Reviewing the needs of forward deployed critical care: South Sudan and the future

2021 ◽  
Vol 167 (5) ◽  
pp. 372-374
Author(s):  
Victoria Bulleid ◽  
T Hooper ◽  
G Nordmann
Keyword(s):  
Critical Care ◽  
Damage Control ◽  
South Sudan ◽  
Damage Control Surgery ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
The Uk ◽  
Care Capacity ◽  
Battle Injuries ◽  
Ballistic Trauma

The UK military medical treatment facility (MTF) that deployed to the United Nations Mission in South Sudan in 2017 was based on a facility that can provide damage control surgery and resuscitation for soldiers with ballistic trauma injuries. It had to be supplemented with additional medical equipment and drugs that could support a peacekeeping mission in Africa. The clinicians used this experience and opportunity to review the critical care capability of UK Army Medical Services forward MTFs and recommend changes to reflect the increasing contemporaneous need on recent deployments to support more casualties with medical, infectious diseases and other non-battle injuries and illnesses. A concurrent review of the facility’s critical care transfer equipment was also undertaken and allowed it to be adapted for use as either transfer equipment or as a critical care surge capability, to increase the facility’s critical care capacity.

scholarly journals Utilization profile of the Canadian-led coalition Role 2 Medical Treatment Facility in Iraq: the growing requirement for multinational interoperability

2018 ◽  
pp. S195-S202
Author(s):  
Mark P. DaCambra ◽  
Raymond L. Kao ◽  
Christopher Berger ◽  
Vivian C. McAlister
Keyword(s):  
Medical Treatment ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Armed Forces ◽  
Mass Casualty ◽  
Clinical Activity ◽  
Treatment Facility ◽  
Similar Frequency ◽  
Medical Treatment Facility ◽  
Battle Injuries

Background: The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations. Methods: We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage. We reviewed the literature to identify utilization profiles for other MTFs over the last 20 years. Results: In total, 1487 patients were assessed. Of these, 5.0% had battle injuries requiring damage-control resuscitation and/or damage-control surgery, with 55 casualties requiring medical evacuation after stabilization. Trauma and disease non-battle injuries accounted for 44% and 51% of patient encounters, respectively. Other than dental conditions, musculoskeletal disorders accounted for most presentations. Fifty-seven units of fresh frozen plasma and 64 units of packed red blood cells were used, and the walking blood bank was activated 7 times. Mass casualty activations involved coordination of health care and logistical resources from more than 12 countries. In addition to host nation military and civilian casualties, patients from 15 different countries were treated with similar frequency. Conclusion: The experience of the Canadian R2MTF in Iraq demonstrates the importance of multinational interoperability in providing cohesive medical care in coalition surgical facilities. Multinational interoperability derives from a unique relationship between higher medical command collaboration, international training and adherence to common standards for equipment and clinical practice.

Four years of orthopaedic activities in Chinese Role 2 Hospital of eastern Mali peacekeeping area

2018 ◽  
Vol 166 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Dawei Zhang ◽  
Z Li ◽  
X Cao ◽  
B Li
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Treatment Facility ◽  
Improvised Explosive Devices ◽  
Skill Sets ◽  
Medical Treatment Facility ◽  
Chinese Military ◽  
Surgical Teams ◽  
Improvised Explosive ◽  
Explosive Devices

IntroductionThe Chinese Role 2 Hospital (CHN-Role 2H) Medical Treatment Facility (MTF) was founded in July 2013 as part of the Chinese commitment to Multidimensional Integrated Stabilization Mission in Mali (MINUSMA). It provides medical care for approximately 5200 personnel of the whole Sector East of MINUSMA including UN military personnel, UN police and UN civilian staff. The aim of this study was to determine the orthopaedic surgical activity over a 4-year period to facilitate the training of future Chinese military surgical teams.Materials and methodsSurgical records of all patients operated on at the CHN-Role 2H between 28 March 2014 to 28 March 2018 were identified, and all orthopaedic activity were analysed.ResultsDuring this period, 1190 patients underwent 2024 surgical procedures. Orthopaedic procedures represented 961/2024 (47.5%) of all the procedures. Battle injury (BI) represented 43% of patients. Improvised explosive devices (IEDs) were responsible for 15.8 % casualties. Fractures (49%) and soft tissue injures (43%) were the most common injuries, with 61% of the fractures being open. Damage control surgery including debridement (23.52%) and external fixation (17.90%) were the most frequently performed interventions.ConclusionOrthopaedic surgery is the most frequently performed surgery in the CHN-Role 2H in Mali. The complexity and severity of injuries demonstrate the urgent need for tailored training and extended skill sets for deploying military orthopaedic surgeons.

