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Niu A, Ma H, Chen Z, Zhang S, Deng J, Luo Y. Exploring the competencies of Chinese critical care nurses in mobile medical teams based on the onion model: A qualitative study. Nurs Crit Care 2024; 29:868-879. [PMID: 37743055 DOI: 10.1111/nicc.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND With frequent conflicts, natural disasters, and public health emergencies globally, mobile medical teams (MMTs) are becoming increasingly critical. Importantly, the competency of critical care nurses in MMTs can substantially affect the effectiveness and quality of its rescue efforts. Yet, these nurses' competencies are not well understood. AIM This study examined the competencies of critical care nurses in MMTs using the Onion Model. STUDY DESIGN A qualitative descriptive method was used to describe the competencies of Chinese MMT critical care nurses. From April to May 2022, a convenience sample of 18 participants (14 critical care nurses and 4 surgeons) from 10 MMTs was recruited for semi-structured interviews. Deductive and inductive coding methods were combined for content analysis. RESULTS In total, 29 competencies were identified, which were grouped into four major domains using the Onion Model. From the outer to inner layers, these domains were knowledge and skills, professional abilities, professional quality, and personal traits. Several novel competencies emerged, including field medical equipment operation skills, on-site hazard identification and safety prevention skills, triage knowledge, and field survival skills. CONCLUSIONS Using the Onion Model, this study furthers the understanding of the competency of critical care nurses in MMTs, especially by revealing the novel competencies. Further, the results can be used to recruit, evaluate, and train critical care nurses for MMTs. RELEVANCE TO CLINICAL PRACTICE Understanding MMT critical care nurses' competencies can help managers plan and provide relevant training and education before deployment, which can improve nurses' performance, and especially reduce the mortalities and disabilities from trauma.
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Affiliation(s)
- Aifang Niu
- School of Nursing, Third Military University/Army Medical University, Chongqing, China
| | - Huijuan Ma
- School of Nursing, Third Military University/Army Medical University, Chongqing, China
| | - Zhe Chen
- Army Health Service Training Base, Third Military University/Army Medical University, Chongqing, China
| | - Suofei Zhang
- School of Nursing, Third Military University/Army Medical University, Chongqing, China
| | - Jing Deng
- School of Nursing, Third Military University/Army Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, Third Military University/Army Medical University, Chongqing, China
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Jarrassier A, Py N, de Rocquigny G, Raux M, Lasocki S, Dubost C, Bordier E, Libert N, Leclerc T, Meaudre É, Pasquier P. Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review. Anaesth Crit Care Pain Med 2024; 43:101409. [PMID: 39089451 DOI: 10.1016/j.accpm.2024.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis. METHODS A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures. RESULTS Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25-63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation. CONCLUSION This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.
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Affiliation(s)
- Audrey Jarrassier
- Department of anesthesiology and intensive care, Bégin Military Teaching Hospital, Saint-Mandé, France.
| | - Nicolas Py
- Department of anesthesiology and intensive care, Bégin Military Teaching Hospital, Saint-Mandé, France
| | - Gaël de Rocquigny
- Department of anesthesiology and intensive care, Bégin Military Teaching Hospital, Saint-Mandé, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013, Paris, France
| | - Sigismond Lasocki
- Department of anesthesiology and intensive care, University Hospital Center of Angers, Angers, France
| | - Clément Dubost
- Department of anesthesiology and intensive care, Bégin Military Teaching Hospital, Saint-Mandé, France; French Military Medical Service Academy - École du Val-de-Grâce, Paris, France
| | - Emmanuel Bordier
- Department of anesthesiology and intensive care, Bégin Military Teaching Hospital, Saint-Mandé, France
| | - Nicolas Libert
- French Military Medical Service Academy - École du Val-de-Grâce, Paris, France; Department of anesthesiology and intensive care, Burn center, Percy Military Teaching Hospital, Clamart, France
| | - Thomas Leclerc
- French Military Medical Service Academy - École du Val-de-Grâce, Paris, France; Department of anesthesiology and intensive care, Burn center, Percy Military Teaching Hospital, Clamart, France
| | - Éric Meaudre
- French Military Medical Service Academy - École du Val-de-Grâce, Paris, France; Department of anesthesiology and intensive care, Sainte-Anne Military Teaching Hospital, Toulon, France
| | - Pierre Pasquier
- French Military Medical Service Academy - École du Val-de-Grâce, Paris, France; Department of anesthesiology and intensive care, Burn center, Percy Military Teaching Hospital, Clamart, France; French Special Operations Medical Forces Command, Villacoublay, France
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Py N, Jarrassier A, Meaudre E, Pasquier P. Reinforced predeployment training of European military surgical teams: The key requirements are technical, non-technical, and also tactical skills. Injury 2024; 55:111571. [PMID: 38703572 DOI: 10.1016/j.injury.2024.111571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- N Py
- Department of anesthesiology and critical care, Bégin Military Teaching Hospital, Saint-Mandé, France.
