Course for Deployment Surgery (ACDS). The objective is to evaluate the neurosurgical pre-deployment training course attended by the military surgeons. METHODS From June 2019 to September 2019, we conducted a cross-sectional survey in the form of a digital self-completed questionnaire, addressed to all graduated military surgeons working in the French Military Training Hospitals. The survey included: (1) a knowledge assessment; and (2) a self-assessment of the training course. The participating surgeons were classified into two groups according to their participation (group 1) or not (group 2) in the neurosurgical module. The main outcome was the score received on the knowledge assessment. RESULTS Among the 145 military surgeons currently in service, 76 participated in our study (53%), of which 49 were classified in group 1 (64%) and 27 in group 2 (36%). Group 1 surgeons had a significantly higher score than Group 2 at the knowledge assessment (mean 21.0±7.1 vs. 17.8±6.0, P=0.041). The most successful questions were related to TBI diagnosis and surgical technique, while the least successful questions dealt with "beyond emergency care" and surgical indications. CONCLUSION The French pre-deployment neurosurgical training course provides a strong neurosurgical background, sufficient to perform life-saving procedures in a modern conflict situation. However, neurosurgical specialized advice should be solicited whenever possible to assist the in-theatre surgeon in surgical decisions.
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Affiliation(s)
- A Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France.
| | - N Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - N Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Julien
- Department of Visceral Surgery, Sainte-Anne Military Hospital, Toulon, France
| | - P Tannyeres
- 9th Army Medical Center, 144th medical unit, French Military Health Service, Canjuers, France
| | - C Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - A Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France; French Military Health Service Academy - École du Val-de-Grâce, Paris, France
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Choufani C, Demoures T, de l'Escalopier N, Chapon MP, Barbier O, Mathieu L. Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad. Eur J Trauma Emerg Surg 2020; 48:593-599. [PMID: 32857239 DOI: 10.1007/s00068-020-01471-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/21/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. METHODS A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application. RESULTS Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage. CONCLUSIONS This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures.
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Affiliation(s)
- Camille Choufani
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France.
| | - Thomas Demoures
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France
| | - Nicolas de l'Escalopier
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
| | - Marie-Pauline Chapon
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France
| | - Olivier Barbier
- Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160, Saint-Mandé, France
- French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Laurent Mathieu
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
- French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005, Paris, France
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Choufani C, Barbier O, Demoures T, Mathieu L, Rigal S. Evaluation of a fellowship abroad as part of the initial training of the French military surgeon. BMJ Mil Health 2020; 167:168-171. [PMID: 32015183 DOI: 10.1136/jramc-2019-001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment. METHODS This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment. RESULTS Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10. CONCLUSION A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.
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Affiliation(s)
- Camille Choufani
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - O Barbier
- Orthopedic and Traumatology, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - T Demoures
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - L Mathieu
- Department of Orthopaedic, Trauma and Reconstructive Surgery, HIA Percy, Clamart, France
| | - S Rigal
- Department of Traumatology and Orthopedics, HIA Percy, Clamart, France
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Abstract
BACKGROUND Due to the increasing threat of terrorist attacks and assassinations even in Europe, the interest in management of severe vascular injuries, which, with an increased incidence of 10% are to be expected with such penetrating wounds, is also growing; however, with increasing subspecialization in surgery there is a threat that the know-how in vascular surgery will become lost among non-vascular surgical specialists. Therefore, the Germany military established an educational program, the so-called DUOplus concept, to ensure that future military surgeons acquire and retain the experience and skills to fulfill the demanding role of a deployed surgeon. OBJECTIVE The DUOplus concept of the German Medical Forces is introduced with a special focus on vascular surgery training. RESULTS All trainee German military surgeons attain a second specialization alongside general surgery. This residency includes several courses in various surgical specialties as well as a 12-month rotation in a vascular surgery department. The core elements of vascular trauma training are two practical courses on life-like models. In these courses, which were developed especially for the needs of non-vascular surgeons in hands-on training, open surgical techniques and damage control measures including resuscitative endovascular balloon occlusion of the aorta (REBOA) are taught on suitable models and intensively practiced. CONCLUSION All surgeons potentially confronted with traumatic and iatrogenic vascular injuries should have some basic competence in the management of vascular trauma. Especially the courses in vascular surgery for non-vascular surgeons offer such a skill set for every surgeon. Next to the German military surgeons, the courses are attended more and more by civilian and military surgeons from different surgical specialties and nationalities.
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Choufani C, Barbier O, Mayet A, Rigal S, Mathieu L. Preparedness Evaluation of French Military Orthopedic Surgeons Before Deployment. Mil Med 2019; 184:e206-e212. [PMID: 29901771 DOI: 10.1093/milmed/usy134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/19/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Camille Choufani
- Department of Orthopaedic Surgery and Traumatology, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Aurélie Mayet
- Department of Epidemiology and Public Health, Camp de Sainte Marthe, Marseille, France
| | - Sylvain Rigal
- Department of Orthopaedic, Traumatology and Reconstructive surgery, Percy Military Teaching Hospital, Clamart, France.,Department of Surgery, French Military Health Service Academy, Ecole du-Val-de-Grâce, Paris, France
| | - Laurent Mathieu
- Department of Orthopaedic, Traumatology and Reconstructive surgery, Percy Military Teaching Hospital, Clamart, France.,Department of Surgery, French Military Health Service Academy, Ecole du-Val-de-Grâce, Paris, France
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Barbier O, Racle M. Has Current French Training for Military Orthopedic Surgeons Deployed in External Operations Been Appropriately Adapted? Mil Med 2018; 183:e411-e415. [DOI: 10.1093/milmed/usy013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/09/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Barbier
- Orthopaedic Department, Begin Military Teaching Hospital, 69, avenue de Paris, Saint-Mandé, France
| | - Maelle Racle
- 1st Military Medical Center, Medical Unit of Vincennes, Cours des Maréchaux, Paris Cedex, France
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13
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Maintaining clinical competencies of military surgeons at the beginning of the 21st century: the French paradigm. J Trauma Acute Care Surg 2017; 83:562-563. [PMID: 28609382 DOI: 10.1097/ta.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Surgical support during the terrorist attacks in Paris, November 13, 2015. J Trauma Acute Care Surg 2017; 82:1122-1128. [DOI: 10.1097/ta.0000000000001461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hinsenkamp M. SICOT contribution to natural disaster assistance: the pre-requisite. INTERNATIONAL ORTHOPAEDICS 2015; 39:1885-6. [PMID: 26183141 DOI: 10.1007/s00264-015-2877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Maurice Hinsenkamp
- Department of Orthopaedic Surgery, Hôpital Erasme, Université Libre de Bruxelles - ULB, Route de Lennik 808, Brussels, B-1070, Belgium.
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