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Published in: International Orthopaedics 10/2015

01-10-2015 | Review Article

Modern teaching of military surgery: why and how to prepare the orthopaedic surgeons before deployment? The French experience

Authors: Laurent Mathieu, Benjamin Joly, Stéphane Bonnet, Antoine Bertani, Frédéric Rongiéras, François Pons, Sylvain Rigal

Published in: International Orthopaedics | Issue 10/2015

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Abstract

Purpose

Improved survival of combat casualties in modern conflicts is especially due to early access to damage control resuscitation and surgery in forward surgical facilities. In the French Army, these small mobile units are staffed with one general surgeon and one orthopaedic surgeon who must be able to perform any kind of trauma or non trauma emergency surgery.

Methods

This concept of forward surgery requires a solid foundation in general surgery which is no longer provided by the current surgical programs due to an early specialization of the residents. Obviously a specific training is needed in war trauma due to the special pathology and practice, but also in humanitarian care which is often provided in military field facilities.

Results

To meet that demand the French Military Health Service Academy created an Advanced Course for Deployment Surgery (ACDS), also called CACHIRMEX (Cours Avancé de CHIRurgie en Mission EXtérieure). Since 2007 this course is mandatory for young military surgeons before their first deployment. Orthopaedic trainees are particularly interested in learning war damage control orthopaedic tactics, general surgery life-saving procedures and humanitarian orthopaedic surgery principles in austere environments.

