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Deployment of the Surgical Evaluation of Hemostatic Capacities
Life-Saving Module (SLM) in 2017 among Commando Candidates

Lessons Learned in Setting Up and Would their Blood Suit a Hemorrhagic
Training Operational Surgical Units War-Injured Patient in Case of Blood
Donation on the Battlefield?

Brice Malgras, MD, PhD
Yann D, MD ; Sébastien C, MD ;
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Introduction Rachel Foricher, MD ; Carine Hejl, MD ;
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The military operations carried out by the French armed forces Stéphane Travers, MD ; Vincent Foissaud, MD ;
occasionally require the use of the Surgical Lifesaving Module Christophe Martinaud, MD, PhD 7
(SLM) to ensure the surgical support of its soldiers. Because of
its extreme mobility and capacity of fast deployment, SLM is
particularly useful in small-scale military operations, such as Background
Special Forces missions. In 2017, the French SLM was for the In case of a warm fresh whole-blood transfusion on the bat-
first time used to ensure surgical support of allied forces that tlefield, the blood donation usually occurs just after a com-
were lacking forward surgical capabilities. bat phase and often after several days on the field. To explore
the hemostatic capacity of such blood, we analyzed the blood
Methods of volunteers attending the commando course of the French
Navy, considering this course as an experimental model, plac-
The SLM is a mobile, heliborne, airborne, surgical structure ing them into the same physiological conditions as those faced
with parachuting capability onto land or sea, and therefore by deployed fighters.
essentially focused on lifesaving procedures, also known as
“damage control” surgery. Because of the need for mobility
and rapid implementation, the SLM is limited to a maximum Methods
of five interventions or, in terms of injuries, to one or two seri- Venous blood was collected at the beginning of the course,
ously injured patients. mimicking the volunteers’ baseline status, and a second time
6 weeks later, from the remaining candidates, during the actual
Results commando training, mimicking the stress conditions. For each
candidate, we observed the differences between the two blood
Over a period of 2 months, five medical teams were succes- samples.
sively deployed with the SLM. A total of 157 casualties were
treated. The most common injuries were caused by shrapnel
(56%), followed by firearms (36%), and blunt trauma (2.5%). Results
Injuries included the limbs (56%), thorax (18%), abdomen Of the 112 men who attended the first day of the course, only
(13%), head (11%), and neck (2%). The average Injury Se- 17 remained 6 weeks later. In the second blood samples, we
verity Score (ISS) was 8.5 (range: 1 to 25), with 26 patients noted significantly increased leucocyte and platelet counts
presenting with an ISS≥15. The average New Injury Severity and significantly decreased hematocrit and hemoglobin levels.
Score (NISS) was 10.8 (range: 1 to 75), with 34 casualties hav- Thrombin generation assays showed significantly lower nor-
ing an NISS≥15. The surgical procedures were broken down as malized peak heights (-31%), lower normalized endogenous
follows: 126 dressings, 16 laparotomies, seven thoracotomies, thrombin potential values (-29%), and lower velocity index
12 isolated thoracic drains (without thoracotomy), one cervi- (-35%). Normalized lag time and time to peak did not differ.
cotomy, 12 amputations, seven limb splints, two limb fascioto- Viscoelastometric testing revealed a significant increase in clot
mies, two external fixators, and one femoral fracture traction. firmness as assessed by maximum amplitude and amplitude at
6 minutes. The clot speed was significantly increased.
Conclusion
The numerous SLM deployments in larger operations high- Conclusion
lighted its ability to adapt in terms of both equipment and This work brings to light new data on coagulation during pro-
personnel. Continuous management of equipment logistics, longed and considerable physical exercise. No obvious delete-
robust personnel training, and appropriate organization of the rious modification of hemostatic properties was observed. The
evacuation procedures were the key elements for optimizing decrease of the endogenous thrombin potentials may reflect a
combat casualty care. As a consequence, the SLM appears to better ability to control the thrombin generation once started.
be an operational surgical unit of choice during deployments. Altogether, these results suggest that this blood could well suit
a hemorrhagic war-injured patient.
Dr Brice Malgras is affiliated with the Bégin Military Teaching Hospi-
tal, Saint-Mandé, France. 1 Dr Yann D is affiliated with the Paris Fire Brigade, Emergency Med-
2
ical Service, France. Dr Sébastien C is affiliated with the French Mil-
itary Medical Service, 7ème Antenne Médicale Spécialisée, France.
Review of the Paris SOF—CMC Conference, Fall 2022 | 121