Page 127 - JSOM Spring 2023

FIGURE 1 New medical combat readiness training based on “Ruck
for Surgery.”
Ruck for Surgery

Jean-Charles de Schoutheete, MD ;
1
Pierre-Michel François, MD 2

he current NATO operational support medical chain is
Tbased on symmetrical armed conflict management. This
organization proved its effectiveness during the two World
Wars and the Korean War. However, during an asymmetric
conflict, moreover of high intensity, a so-called guerrilla medi-
cine turns out to be more effective.

Knowing this and seeing the evolution of geopolitics in Eu-
rope, a survey was recently sent to young caregivers at Belgian As new perspectives, these invasive procedures should be im-
Defense. It appears that they are motivated but that they are plemented in military medical doctrine so that they could be
not currently well trained to go on a military mission abroad performed as quickly as possible after trauma by the lowest
and that they know it. The gap between a sick call practice possible echelon. This would reduce preventable trauma-re-
linked to the obtained diploma and trauma call requirements lated mortality. It also seems essential to teach these critical
linked to the mission’s risks is substantial. procedures to surgical and medical emergency teams, both
military and civilian, before being deployed to combat zones.
Therefore, a retrospective study of the Belgian Special Opera-
tions Surgical Team casualty logbook in Iraq was conducted. Because a diploma is not enough to treat injuries sustained in
The primary objective was to evaluate the surgical manage- an asymmetric, high-intensity combat environment, training
ment performed and to compare it with the results of other for trauma call and training in a not-armed-conflict austere
military surgical teams. The secondary objectives were three- environment can help care providers reach an acceptable level
fold: investigation of the inadequacy between the current of (para-) medical capability.
doctrine and patients’ survival; definition of which invasive
procedures should be implemented to reduce preventable mor- 1 Dr Jean-Charles de Schoutheete is affiliated with Queen Astrid Military
2
tality in a pre-hospital environment; and implementation of Hospital and University Hospitals Leuven, Belgium. Dr Pierre-Michel
François is affiliated with the Medical Competence Center of Belgian
the current doctrine. Defense and Cliniques Universitaires, Saint Luc, Belgium.
This study showed that the 15 most frequent damage-control
resuscitation and surgery procedures performed by Belgians
in Iraq accounted for 87% of all the invasive procedures per- The French Aeromedical Special
formed at the casualty collection point where the Belgian sur-
gical team worked. Operation Forces

Based on the survey and on the study, structural hard-skills Damage Control Resuscitation and
training in Belgium for those learning these procedures on a Surgery Team
dead model seems essential and started to be organized in the
6 months preceding a mission abroad. In addition, soft-skills
training linked with external validation of the operability
2
1
would guarantee interoperability and maximum quality. Fur- Jean Cotte, MD ; Guillaume Boddaert, MD ;
thermore, structural training abroad, such as that identified by Emmanuel Hornez, MD ; William Menini, CRNA ;
3
4
Belgian military surgeons in Africa, would meet staff expec- Marie Meriaux ; Pierre Mahe, MD ;
5
6
tations regarding hard skills, soft skills, and stress resilience. 7
This training should be biannual for operational personnel, Pierre Pasquier, MD
regardless of mission planning. Figure 1 presents this whole
training concept. The two main capacities that led to the Module de Chirurgie
Vitale 2022 (MCV22) were
In conclusion, medical and surgical support based on “spoke-
hub” transport management with (para-) medical teams 1. the delivery of the highest standard of care for the most
trained in invasive damage-control resuscitation techniques, prevalent causes of avoidable death among SOF operators,
which apply subsidiarity, and having three medical and sur- mainly hemorrhagic shock, for two immediate/Priority 1
gical backpacks, looks promising. Western countries would (P1) casualties; and
benefit from redirecting budgets toward the development of 2. the capacity to deliver this care as far forward as necessary,
guerrilla medicine to cope better, with limited personnel and including in-flight surgery.
logistics, with the current geopolitical challenges.

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