Page 69 - JSOM Fall 2022

Ultrasonography Performed by Military Nurses in Combat Operations

A Perspective for the Future?

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Kévin Balasoupramanien, MD ; Guillaume Comat, MD ; Aurélien Renard, MD, MSc, Pr ;
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Jean-Guillaume Meusnier, MD ; Coline Montigon, MD ; Anne-Sophie Pitel, MD ;
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Marc Bascou, MD ; Rémy Dubourg, MD ; Nicolas Cazes, MD *
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ABSTRACT
Introduction: In current French military operations, it is not put an end to the industrial organization of terrorism that
uncommon for military nurses (MNs) alone to be required to had developed in northern Mali, Operation Barkhane (Appen­
support soldiers in isolated areas. At a time when advanced dix 1) took over and has been supporting the armed forces of
practice nurses in the civilian sector develop extended skills, the Sahel countries (Mauritania, Mali, Burkina Faso, Niger,
we asked MNs about their willingness to be trained in point­ and Chad) to prevent the reconstitution of terrorist refuge ar­
of­care ultrasound (POCUS). Methods: We conducted a web­ eas in the region since 1 August 2014. At present, it represents
based survey from 1 November 2018 to 1 December 2018, the largest French deployment in a foreign operation, with
including all MNs deployed in Operation Barkhane. The ques­ 5,100 soldiers.
tionnaire, sent by e­mail, aimed to describe the willingness of
MNs to be trained in POCUS. Their opinion on the usefulness The French tactical combat casualty care (TCCC) course al­
of this training, the situations, and ultrasound (US) targets that lows any combatant, regardless of their employment level,
seemed most useful to them were also studied. Results: Thirty to provide lifesaving skills to render basic medical aid to a
of 34 questionnaires were completed. On average, MNs had trauma casualty. Three types of courses are given: level 1 for
7.4 years of practice and had been deployed three times for all servicemembers, level 2 for combat medics, and level 3
military operations. Five MNs reported having had informal common for MNs and MPs. The course is mandatory before a
training in clinical US by the military physicians (MPs) they foreign deployment. In the absence of the MP, the protocolized
work with and had performed POCUS in real­life situations; level 3 French TCCC course allows the MN alone to stabilize
24 (96%) of the untrained MNs wanted to be trained. Twen­ a wounded soldier while waiting for the medical evacuation
ty­nine (96%) of the MNs felt that there was added value in team. It assures the acquisition of a high level of knowledge
knowing how to perform POCUS, especially in operations and in traumatology and the practice of specialized medical pro­
in isolated posts without an MP. Focused assessment with so­ cedures, such as placing a chest tube, transfusing blood prod­
nography for trauma and pleural and renal US were the tar­ ucts, and using vasopressive amines.
gets considered most useful to them, in that order. Conclusion:
MNs are interested in learning POCUS and say it would be All MNs follows the same level 3 TCCC course. They are in­
beneficial for the patient. Available scientific data tend to val­ volved in the entire French chain of care for the war­wounded
idate their ability after a brief training course to perform reli­ soldier. They provide advanced care in the field, during tacti­
able, targeted US examinations in the field. cal helicopter medical evacuation to a deployed vital surgery
unit, and then during the strategic plane medical evacuation
Keywords: ultrasonography; military medicine; military nurse to a metropolitan French military teaching hospital. Those as­
signed to operational units provide care in forward medical
posts as close as possible to the fighting force, paired with an
MP or a combat medic.
Introduction
The aim of the military health system on the battlefield is to The tactical helicopter medical evacuation team that ensures
preserve the fighting force in an austere, resource­scarce en­ the transport from the field to the vital surgery unit includes
vironment to accomplish the military objective. The French an MN and an MP, both assigned to operational units. The
defense health service is committed to providing emergency vital surgery unit is composed of surgeons, anaesthetists, and
and routine health care as close to the operations as possible. MNs assigned to military teaching hospitals in France. Finally,
following damage­control surgery performed in a deployed vi­
After Operation Serval (11 January 2013 to 31 July 2014), tal surgery unit, the strategic plane medical evacuation team
which stopped the jihadist offensive threatening Bamako and overseeing the repatriation of the injured to a military teaching
*Correspondence to md.ncazes@gmail.com
1 Kévin Balasoupramanien is affiliated with the Emergency Department, Hôpital d’Instruction des Armées Laveran, Marseille, France. Guillaume
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Comat is affiliated with the Antenne médicale de Calvi, Centre Médical des Armées de Marseille, Marseille. Aurélien Renard is affiliated with
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the Emergency medical service, Bataillon de marins­pompiers de Marseille, Marseille. Jean-Guillaume Meusnier is affiliated with the Antenne
médicale de Varces, Centre médical des armées de Lyon, Lyon, France. Coline Montigon is affiliated with the Antenne médicale de Phalsbourg,
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Centre Médical des Armées de Phalsbourg, Phalsbourg, France. Anne-Sophie Pitel is affiliated with the Antenne médicale de Sarrebourg, Centre
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Médical des Armées de Strasbourg, Strasbourg, France. Marc Bascou is affiliated with the Antenne médicale de Nansouty, Centre Médical des
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Armées de Bordeaux, Bordeaux, France. Rémy Dubourg is affiliated with the Bureau Opérations, Direction centrale du service de santé des
armées, Paris, France. Nicolas Cazes is affiliated with the Emergency Medical Service, Bataillon de marins­pompiers de Marseille, Marseille.
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