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.

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.

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.

scholarly journals Strategic Orthopedic Evacuations to the Spanish Role 4 During a Decade (2009–2018)

2019 ◽  
Vol 185 (5-6) ◽  
pp. e734-e741
Author(s):  
Rafael García Cañas ◽  
Ricardo Navarro Suay ◽  
Carlos Rodríguez Moro ◽  
Daniel Aedo Martín ◽  
Rafael Tamburri Bariaín ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Orthopedic Surgery ◽  
Armed Forces ◽  
Categorical Variables ◽  
Medical Support ◽  
Treatment Facility ◽  
Research Committee ◽  
Cross Sectional ◽  
Medical Treatment Facility ◽  
Lesion Pattern

Abstract Introduction Casualty evacuation is a key point in medical support to military operations, sometimes being necessary to transfer them to National Territory for a definitive diagnosis and treatment. The aim of this work is to analyze the patients evacuated from Areas of Operations to the Orthopedic Surgery and Traumatology Unit of the Spanish Role 4 Medical Treatment Facility in the last 10 years. Material and Methods A cross-sectional, descriptive, and retrospective study carried out in the period between January 1, 2009 and December 31, 2018. The study population was all personnel evacuated from the Area of Operations to Spanish Role 4. For categorical variables, absolute and relative percent frequencies were used. Spanish military authorization was obtained to perform this study. This study has been approved by the Ethics and Clinical Research Committee of the Defense Central Hospital “Gómez Ulla” (code 12/17). Results A total of 520 medical evacuations have been performed on Role 4, of which 227 were on the Orthopedic Surgery and Traumatology Unit. Seven percent of the evacuees were categorized as “combat” casualties. The areas of operations from which more patients have been evacuated were Afghanistan and Lebanon, 30.39% and 19.38%, respectively. The most frequent lesion pattern was the fracture affecting the extremities. Accidents (n = 98, 43.17%) and sport (n = 57; 25.3%) were the main causes of injury. Sixty-seven (29.51%) patients were treated surgically in Role 4. No deaths were recorded among patients in this series. Conclusion Evacuations because of trauma cause more than half of the medical repatriations carried out on the National Territory, of which the majority are due to fractures affecting the limbs, especially the bones of the hand. Sport was the first preventable cause of injury among evacuated patients. Our results are similar to the experience obtained by other allied armed forces. It is a moral imperative and a fundamental necessity for the Spanish military medical services to promote and maintain the Spanish Role 4 Medical Treatment Facility as an indispensable element in medical support for international missions.

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.

Analysis of Camp Pendleton California Medical Treatment Facility Budget and Execution Process

2008 ◽  
Author(s):  
Jr. Constantino ◽  
Dominador D.
Keyword(s):  
Medical Treatment ◽  
Treatment Facility ◽  
Medical Treatment Facility

scholarly journals Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support

2020 ◽  
Author(s):  
John Breeze ◽  
William G Gensheimer ◽  
Joseph J DuBose
Keyword(s):  
Medical Treatment ◽  
Emergency Room ◽  
Neck Region ◽  
Neck Injuries ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
Trauma Registries ◽  
Neck Wound ◽  
Major Injury ◽  
High Negative Predictive Value

ABSTRACT Introduction Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma. Materials and Methods All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region. Results During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%). Conclusion Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.

scholarly journals Analysis of cases managed by dermatological service in the Chinese peacekeeping level 1+ medical treatment facility in Lebanon, 2018–2019

2020 ◽  
pp. jramc-2019-001315
Author(s):  
Xingwang Wang ◽  
H Yang ◽  
Yuqing Wang ◽  
Jin Yuan ◽  
Qinghua Yu
Keyword(s):  
Medical Treatment ◽  
Skin Diseases ◽  
Acne Vulgaris ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
Common Category ◽  
Medical Facilities ◽  
Different Types ◽  
Level 1 ◽  
Basic Medical

IntroductionTo accomplish the peacekeeping mission in Lebanon, China has deployed a level 1+ (CHN L1+) medical treatment facility (MTF) as per the new memorandum. The aim of this study was to review and analyse the skin diseases managed by Chinese dermatological service so as to gain the latest prevalence of different types of skin diseases in this mission area.MethodsAll patients assessed and treated by the dermatological service of CHN L1+ MTF from January 2018 to May 2019 were included. A comparative analysis was made between this study and data published by other peacekeeping medical facilities.ResultsA total of 549 patients were included (87.4% men, with an average age of 35 years old), consisting of 399 military personnel and 150 civilians. Dermatitis and eczema (27.1%) were the most common category of skin diseases, followed by cutaneous mycoses (13.3%) and disorders of skin appendages (10.6%). Among these categories, unspecified dermatitis (9.3%), acne vulgaris (6.6%), tinea corporis (5.3%), folliculitis (5.1%) and tinea pedis (4.7%) were the top five most common reasons for dermatological consultation.ConclusionsTo get a clearer understanding of the disease-type profile in this mission area was beneficial for peacekeeping doctors to make more accurate diagnosis, as well as to prepare more comprehensive medicines during the predeployment period. As dermatological service was lacking in basic medical troops, we would recommend the use of telemedicine to promote dermatological consultations when a specialist was not deployed.

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.

scholarly journals Extending existing recommended military casualty evacuation timelines will likely increase morbidity and mortality: a UK consensus statement

2020 ◽  
Vol 166 (5) ◽  
pp. 287-293 ◽  
Author(s):  
Nicholas James Scallan ◽  
D D Keene ◽  
J Breeze ◽  
T J Hodgetts ◽  
P F Mahoney
Keyword(s):  
Delphi Study ◽  
Hospital Care ◽  
Damage Control ◽  
Clinical Care ◽  
Care Facility ◽  
Damage Control Surgery ◽  
Armed Forces ◽  
Prehospital Emergency Care ◽  
Future Research ◽  
Ct Scanner

IntroductionFuture conflicts may have limited use of aviation-based prehospital emergency care for evacuation. This will increase the likelihood of extended evacuation timelines and an extended hold at a forward hospital care facility following the completion of damage control surgery or acute medical interventions.MethodsA three-round Delphi Study was undertaken using a panel comprising 44 experts from the UK armed forces including clinicians, logisticians, medical planners and commanders. The panel was asked to consider the effect of an extended hold at Deployed Hospital Care (Forward) from the current 2-hour timeline to +4, +8, +12 and +24 hours on a broad range of clinical and logistical issues. Where 75% of respondents had the same opinion, consensus was accepted. Areas where consensus could not be achieved were used to identify future research priorities.ResultsConsensus was reached that increasing timelines would increase the personnel, logistics and equipment support required to provide clinical care. There is a tipping point with a prolonged hold over 8 hours, after which the greatest number of clinical concerns emerge. Additional specialties of surgeons other than general and orthopaedic surgeons will likely be required with holds over 24 hours, and robust telemedicine would not negate this requirement.ConclusionsRetaining acute medical emergencies at 4 hours, and head injuries was considered a particular risk. This could potentially be mitigated by an increased forward capacity of some elements of medical care and availability of a CT scanner and intracranial pressure monitoring at over 12 hours. Any efforts to mitigate the effects of prolonged timelines will come at the expense of an increased logistical burden and a reduction in mobility. Ultimately the true effect of prolonged timelines can only be answered by close audit and analysis of clinical outcomes during future operations with an extended hold.

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