| | - A Jarrassier
- Department of anesthesiology and critical care, Bégin Military Teaching Hospital, Saint-Mandé, France
| | - E Meaudre
- Department of anesthesiology and critical care, Saint-Anne Military Teaching Hospital, Toulon, France; École du Val-de-Grâce, French Military Medical Academy, Paris, France
| | - P Pasquier
- École du Val-de-Grâce, French Military Medical Academy, Paris, France; Department of anesthesiology and critical care, Percy Military Teaching Hospital, Clamart, France; French Special Operations Forces Medical Command, Villacoublay, France
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Riff JC, Duranteau O, Ausset S, Pasquier P, Fleuriot E, Corominas V, Boutonnet M. The first two years of the use of low titer group O whole blood during French Military overseas operations: A retrospective study. Transfusion 2024; 64 Suppl 2:S34-S41. [PMID: 38441209 DOI: 10.1111/trf.17776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND On the battlefield, hemorrhage is the main cause of potentially preventable death. To reduce mortality due to hemorrhagic injuries, the French Military Medical Service (FMMS) has deployed low titer group O whole blood (LTOWB) since June 2021 during operation BARKHANE in the Sahel-Saharan strip. Questions persist regarding the circumstances under which the FMMS employs LTOWB during overseas operations. STUDY DESIGN We performed a retrospective analysis of all LTOWB transfused by the FMMS during overseas operations in the Sahel-Saharan strip between June 1, 2021, and June 1, 2023. Information was collected from battlefield forward transfusion sheets. RESULTS Over the 2-year study period, 40 units of LTOWB were transfused into 25 patients. Of the 25 patients, 18 were combat casualties and seven were transfused for non-trauma surgery. Of the 40 units of LTOWB transfused, 22 were provided during Role 2 care, 11 during tactical medical evacuation (MEDEVAC), and seven in light and mobile surgical units. Among combat casualties, LTOWB was the first blood product transfused in 13 patients. In combat casualties, 6 h post-trauma, the median ratio of plasma: red blood cells (RBCs) was 1.5, and the median equivalent platelet concentrate (PC) transfused was 0.17. No immediate adverse events related to LTOWB transfusion were reported. CONCLUSION LTOWB is transfused by the FMMS during overseas operations from the tactical MEDEVAC until Role 2 care. Deployment of LTOWB by the FMMS enables an early high-ratio plasma/RBC transfusion and an early platelet transfusion for combat casualties.
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Affiliation(s)
- Jean-Clément Riff
- Intensive Care Unit, Percy Military Training Hospital, Clamart, France
| | - Olivier Duranteau
- Intensive Care Unit, Percy Military Training Hospital, Clamart, France
| | - Sylvain Ausset
- French Military Medical Schools, Lyon, France
- Ecole du Val-de-Grâce, French Military Medical Service Academy, Paris, France
| | - Pierre Pasquier
- Intensive Care Unit, Percy Military Training Hospital, Clamart, France
- Ecole du Val-de-Grâce, French Military Medical Service Academy, Paris, France
- Special Operation Forces Medical Command, Villacoublay, France
| | | | | | - Mathieu Boutonnet
- Intensive Care Unit, Percy Military Training Hospital, Clamart, France
- Ecole du Val-de-Grâce, French Military Medical Service Academy, Paris, France
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Niu A, Ma H, Chen Z, Zhu X, Luo Y. Exploring the competencies of operating room nurses in mobile surgical teams based on the Onion Model: a qualitative study. BMC Nurs 2023; 22:254. [PMID: 37528375 PMCID: PMC10394863 DOI: 10.1186/s12912-023-01417-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND With the frequent occurrence of public health emergencies, conflicts and natural disasters around the world, mobile surgical teams are becoming more crucial. The competency of the operating room (OR) nurse has a substantial impact on the effectiveness and quality of the surgical team's treatment, still there is limited knowledge about OR nurse competencies in mobile surgical teams. This study aimed to explore the competencies of OR nurses in mobile surgical teams based on the Onion Model. METHODS We conducted a qualitative descriptive study of participants from 10 mobile surgical teams in 2022. Twenty-one surgical team members were interviewed, including 15 OR nurses, four surgeons, and two anesthesiologists. Data were collected through semi-structured interviews. The data were analyzed using Mayring's content analysis. RESULTS Twenty-eight competencies were found in the data analysis, which were grouped into four major domains using the Onion Model. From the outer layer to the inner layer were knowledge and skills, professional abilities, professional quality, and personal traits. The qualitative data revealed several novel competencies, including triage knowledge, self and mutual medical aid, outdoor survival skills, and sense of discipline. CONCLUSIONS The application of the Onion Model promotes the understanding of competency and strengthens the theoretical foundations of this study. New competencies can enrich the content of the competencies of OR nurses. The results of this study can be used for clinical recruitment, evaluation and training of OR nurses in mobile surgical teams. This study encourages further research to develop competency assessment tools and training programs for OR nurses.
