Page 119 - JSOM Winter 2018

Paris – French Strategy Against Terrorism Air Force Mobile Field Surgical Team was the first-generation
F. Ramon, R. Roffi, D. Commeau, J. Galant, C. Boutillier du Retail conventional force concept capable to forward deploy surgical
Medical Center of Satory and critical care capabilities. The six-person Ground Surgical
Team (GST) was developed as the next-generation concept,
he recent attacks targeting the European countries led to a
Tsubstantial evolution of tactical medicine. At GIGN Medi- evolving to provide an even smaller footprint in more austere
cal Center, we have been preparing ourselves to such situations locations. The modular configuration of the GST can provide
for a long time, thanks to our military status and the multiple damage control surgery for 3 patients with a 12-hour critical
operations we have carried abroad. We have worked at adapt- care holding capability within the first increment and flex to
ing what we have seen in Afghanistan and Mali to what we a total of 10 damage control procedures with the entire 1500
could encounter on our territory, because of the evolution of pounds (682 kilograms) of supplies. Along with the develop-
the terrorists’ modus operandi. Mass terror attacks, suicide and ment of this new capability came the development of a new
drone bombings, multiple sites attacks are some of the threats training pipeline. Pulling from the experiences of subject-mat-
we need to anticipate, because of the panic they usually trigger. ter experts, a 3-week training program was developed com-
The so-called “Fog of War” is typically a time of misunder- bining didactics, medical simulation, and a week-long field
standing, where some of the wounded will die because of a exercise. The first GST deployed in May 2017 with a hand-
lack of care. If we teach our armed forces the first care that can picked team of veteran deployers. As with any new platform,
stabilize the wounded until the arrival of the first caregivers, as there were implementation challenges in both logistics and a
well as the basics of triage, we can hope to have more survivors. steady need for socialization of the concept. However, oppor-
In order to do this, every member of GIGN (and the French tunities for the team during the 90-day deployment allowed
army) is trained to Combat Care Lvl 1 (SC1), which includes for concept validation, creation of operationally tailored con-
the use of a tourniquet and safety blanket, and the implemen- figurations, and advancement of the training platform and lo-
tation of extraction and secure position techniques. We have gistical requirements for future GST deployments.
also trained some of them to Combat Care Lvl 2 (SC2), which
means they know how to put an intravenous or intra-bone line, Belgian Special Operations Surgical Team:
how to prepare some drugs, perform a tracheotomy and an Experiences From Casualty Collection Points in Iraq
exsufflation in case of a tensive pneumothorax. Our operators J.C. de Schoutheete, F. Waroquier, L. De Cupere, M. O’Connor,
also have some basics in triage, in order to assist us in direct- K. Van Cleynenbreugel, J.C. Ceccaldi, B. Vanderheyden
ing the wounded according to the seriousness of the injuries. ringing surgery to a Casualty Collection Point (CCP) near
In every squad, we also have a doctor and a nurse, trained to Bthe frontline is a new concept that only a few western na-
tactical medicine. They know how to use an algorithm similar tions are doing. The NATO AJP-4.10 (B) does not describe
to TCCC, which we call “SAFE MARCHE RYAN”, where the this but it is currently discussed and it will be implemented in
first thing to do is to protect themselves, then to perform the the next NATO AJP-4.10 (C).
care, beginning with the management of massive bleedings.
At the beginning of the battle for Mosul in 2016, only Special
In terms of equipment, we have created several medical kits Operations Force (SOF) Medics were involved at CCP’s but
that we carry in backpacks, including a set of tourniquets, gradually, because the frontline was pushed west farther away
Quick Clots, blankets and light stretchers, in order to quickly from the Role 2, surgical teams were asked to treat patients at
control any massive bleeding and extract the injured to a rear these locations. The idea was to bridge the conventional medi-
and safe zone. This evolution of our equipment has been in- cal capacity by putting a forward surgical element, performing
spired by the massive findings stating that numerous deaths triage and medical stabilization as soon as possible, or surgical
can be avoided when massive bleedings get quickly stabilized. stabilization if required, before further evacuation to a Role
Our current human and material organization allows us to 2 medical treatment facility. This CCP system worked in par-
make an intellectual switch between the tactical squad in allel with the medical facilities provided by the Iraqi Ministry
charge of the operation and which becomes in a snap a med- of Health and by different Non-Governmental Organizations.
ical team including paramedics, with one to two doctors in However, most of the patients seen at a CCP were evacuated
charge of the medical crisis management, one to two nurses after stabilization to these entities.
who can go from a wounded nest to another to assist the SC2, Belgium sent a Special Operations Surgical Team (SOST) to
and several SC2 taking care of some wounded nests with the CCPs during 6 months in 2017. A Belgian SOST consists in
SC1s, helping them providing very basic, emergency care. six people: an anesthesiologist, a surgeon, an anesthesiology
Our will is to permanently improve the efficiency of our cares, nurse, an operation room nurse, an operation room technician
and we are firmly convinced that international cooperation and a SOF medic. They were located 10 to 20 minutes (evac-
and exchange between experts is crucial in this domain. uation time) from the frontline with the first checkpoint one
minute away. The evacuation time to the next local medical
Ground Surgical Team: Development and treatment facility and to the coalition Role 2 was between 5
and 60 minutes and 30 to 40 minutes respectively. The Belgian
Realization of a New Deployment Concept SOST did not have a laboratory or x-ray capacities at their
Maj Suzanne See, Maj Elizabeth Anne Hoettels
disposal but they were equipped with an ultrasound device, a
he dynamic global environment requires the adaptation of sterilization device and whole blood capability. The SOST saw
Tmedical concepts to optimally meet mission requirements. more than 500 patients, from which about 10% required a
As the operational picture shifts, the demand for more mo- surgical treatment. They treated a broad spectrum of patients,
bile trauma resuscitation capabilities has increased. Concur- from which a six-month-old baby. In addition, they success-
rent requirements demand teams that have a small footprint fully performed three retrograde endovascular balloon occlu-
with a limited transportation and logistical requirement. The sions of the aorta.

2018 CMC Conference Abstracts | 117