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MEDEVAC/CASEVAC

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Je n'ai pas trouvé de fil spécifique sur les évacuations des blessés et leur prise en charge urgente , alors que l'amélioration de celle-ci est un facteur crucial de la diminution du nombre de perte

While US forces had seen only a 6 per cent drop in the combat mortality rate between World War II and the 1990 Persian Gulf War (30 per cent to 24 per cent) – owing perhaps to AE long being viewed as a last resort behind the philosophy of getting the injured soldier fixed up and straight back into action – the figure for recent campaigns in Iraq, Afghanistan and Libya is under 10 per cent.

The reason behind this change is down to a number of factors, but the formation of CCATTs in 1996 has been a huge boon owing to its focus on continuously stabilizing patients during transport. These teams offer the specialities of a CC doctor, a CC nurse, and a cardiopulmonary technician, all individually trained within an 8 week programme.

Alongside the progress was the attention to joint trauma solutions, which exposed a gap in critical care within the aircraft. To address this, Tactical Critical Care Evacuation Teams (TCCETs) have also been established to provide even more advanced care, from aggressive resuscitation at the point-of-injury and throughout the evacuation process.

Today, the average timeframe for getting a wounded soldier from the battlefield to surgical care is between 20-75 minutes, while taking a downed infantryman from the combat zones of Enduring Freedom to the military hospital in Landstuhl is between 24-48 hours, and to the Continental United States (CONUS MTF), just 2-4 days. This is quite an improvement on the 8 day average at the beginning of the Afghanistan campaign, and even more so on the 45 days once suffered by those deployed to Vietnam.......

...

...New Technology

As USAF looks to develop its medical capability at a strategic level, so to is it looking to develop the instruments on-hand.

AE teams are now benefiting from the likes of video assisted intubation, vacuum spinal immobilisation and virtual (simulator) training.

Colonel (Rtd) Jace Sotomayer, senior advisor to the Air Force Surgeon General HQ, has a firm understanding of the needs for airborne combat healthcare given his background as an aviator.

His work involves liaising with analysts, academics and manufacturers to work out the best approaches to modernising equipment at every level, from where there is an immediate hazard present to when evacuation and en-route care is required.

http://www.defenceiq.com/air-forces-and-military-aircraft/articles/are-medical-evacuation-efforts-worrying-militaries/&mac=DFIQ_OI_Featured_2011&utm_source=defenceiq.com&utm_medium=email&utm_campaign=DFIQOptIn&utm_content=8/14/12

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Une mousse à injecter pour diminuer la perte sanguine en cas de blessure abdominale :

A foam-based technology has been developed which is designed to fill in the spaces in an injured victim’s abdominal cavity, creating pressure in the voids, and substantially reducing blood loss from internal bleeding. In fact, early tests have shown a six-fold reduction in blood loss, and a dramatic increase in 3-hour survival rates from 8 percent to 72 percent. The foam was developed for DARPA’s Wound Stasis program by Arsenal Medical.

The foam is injected into the patient’s abdomen using a two-part compound that expands when mixed together. The foam then conforms to the inside of the body cavity, slowing internal bleeding. Once the patient can be stabilized at a hospital, the foam can be removed by a surgeon.

While the idea of filling my body cavities with something similar to that spray foam insulation really sounds awful, I suppose I’d subject myself to it if it meant the difference between living and bleeding to death.

http://technabob.com/blog/2012/12/10/darpa-wound-stasis-foam/

The foam is actually a polyurethane polymer that forms inside a patient’s body upon injection of two liquid phases, a polyol phase and an isocyanate phase, into the abdominal cavity. As the liquids mix, two reactions are triggered. First, the mixed liquid expands to approximately 30 times its original volume while conforming to the surfaces of injured tissue. Second, the liquid transforms into solid foam capable of providing resistance to intra-abdominal blood loss. The foam can expand through pooled and clotted blood and despite the significant hydrostatic force of an active hemorrhage.