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Affiliation(s)
- Aifang Niu
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Huijuan Ma
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Zhe Chen
- Army Health Service Training Base, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Xiaoli Zhu
- Emergency department, General hospital of xinjiang military command, No. 754 Beijing Street, Urumqi, Xin Jiang, P.R. China
| | - Yu Luo
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China.
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Pasquier P, Saleten M, Laitselart P, Martinez T, Descamps C, Debien B, Boutonnet M. Who's who in the trauma bay? Association between wearing of identification jackets and trauma teamwork performance: A simulation study. J Emerg Trauma Shock 2022; 15:139-145. [DOI: 10.4103/jets.jets_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
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Luft A, Pasquier P, Soucanye de Landevoisin E, Morel-Stum N, Baillon A, Louis S, Menini W, Sagalle Y, Gintte J, Bouquet A, Avaro JP. The Damage Control Resuscitation and Surgical Team: The New French Paradigm for Management of Combat Casualties. Mil Med 2020; 187:e275-e281. [PMID: 33242064 DOI: 10.1093/milmed/usaa322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/15/2020] [Accepted: 08/20/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The aim of this work was to introduce the new French forward resuscitation and surgical unit. It's also to discuss the choices and waivers granted to fit the tactical context of modern conflicts and the current epidemiology of combat casualties. MATERIALS AND METHODS A multidisciplinary task force of 11 people proceeded to the conception and the creation of a new military resuscitation and surgical unit. The preliminary work included a scoping review of the combat casualties' epidemiology in modern conflicts and an analysis of the recent French medical-surgical treatment facilities lessons learned. In April 2019, a technical-operational evaluation was conducted to confirm all the technical, ergonomic, and organizational choices made during the design phase. RESULTS The multidisciplinary task force resulted in the creation of the Damage Control Resuscitation and Surgical Team (DCRST). The DCRST focused on the resuscitation strategy, including transfusion of blood products, and the life-saving surgical procedures to be performed as close as possible to the point of injury. It was designed for the resuscitation of two patients: the life-saving surgery of two patients and the very short-term intensive care (<12 hours) of four patients at the same time. The DCRST provided sufficient autonomy to provide take care of four T1 and four T2 or T3 casualties per day for 48 hours. It was armed with 23 soldiers. The technical equipment represented 5,300 kg and 27 m3. All the technical medical equipment could be stored in two 20-foot containers. CONCLUSION The DCRST represents a new paradigm in medical support of French military operations. It offers the advantage of two combat casualties' surgical management at the same time, as close as possible to the combat zone. It responds to a 2-fold epidemiological and logistical challenge.