Novel equipment used in the UK Role 2 medical treatment facility as part of Operation TRENTON in South Sudan

2021 ◽  
pp. bmjmilitary-2020-001693
Author(s):  
James Ralph ◽  
E J Hutley ◽  
G Nordmann
Keyword(s):  
Medical Treatment ◽  
South Sudan ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
Austere Environment ◽  
The Uk ◽  
Medical Planning

The deployment of a UK military Role 2 Medical Treatment Facility (MTF) to South Sudan during Operation TRENTON into an isolated location and austere environment with a prolonged hold produced potential medical planning challenges. The MTF was augmented with both specific personnel and equipment in order to meet these challenges. This paper discusses equipment available in this facility not previously used at Role 2 before and how it could be used to supplement medical operational deployments in future.

Peacekeepers suffered combat-related injuries in Mali: a retrospective, descriptive study

2018 ◽  
Vol 166 (3) ◽  
pp. 161-166
Author(s):  
Zhao Yongqiang ◽  
H Dousheng ◽  
L Yanning ◽  
M Xin ◽  
W Kunping
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Descriptive Study ◽  
Body Parts ◽  
Medical Treatment Facility ◽  
Chinese Military ◽  
Overseas Operations ◽  
Minor Injuries ◽  
Improvised Explosive ◽  
Explosive Devices

PurposeTo describe the combat-related injuries cured by Chinese Level 2 medical treatment facility (CHN L2) in Mali from 1 March 2016 to 1 March 2018, including type of weapon, mortality, nature of injuries, degree and location of injuries and surgical procedures.Methods A retrospective, descriptive study of 176 injured cases that met the terrorist attacks was conducted. The medical data were collected by an electronic database system. All collected data were entered into an Excel spreadsheet for calculation.ResultsWe found that improvised explosive devices (114/176, 65%) were the most commonly used weapons of attack in Mali. 68.75% of the injuries (121/176) were classified as 'minor injuries according to Abbreviated Injury Scale score. As one patient may suffer multiple injuries, each location and nature of injuries was counted separately. Surface injuries were the top (116/197, 58.88%), followed by orthopaedic injuries (52/197, 26.39%) and internal injuries (29/197, 14.72%). The extremities were the most frequently injured body parts (144/197, 73.09%). We operated 175 surgeries to deal with the 176 combat-related injuries, which accounted for 40.05% of all 437 surgeries. The surgical debridement to remove fragments of explosive was the most frequently performed surgery. We also admitted 20 cases (18/176, 34%) into intensive care unit and transferred 40 cases to Level 3 medical facility.Conclusion Peacekeepers taking protective measures for head and trunk frequently got surface injuries. And their unprotected extremities often got injured. The fragment removal was the top surgery and the damage control surgery was the highly technical nature surgery we performed. Chinese military should offer advanced surgical training course to military surgeons who carry out overseas operations.