In tests, removal of the foam took less than one minute following incision by a surgeon. The foam was removed by hand in a single block, with only minimal amounts remaining in the abdominal cavity, and with no significant adherence of tissue to the foam. Features appearing in relief on the extracted foam showed conformal contact with abdominal tissues and partial encapsulation of the small and large bowels, spleen, and liver. Blood absorption was limited to near the surface of the foam; the inside of the foam block remained almost uniformly free of blood.

http://www.darpa.mil/NewsEvents/Releases/2012/12/10.aspx

http://www.youtube.com/watch?v=pT1d6jxKwpk

La réalité est toutefois moins mirifique pour le moment que celle brossée sur une animation You Tube :

La publication d'un test comparé de survie après blessure abdominale à effectivement été publiée en Juin 2013 chez ... La Souris

Self-expanding polyurethane polymer improves survival in a model of noncompressible massive abdominal hemorrhage.

AuthorsDuggan M, et al. Show all Journal

J Trauma Acute Care Surg. 2013 Jun;74(6):1462-7. doi: 10.1097/TA.0b013e31828da937.

Affiliation

Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA.

Abstract

BACKGROUND: Intracavitary noncompressible hemorrhage remains a significant cause of preventable death on the battlefield. Two dynamically mixed and percutaneously injected liquids were engineered to create an in situ self-expanding polymer foam to facilitate hemostasis in massive bleeding. We hypothesized that intraperitoneal injection of the polymer could achieve conformal contact with sites of injury and improve survival in swine with lethal hepatoportal injury.

METHODS: High grade hepatoportal injury was created in a closed abdominal cavity, resulting in massive noncoagulopathic, noncompressible hemorrhage. Animals received either standard battlefield fluid resuscitation (control, n = 12) or fluid resuscitation plus intraperitoneal injection of hemostatic foam (polymer, n = 15) and were monitored for 3 hours. Blood loss was quantified, and all hepatoportal injuries were inspected for consistency.

RESULTS: Before intervention, all animals initially experienced severe, profound hypotension and near-arrest (mean arterial pressure at 10 minutes, 21 [5.3] mm Hg). Overall survival at 3 hours was 73% in the polymer group and 8% in the control group (p = 0.001). Median survival time was more than 150 minutes in the polymer group versus 23 minutes (19-41.5 minutes) in the control group (p < 0.001), and normalized blood loss in the polymer group was 0.47 (0.30) g/kg per minute versus 3.0 (1.3) g/kg per minute in the controls (p = < 0.001). All hepatoportal injuries were anatomically similar, and the polymer had conformal contact with injured tissues.

CONCLUSION: Intraperitoneal polymer injection during massive noncompressible hemorrhage reduces blood loss and improves survival in a lethal, closed-cavity, hepatoportal injury model. Chronic safety and additional efficacy studies in other models are needed.

Les résultats semblent prometteurs 2h30 de survie dans le cas de l'injection de mousse abdominale Versus 23 minutes...

Mais comme il est conclut : d'autres études sont nécessaires dans d'autres "modèles"...

Edited by BPCs

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Un capteur léger qui permettrait de faire un diagnostic précoce d'une hémorragie intra cérébrale sans être obligé de descendre le blessé sur une structure hospitalière plus lourde dotée d'un scanner :

Image IPB

http://www.gizmag.com/veps-traumatic-brain-injury-rapid-diagnosis/28042/

ictims of penetrating head injuries usually seek immediate attention, as the hole in their skull is difficult to miss. However, people with closed-head injuries may show few immediate signs of the trauma, and appropriate diagnostic equipment (primarily a CAT scanner) is often not immediately available. A Mexican-US team of researchers has now developed a simple, easy to operate, and inexpensive electromagnetic sensor for traumatic brain injuries, suited to on site use by field personnel and paramedics

...

This suggests that the VEPS sensor can indeed act as a new instrument of field triage, to identify patients critically in need of immediate care so the medical rescue system can put them on a fast track toward treatment. Additionally, immediate diagnosis of sports-related head injuries would help protect our athletes in the harsher contact sports. It also seems possible that further development of VEPS as a diagnostic tool might result in a tool capable of finer distinctions, so that effective diagnosis of head injuries may not require access to a CT scanner.

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Pour limiter l'importance de la perte de sang lors des blessures sur le champ de bataille, les médecins de la Royal Army envisagent de distribuer des doses d'acide tranexamique qui est utilisé habituellement pour limiter l'importance de la perte sanguine lors des actes de chirurgie très hémorragiques.

Ceci se fait de manière simple par l'utilisation d'un stylo auto injecteur pour intramusculaire.

Dans cette article, ils étudient la faisabilité de cette pratique.