Conclusion

Additional pre-deployment training was recently developed to improve the preparation of mobile surgical teams, as well as a continuing medical education for any active-duty or reserve surgeon to be deployed.
Literature
1.
go back to reference Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF (2006) Understanding combat casualty care statistics. J Trauma 60:397–401CrossRefPubMed Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF (2006) Understanding combat casualty care statistics. J Trauma 60:397–401CrossRefPubMed
2.
go back to reference Rosenfeld JV (2010) How will we produce the next generation of military surgeons? Re: skill sets and competencies for the modern military surgeon: lessons from UK military operations in Southern Afghanistan. Injury 41:435–436CrossRefPubMed Rosenfeld JV (2010) How will we produce the next generation of military surgeons? Re: skill sets and competencies for the modern military surgeon: lessons from UK military operations in Southern Afghanistan. Injury 41:435–436CrossRefPubMed
3.
go back to reference Rignault DP (1990) Is war surgery a specialty? Part 1. Mil Med 155(3):91–97PubMed Rignault DP (1990) Is war surgery a specialty? Part 1. Mil Med 155(3):91–97PubMed
4.
go back to reference Rignault DP (1990) How to train war surgery specialists, Part 2. Mil Med 155(4):143–147PubMed Rignault DP (1990) How to train war surgery specialists, Part 2. Mil Med 155(4):143–147PubMed
5.
go back to reference Porta CR, Robins R, Eastridge B, Holcomb J, Schreiber M, Martin M (2014) The hidden war: humanitarian surgery in a combat zone. Am J Surg 207(5):766–772CrossRefPubMed Porta CR, Robins R, Eastridge B, Holcomb J, Schreiber M, Martin M (2014) The hidden war: humanitarian surgery in a combat zone. Am J Surg 207(5):766–772CrossRefPubMed
6.
go back to reference Causey M, Rush RM, Kjorstad RJ, Sebesta JA (2012) Factors influencing humanitarian care and the treatment of local patients within the deployed military medical system: casualty referral limitations. Am J Surg 203:574–577CrossRefPubMed Causey M, Rush RM, Kjorstad RJ, Sebesta JA (2012) Factors influencing humanitarian care and the treatment of local patients within the deployed military medical system: casualty referral limitations. Am J Surg 203:574–577CrossRefPubMed
7.
go back to reference DuBose J, Rodriguez C, Martin M, Nunez T; The Eastern Association for the Surgery of Trauma Military Ad Hoc Committee et al (2012) Preparing the surgeon for war: present practices of US, UK, and Canadian militaries and future directions for the US military. J Trauma 73(6):S423–S430CrossRef DuBose J, Rodriguez C, Martin M, Nunez T; The Eastern Association for the Surgery of Trauma Military Ad Hoc Committee et al (2012) Preparing the surgeon for war: present practices of US, UK, and Canadian militaries and future directions for the US military. J Trauma 73(6):S423–S430CrossRef
8.
go back to reference McManus JG, Eastridge BJ, DeWitte M, Greydanus DJ, Rice J, Holcomb JB (2007) Combat trauma training for current casualty care. J Trauma 62:S13CrossRefPubMed McManus JG, Eastridge BJ, DeWitte M, Greydanus DJ, Rice J, Holcomb JB (2007) Combat trauma training for current casualty care. J Trauma 62:S13CrossRefPubMed
10.
go back to reference Pons F (2007) Chirurgien des armées: la nécessité d’une formation particulière. E-mem Acad Chir 6(4):49–52 Pons F (2007) Chirurgien des armées: la nécessité d’une formation particulière. E-mem Acad Chir 6(4):49–52
11.
go back to reference Brown KV, Guthrie HC, Ramasamy A, Kendrew JM, Clasper J (2012) Modern military surgery: lessons from Iraq and Afghanistan. J Bone Joint Surg (Br) 94:536–543CrossRef Brown KV, Guthrie HC, Ramasamy A, Kendrew JM, Clasper J (2012) Modern military surgery: lessons from Iraq and Afghanistan. J Bone Joint Surg (Br) 94:536–543CrossRef
12.
go back to reference Schoenfeld AJ (2012) The combat experience of military surgical assets in Iraq and Afghanistan: a historical review. Am J Surg 204:377–383CrossRefPubMed Schoenfeld AJ (2012) The combat experience of military surgical assets in Iraq and Afghanistan: a historical review. Am J Surg 204:377–383CrossRefPubMed
13.
go back to reference Mathieu L, Bertani A, Gaillard C, Chaudier P, Ollat D, Bauer B, Rigal S (2014) Combat-related upper extremity injuries : surgical management specificities on the theatres of operations. Chir Main 33:174–182CrossRefPubMed Mathieu L, Bertani A, Gaillard C, Chaudier P, Ollat D, Bauer B, Rigal S (2014) Combat-related upper extremity injuries : surgical management specificities on the theatres of operations. Chir Main 33:174–182CrossRefPubMed
14.
go back to reference Balandraud P, Puidupin M, Escarment J, Pons F (2010) Life-saving surgical unit: a new forward surgical unit for the French Army. E-mem Acad Chir 10(3):69–71 Balandraud P, Puidupin M, Escarment J, Pons F (2010) Life-saving surgical unit: a new forward surgical unit for the French Army. E-mem Acad Chir 10(3):69–71
15.
go back to reference Mathieu L, Gaillard C, Pellet N, Bertani A, Rigal S, Rongiéras F (2014) Soft tissue coverage of war extremity injuries: the use of pedicled flap transfers in a combat support hospital. Int Orthop 38:2175–2181CrossRefPubMed Mathieu L, Gaillard C, Pellet N, Bertani A, Rigal S, Rongiéras F (2014) Soft tissue coverage of war extremity injuries: the use of pedicled flap transfers in a combat support hospital. Int Orthop 38:2175–2181CrossRefPubMed
16.
go back to reference Mathieu L, Saint-Macary E, Frank M, Bertani A, Rongiéras F, Balandraud P, Rigal S (2014) Multiple blast extremity injuries: is definitive treatment achievable in a field hospital for local casualties? Int Orthop 38(12):2565–2569. doi:10.1007/s00264-014-2532-6 Mathieu L, Saint-Macary E, Frank M, Bertani A, Rongiéras F, Balandraud P, Rigal S (2014) Multiple blast extremity injuries: is definitive treatment achievable in a field hospital for local casualties? Int Orthop 38(12):2565–2569. doi:10.​1007/​s00264-014-2532-6