Clinical activity at the UK military level 2 hospital in Bentiu, South Sudan during Op TRENTON from June to September 2017

2019 ◽  
pp. jramc-2018-001154 ◽  
Author(s):  
Mark S Bailey ◽  
I Gurney ◽  
J Lentaigne ◽  
J S Biswas ◽  
N E Hill
Keyword(s):  
United Nations ◽  
South Sudan ◽  
Febrile Illness ◽  
Clinical Information ◽  
Service Development ◽  
Clinical Activity ◽  
The Uk ◽  
Battle Injuries ◽  
Level 2

IntroductionDiseases and non-battle injuries (DNBIs) are common on UK military deployments, but the collection and analysis of clinically useful data on these remain a challenge. Standard medical returns do not provide adequate clinical information, and clinician-led approaches have been laudable, but not integrated nor standardised nor used long-term. Op TRENTON is a novel UK military humanitarian operation in support of the United Nations Mission in South Sudan, which included the deployment of UK military level 1 and level 2 medical treatment facilities at Bentiu to provide healthcare for UK and United Nations (UN) personnel.MethodsA service evaluation of patient consultations and admissions at the UK military level 2 hospital was performed using two data sets collected by the emergency department (ED) and medicine (MED) teams.ResultsOver a three-month (13-week) period, 286 cases were seen, of which 51% were UK troops, 29% were UN civilians and 20% were UN troops. The ED team saw 175 cases (61%) and provided definitive care for 113 (40%), whereas the MED team saw and provided definitive care for 128 cases (45%). Overall, there were 75% with diseases and 25% with non-battle injuries. The most common diagnoses seen by the ED team were musculoskeletal injuries (17%), unidentified non-malarial undifferentiated febrile illness (UNMUFI) (17%), malaria (13%), chemical pneumonitis (13%) and wounds (8%). The most common diagnoses seen by the MED team were acute gastroenteritis (AGE) (56%), UNMUFI (12%) and malaria (9%). AGE was due to viruses (31%), diarrhoeagenic Escherichia coli (32%), other bacteria (6%) and protozoa (12%).ConclusionData collection on DNBIs during the initial phase of this deployment was clinically useful and integrated between different departments. However, a standardised, long-term solution that is embedded into deployed healthcare is required. The clinical activity recorded here should be used for planning, training, service development and targeted research.

Maritime in transit care

2015 ◽  
Vol 101 (2) ◽  
pp. 104-106
Author(s):  
G Bott ◽  
J Barnard ◽  
K Prior
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Medical Emergency ◽  
Medical Evacuation ◽  
Medical Treatment Facility ◽  
Large Joint ◽  
Patient Load ◽  
Response Team ◽  
High Level ◽  
In Transit

AbstractOperation GRITROCK saw the first operational deployment of the Maritime In Transit Care team from the Role 2 (Enhanced) (R2(E)) Medical Treatment Facility, which is able to provide Damage Control Surgery and the limited holding of patients, situated on board RFA ARGUS. Whilst the Medical Emergency Response Team demonstrated the capability of advanced military Pre-Hospital Emergency Care (PHEC) on Op HERRICK, the need to provide a similar high level of care on contingency operations was recognised. Op GRITROCK allowed for the continued exploration of a maritime capability from an established R2(E) platform whilst providing medical evacuation capability for a significant population at risk distributed over a large Joint Operation Area. Although the patient load during the operation was low, key lessons were learnt and opportunities identified to further develop the newly recognised sub-speciality of PHEC, both medically and logistically, and these will be discussed in this article.

scholarly journals Assembly Line ICU: what the Long Shops taught us about managing surge capacity for COVID-19

2020 ◽  
Vol 9 (4) ◽  
pp. e001117
Author(s):  
Callum Oakley ◽  
Craig Pascoe ◽  
Daivd Balthazor ◽  
Davinia Bennett ◽  
Nandan Gautam ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Assembly Line ◽  
Tertiary Hospital ◽  
Multiple Organ ◽  
Adaptive Responses ◽  
Whole Process ◽  
The Uk ◽  
Care Capacity ◽  
And Training