Battlefield administration of tranexamic acid by combat troops: a feasibility analysis.

Wright C. J R Army Med Corps. 2013 Oct 23. doi: 10.1136/jramc-2013-000152.

Affiliation

Abstract

This paper suggests that 1 g tranexamic acid should be incorporated as an intramuscular auto-injector and issued to combat troops for self- or buddy-administration in the event of suffering severe injury. Early administration of tranexamic acid has shown to be beneficial in preventing death from bleeding in trauma patients in both the military and the civilian settings. Tranexamic acid is cheap, safe, easy to administer and saves lives. Future conflicts may be characterised by prolonged pre-hospital times and delayed access to advanced medical care. The use of this drug is the next logical step in reducing combat trauma deaths.

Que cette proposition soit issue de la Royal Army n'est sans doute pas un hasard :

De part sa structure profondément réformée, le SSA Britannique est actuellement disséminé au sein de service d'urgence ou de chirurgie situés dans les hôpitaux civils.

Ils ont du, de ce fait, participer à une vaste étude regroupant de nombreux services d'urgence britannique testant l'effet de l'injection d'acide tranexamique dans les blessures traumatiques :

There was no evidence of heterogeneity in the effect of tranexamic acid on the risk of thrombotic events (P=0.74). If the effect of tranexamic acid is assumed to be the same in all risk strata (<6%, 6-20%, 21-50%, >50% risk of death at baseline), the percentage of deaths that could be averted by administration of tranexamic acid within three hours of injury in each group is 17%, 36%, 30%, and 17%, respectively.

http://www.ncbi.nlm.nih.gov/m/pubmed/22968527/?i=6&from=/24155347/related Edited by BPCs

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Dans la suite de ce précédent Post, les forces de Défense israeliennes ont montré la faisabilité de l'administration à la phase pré hospitalière de l'acide tranexamique au niveau du "Point of Injury" :

Injury. 2014 Jan;45(1):66-70. doi: 10.1016/j.injury.2013.08.025. Epub 2013 Sep 7.

Tranexamic acid in the prehospital setting: Israel Defense Forces' initial experience.

RESULTS:

Forty casualties who received TXA in the prehospital setting were identified. Most casualties were male (n=35; 88%) and young adults (median 28 years). The mechanism of injury was penetrating in 22 cases (55%). TXA was administered earlier than it could have been in the hospital setting without delaying evacuation. There were no reports of adverse outcomes that could be reasonably attributed to TXA. Casualties who received TXA per protocol were sicker than those who received it not per protocol.

CONCLUSIONS:

We have shown that TXA may be successfully given in the prehospital setting without any apparent delays in evacuation. In light of recent evidence, the ability to give TXA closer to the time of wounding represents an important step towards improving the survival of trauma victims with haemorrhage, even before definitive care is available. While this may be especially relevant in austere combat environments, there is likely benefit in the civilian sector as well. The safety profile of TXA is an important consideration as prehospital personnel tended to overtreat casualties without indications for TXA per protocol. We suggest that TXA be considered a viable option for use by advanced life support providers at or near the point of injury.

"advanced life support providers" ce terme peut aussi amener à envisager la question du "paramedics" en guise d'AuxSan dans une section, vu la carence actuelle en Infirmier dans le SSA...

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C'est quoi le TXA ? Une sorte de super glue pour fermer la blessure ?

edit: je viens de lire le message d'avant. Je vois mieux maintenant...

Edited by TimTR

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On met souvent en avant des petites innovations pratique pour le terrain, mais quand on y regarde on s'aperçoit qu'au final on ne réinvente pas tant que ça. 

Depuis pas mal de temps on a vu apparaître du moyen pour transporter un blessé avec autre chose qu'un brancard, peu pratique au combat. Donc on a vu arriver un filet qui ressemble au système pour sangler les charges dans les avions, avantage il se range bien, on peu traîner le blessé etc... 

Je connais bien cette vidéo d'Indochine mais j'avais jamais fait gaffe, à 8 minutes 05 secondes on voit des paras de la Légion qui transportent un blessé dans un filet qui ressemble au concept qu'on a vu depuis quelques temps être mis en avant, depuis l'Afghanistan il me semble. 

Alors au final, j'ai l'impression que des  innovations n'ont rien d'innovante . Comme quoi... 

 

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