17.
go back to reference Owens BD, Kragh JF Jr, Wenke JC, Macaitis J (2008) Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 64:95–99CrossRef Owens BD, Kragh JF Jr, Wenke JC, Macaitis J (2008) Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 64:95–99CrossRef
19.
go back to reference Ramasamy A, Hinsley DE, Edwards DS, Stewart MPM, Midwinter M, Parker PJ (2010) Skill sets and competencies for the modern military surgeon: lessons from UK military operations in Southern Afghanistan. Injury 41:453–459CrossRefPubMed Ramasamy A, Hinsley DE, Edwards DS, Stewart MPM, Midwinter M, Parker PJ (2010) Skill sets and competencies for the modern military surgeon: lessons from UK military operations in Southern Afghanistan. Injury 41:453–459CrossRefPubMed
20.
go back to reference Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S (2011) Damage control orthopedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers. Orthop Traumatol Surg Res 97(8):852–859CrossRefPubMed Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S (2011) Damage control orthopedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers. Orthop Traumatol Surg Res 97(8):852–859CrossRefPubMed
21.
go back to reference Fourrier P, Herlemont P (1990) Humanitarian missions and surgical training. Chirurgie 117(7):577–579 Fourrier P, Herlemont P (1990) Humanitarian missions and surgical training. Chirurgie 117(7):577–579
22.
go back to reference Shastri-Hurst N, Naumann DN, Bowley DM, Whitbread T (2014) Military surgery in the new curriculum: whither general surgery training in uniform? J R Army Med Corps 0:1–6 Shastri-Hurst N, Naumann DN, Bowley DM, Whitbread T (2014) Military surgery in the new curriculum: whither general surgery training in uniform? J R Army Med Corps 0:1–6
23.
go back to reference Bertani A, Launay F, Candoni P, Mathieu L, Rongiéras F, Chauvin F (2012) Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance. Orthop Traumatol Surg Res 98:803–807CrossRefPubMed Bertani A, Launay F, Candoni P, Mathieu L, Rongiéras F, Chauvin F (2012) Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance. Orthop Traumatol Surg Res 98:803–807CrossRefPubMed
24.
go back to reference Possley DR, Burns TC, Stinner DJ, Murray CK, Wenke JC, Hsu JR (2010) Temporary external fixation is safe in combat environment. J Trauma 69(Suppl 1):135–139CrossRef Possley DR, Burns TC, Stinner DJ, Murray CK, Wenke JC, Hsu JR (2010) Temporary external fixation is safe in combat environment. J Trauma 69(Suppl 1):135–139CrossRef
25.
go back to reference Mathieu L, Bertani A, Chaudier P, Charpail C, Rongiéras F, Chauvin F (2014) Management of the complications of traditional bone setting for upper extremity fractures: the experiences of a French Forward Surgical Team in Chad. Chir Main 33:137–143CrossRefPubMed Mathieu L, Bertani A, Chaudier P, Charpail C, Rongiéras F, Chauvin F (2014) Management of the complications of traditional bone setting for upper extremity fractures: the experiences of a French Forward Surgical Team in Chad. Chir Main 33:137–143CrossRefPubMed
26.
go back to reference Mathieu L, Bertani A, Danis J, Vigouroux F, Rongiéras F, Chauvin F (2014) Management of neglected open extremity fractures in low-resource settings: experience of a French Health Force Service in Chad. Orthop Traumatol Surg Res 100:815–820CrossRefPubMed Mathieu L, Bertani A, Danis J, Vigouroux F, Rongiéras F, Chauvin F (2014) Management of neglected open extremity fractures in low-resource settings: experience of a French Health Force Service in Chad. Orthop Traumatol Surg Res 100:815–820CrossRefPubMed
27.
go back to reference Rowley DI (1996) The management of war wounds involving bone. J Bone Joint Surg 78B:706–709 Rowley DI (1996) The management of war wounds involving bone. J Bone Joint Surg 78B:706–709
28.
go back to reference Schreiber MA, Holcomb JB, Conaway CW, Campbell KD, Wall M, Mattox KL (2002) Military trauma training performed in a civilian trauma center. J Surg Res 104:8–14CrossRefPubMed Schreiber MA, Holcomb JB, Conaway CW, Campbell KD, Wall M, Mattox KL (2002) Military trauma training performed in a civilian trauma center. J Surg Res 104:8–14CrossRefPubMed
29.
go back to reference Thorson CM, Dubose JJ, Rhee P, Knuth TE, Dorlac WC, Bailey JA, Garcia GD, Ryan ML, Van Haren RM, Proctor KG (2012) Military trauma training at civilian centers: a decade of advancements. J Trauma 73:S483–S489CrossRef Thorson CM, Dubose JJ, Rhee P, Knuth TE, Dorlac WC, Bailey JA, Garcia GD, Ryan ML, Van Haren RM, Proctor KG (2012) Military trauma training at civilian centers: a decade of advancements. J Trauma 73:S483–S489CrossRef
30.
go back to reference McCunn M, York GB, Hirshon JM, Jenkins DH, Scalea TM (2011) Trauma readiness training for military deployment: a comparison between U.S. trauma centre and an Air Force theatre hospital in Balad, Iraq. Mil Med 176:769–776CrossRef McCunn M, York GB, Hirshon JM, Jenkins DH, Scalea TM (2011) Trauma readiness training for military deployment: a comparison between U.S. trauma centre and an Air Force theatre hospital in Balad, Iraq. Mil Med 176:769–776CrossRef
Metadata
Title
Modern teaching of military surgery: why and how to prepare the orthopaedic surgeons before deployment? The French experience
Authors
Laurent Mathieu
Benjamin Joly
Stéphane Bonnet
Antoine Bertani
Frédéric Rongiéras
François Pons
Sylvain Rigal
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 10/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2741-7

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