ObjectivesTo safely expand and adapt the normal workings of a large critical care unit in response to the COVID-19 pandemic.MethodsIn April 2020, UK health systems were challenged to expand critical care capacity rapidly during the first wave of the COVID-19 pandemic so that they could accommodate patients with respiratory and multiple organ failure. Here, we describe the preparation and adaptive responses of a large critical care unit to the oncoming burden of disease. Our changes were similar to the revolution in manufacturing brought about by ‘Long Shops’ of 1853 when Richard Garrett and Sons of Leiston started mass manufacture of traction engines. This innovation broke the whole process into smaller parts and increased productivity. When applied to COVID-19 preparations, an assembly line approach had the advantage that our ICU became easily scalable to manage an influx of additional staff as well as the increase in admissions. Healthcare professionals could be replaced in case of absence and training focused on a smaller number of tasks.ResultsCompared with the equivalent period in 2019, the ICU provided 30.9% more patient days (2599 to 3402), 1845 of which were ventilated days (compared with 694 in 2019, 165.8% increase) while time from first referral to ICU admission reduced from 193.8±123.8 min (±SD) to 110.7±76.75 min (±SD). Throughout, ICU maintained adequate capacity and also accepted patients from neighbouring hospitals. This was done by managing an additional 205 doctors (70% increase), 168 nurses who had previously worked in ICU and another 261 nurses deployed from other parts of the hospital (82% increase).Our large tertiary hospital ensured a dedicated non-COVID ICU was staffed and equipped to take regional emergency referrals so that those patients requiring specialist surgery and treatment were treated throughout the COVID-19 pandemic.ConclusionsWe report how the challenge of managing a huge influx of patients and redeployed staff was met by deconstructing ICU care into its constituent parts. Although reported from the largest colocated ICU in the UK, we believe that this offers solutions to ICUs of all sizes and may provide a generalisable model for critical care pandemic surge planning.

scholarly journals 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

2020 ◽  
Author(s):  
Henri de Lesquen ◽  
Marie Bergez ◽  
Antoine Vuong ◽  
Alexandre Boufime-Jonqheere ◽  
Nicolas de l’Escalopier
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Damage Control ◽  
Surgical Care ◽  
Damage Control Surgery ◽  
Surgical Team ◽  
Golden Hour ◽  
Surgical Teams

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.

scholarly journals Aeromedical Evacuations Within the French Armed Forces: Analysis of 2,129 Patients

2019 ◽  
Vol 185 (3-4) ◽  
pp. 468-476 ◽  
Author(s):  
Antoine Luft ◽  
Simon-Pierre Corcostegui ◽  
Marianne Millet ◽  
Jonathan Gillard ◽  
Jerome Boissier ◽  
...  
Keyword(s):  
North Atlantic ◽  
Damage Control ◽  
Cohort Analysis ◽  
Damage Control Surgery ◽  
Armed Forces ◽  
North Atlantic Treaty Organization ◽  
Military Operations ◽  
Aeromedical Evacuation ◽  
Medical Teams ◽  
Battle Injuries

Abstract Introduction The doctrine of medical support during French military operations is based on a triptych: forward medical stabilization, forward damage control surgery, and early strategic aeromedical evacuation (Strategic-AE). The aim of this study was to describe the last piece, the evacuation process of the French Strategic-AE. Methods We conducted a retrospective cohort analysis using patient records from 2015 to 2017. All French service members requiring an air evacuation from a foreign country to a homeland medical facility were included. Data collected included age, medical diagnosis, priority categorization, boarding location, distance from Paris, type of plane and flight, medical team composition, timeline, and dispatch at arrival. Results We analyzed 2,129 patients evacuated from 71 countries, most from Africa (1,256), the Middle East (382), and South America (175). Most patients (1,958) were not severely injured, although some considered priority (103) or urgent (68). Diagnoses included disease (48.6%), nonbattle injuries (43%), battle stress (5.3%), and battle injuries (3%). 246 Strategic-AE used medical teams in flight, 136 of them in a dedicated Falcon aircraft. The main etiologies for those evacuations were battle injuries (24%), cardiovascular (15.4%), infections (8%), and neurologic (7.3%). The median time of management for urgent patients was about 16 hours but longer for priority patients (26 hours). Once in France, 1,146 patients were admitted to a surgery department and 96 to an intensive care unit. Conclusion This is the first study to analyze the French Strategic-AE system, which is doctrinally unique when compared to its North Atlantic Treaty Organization allies. North Atlantic Treaty Organization allies favor care in the theatre in place of the French early Strategic-AE. However, in the event of a high intensity conflict, a combination of these two doctrines could be useful.

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