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Affiliation(s)
- Antoine Luft
- French Military Medical Service - Surgeon General Office, 75509 Paris Cedex 15, France.,French Military Medical Service - Percy Military Training Hospital, 92 140 Clamart, France
| | - Pierre Pasquier
- French Military Medical Service - Percy Military Training Hospital, 92 140 Clamart, France
| | | | - Nelly Morel-Stum
- French Military Medical Service- Military Medical Supply and Health Care Product General Office, 45400 Chanteau, France
| | - Arthur Baillon
- French Military Medical Service - Military Medical Supply and Health Care Product General Office, 45400 Chanteau, France
| | - Serge Louis
- French Military Medical Service - Military Medical Supply and Health Care Product General Office, 45400 Chanteau, France
| | - William Menini
- French Military Medical Service - Sainte Anne military training hospital, 83000 Toulon, France
| | - Yannick Sagalle
- French Military Medical Service - Percy Military Training Hospital, 92 140 Clamart, France
| | - Julie Gintte
- French Military Medical Service - 12th Military Medical Center, 33068 Bordeaux CEDEX, France
| | - Antoine Bouquet
- French Military Medical Service - Surgeon General Office, 60 boulevard du Général Valin CS 21623, 75509 Paris Cedex 15, France
| | - Jean-Philippe Avaro
- French Military Medical Service - Sainte Anne Military Training Hospital, 83000 Toulon, France
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Crego Vita DM, García Cañas R, Rodríguez Moro C, Prieto Vázquez M, Areta Jiménez FJ. An Innovative Technique for Intraoperative Radiological Assessment of Pelvic and Spine Fractures in Austere Environment. Mil Med 2020; 187:e1-e5. [PMID: 33215682 DOI: 10.1093/milmed/usaa502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Managing pelvic and spine fractures in the austere environment can be challenging even for skilled orthopedic surgeons, largely due to the difficulty of radiological visualization of bone structures. We present a simple alternative to the metallic operating table by placing the patient on a spinal board that will allow for a better radiological assessment of these fractures. MATERIAL AND METHODS A cross-sectional, descriptive, and retrospective study was carried out in the period between 2015 and 2020. The study population was all patients with pelvic o spine fractures, managed surgically using a spinal board in the Spanish Role 2 or in the Spanish Role 4. RESULTS Seven patients underwent surgery in total using a spinal board, pelvic fracture being the the main diagnosis (n = 6; 85.71%). The distribution of surgical procedures was as follows: percutaneous pedicle screw fixation (one case), external fixation of the pelvis (two cases), percutaneous screw fixation of the pelvis (two cases), and open reduction and internal fixation of the pelvis (two cases). The mean duration of surgical interventions was 52 minutes, and a successful reduction and synthesis of the fracture was obtained in all the patients, with no complications reported. CONCLUSION A spinal board can be a useful, simple, and effective device for the orthopedic surgeon in the deployed setting. The described technique is simple, fast, and efficient in getting a complete radiological assessment of complex regions such as the pelvis and the spine, facilitating the surgical management of these injuries.
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Affiliation(s)
- Diana M Crego Vita
- Orthopedic Surgery and Traumatology Unit, Defence Central Hospital "Gómez Ulla", Madrid 28047, Spain
| | - Rafael García Cañas
- Orthopedic Surgery and Traumatology Unit, Defence Central Hospital "Gómez Ulla", Madrid 28047, Spain
| | - Carlos Rodríguez Moro
- Orthopedic Surgery and Traumatology Unit, Defence Central Hospital "Gómez Ulla", Madrid 28047, Spain
| | - María Prieto Vázquez
- Orthopedic Surgery and Traumatology Unit, Defence Central Hospital "Gómez Ulla", Madrid 28047, Spain
| | - Fco Javier Areta Jiménez
- Orthopedic Surgery and Traumatology Unit, Defence Central Hospital "Gómez Ulla", Madrid 28047, Spain
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de Lesquen H, Bergez M, Vuong A, Boufime-Jonqheere A, de l'Escalopier N. Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel. Mil Med 2020; 186:e30-e33. [PMID: 33169148 PMCID: PMC7717289 DOI: 10.1093/milmed/usaa273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.
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Affiliation(s)
- Henri de Lesquen
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, 8300, Toulon, France
| | - Marie Bergez
- 4th Forward Surgical Team, French Military Health Service, France.,Département d'Anésthésie-Réanimation, Etablissement Hospitalier Civilo Militaire de Metz., 57070 Metz, France
| | - Antoine Vuong
- 183ème Antenne Medical de Mont de Marsan, 12ème Centre Médical des Armées de Bordeaux, 4000 Mont de Marsan, France
| | | | - Nicolas de l'Escalopier
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Orthopedic, Traumatology and Reconstructive Surgery, PERCY Military Teaching Hospital, 92140, Clamart, France
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