Five years of prolonged field care: prehospital challenges during recent French military operations

Travers, Stéphane; Carfantan, Cyril; Luft, Antoine; Aigle, Luc; Pasquier, Pierre; Martinaud, Christophe; Renard, Aurélien; Dubourg, Olivier; Derkenne, Clément; Kedzierewicz, Romain; Franchin, Marilyn; Bay, Christian; Andrew, P.; Ausset, Sylvain

doi:10.1111/trf.15262

Cited by 43 publications

(48 citation statements)

References 43 publications

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“…This has been partially achieved by the large diffusion of massive bleeding control strategies based on compressive devices such as tourniquets ( 24 ). However, the time of the pre-hospital phase has been considerably increased in recent conflicts (Sahel), promoting the duration of the shock and the onset of complications ( 25 , 26 ).…”

Section: Traumatic Hemorrhagic Shockmentioning

confidence: 99%

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

et al. 2021

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Severe trauma is the principal cause of death among young people worldwide. Hemorrhagic shock is the leading cause of death after severe trauma. Traumatic hemorrhagic shock (THS) is a complex phenomenon associating an absolute hypovolemia secondary to a sudden and significant extravascular blood loss, tissue injury, and, eventually, hypoxemia. These phenomena are responsible of secondary injuries such as coagulopathy, endotheliopathy, microcirculation failure, inflammation, and immune activation. Collectively, these dysfunctions lead to secondary organ failures and multi-organ failure (MOF). The development of MOF after severe trauma is one of the leading causes of morbidity and mortality, where immunological dysfunction plays a central role. Damage-associated molecular patterns induce an early and exaggerated activation of innate immunity and a suppression of adaptive immunity. Severe complications are associated with a prolonged and dysregulated immune–inflammatory state. The current challenge in the management of THS patients is preventing organ injury, which currently has no etiological treatment available. Modulating the immune response is a potential therapeutic strategy for preventing the complications of THS. Mesenchymal stromal cells (MSCs) are multipotent cells found in a large number of adult tissues and used in clinical practice as therapeutic agents for immunomodulation and tissue repair. There is growing evidence that their efficiency is mainly attributed to the secretion of a wide range of bioactive molecules and extracellular vesicles (EVs). Indeed, different experimental studies revealed that MSC-derived EVs (MSC-EVs) could modulate local and systemic deleterious immune response. Therefore, these new cell-free therapeutic products, easily stored and available immediately, represent a tremendous opportunity in the emergency context of shock. In this review, the pathophysiological environment of THS and, in particular, the crosstalk between the immune system and organ function are described. The potential therapeutic benefits of MSCs or their EVs in treating THS are discussed based on the current knowledge. Understanding the key mechanisms of immune deregulation leading to organ damage is a crucial element in order to optimize the preparation of EVs and potentiate their therapeutic effect.

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Section: Traumatic Hemorrhagic Shockmentioning

confidence: 99%

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

et al. 2021

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“…Patients treated with FLYP received earlier plasma transfusion and had improved coagulation parameters through the first 6 hours, compared to patients who received FFP, and no adverse events were noted [62]. Reports of the use of FLYP in the prehospital environment have also been promising [60,63].…”

Section: French Lyophilized Plasma (Flyp)mentioning

confidence: 99%

Dried Plasma for Trauma Resuscitation

Weiskopf

2020

Trauma Induced Coagulopathy

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“…Studies using historical data gathered from the past battles are demonstrated in [ 8 , 9 , 10 , 11 ]. All the referenced statistics on casualties are related to the history of WW1–WW2 or to the very asymmetric military environment.…”

Section: Literature Reviewmentioning

confidence: 99%

Optimization of the Casualties’ Treatment Process: Blended Military Experiment

Hodicky¹,

Procházka

Jersák³

et al. 2020

Entropy

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At the battalion level, NATO ROLE1 medical treatment command focuses on the provision of primary health care being the very first physician and higher medical equipment intervention for casualty treatments. ROLE1 has paramount importance in casualty reductions, representing a complex system in current operations. This study deals with an experiment on the optimization of ROLE1 according to the key parameters of the numbers of physicians, the number of ambulances and the distance between ROLE1 and the current battlefield. The very first step in this study is to design and implement a model of current battlefield casualties. The model uses friction data generated from an already executed computer assisted exercise (CAX) while employing a constructive simulation to produce offense and defense scenarios on the flow of casualties. The next step in the study is to design and implement a model representing the transportation to ROLE1, its structure and behavior. The deterministic model of ROLE1, employing a system dynamics simulation paradigm, uses the previously generated casualty flows as the inputs representing human decision-making processes through the recorder CAX events. A factorial experimental design for the ROLE1 model revealed the recommended variants of the ROLE1 structure for both offensive and defensive operations. The overall recommendation is for the internal structure of ROLE1 to have three ambulances and three physicians for any kind of current operation and any distance between ROLE1 and the current battlefield within the limit of 20 min. This study provides novelty in the methodology of casualty estimations involving human decision-making factors as well as the optimization of medical treatment processes through experimentation with the process model.

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Five years of prolonged field care: prehospital challenges during recent French military operations

Cited by 43 publications

References 43 publications

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

Dried Plasma for Trauma Resuscitation

Optimization of the Casualties’ Treatment Process: Blended Military Experiment

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