Page 128 - JSOM Spring 2023

To meet these imperatives, drastic choices had to be made. From
the medical point of view, the six-member team (one trauma
surgeon, one specialized surgeon, one anesthesia/ intensive care War-Wounded Analgesia
physician, one nurse anesthetist, one operating room nurse,
one SOF medic) was kept, but the gear was rationalized. All
the equipment either directly provides damage-control surgery Simon-Pierre Corcostegui, MD
(DCS; e.g., surgical boxes) or damage-control resuscitation
(DCR; e.g., packed red blood cells, tranexamic acid) or allows
the delivery of DCR/DCS (e.g., respirator). All non- essential he analgesia of the war-wounded is a topic of interest not
medical equipment has been removed. Tonly because of its impact on mortality but also because
of the possible appearance of posttraumatic stress syndrome
The in-flight surgery capacity is now fully integrated to the in case of poor pain management. The French military medi-
MCV22, the equipment being splittable into two redundant cal service implements a standardized method of care for the
parts. From a logistical viewpoint, to be an asset rather than war-wounded following a continuum of care. Each soldier has
a burden to the conduct of small-footprint operations, the at his disposal a syrette of subcutaneous morphine for early
whole MCV22, including the equipment as well as the team, pain management. More advanced care requires the presence
can be transported in all types of helicopters currently in use of a physician or a nurse. Despite training efforts, analgesia for
by French SOF. The training curriculum was also standardized French war-wounded, especially in the Sahel, is insufficient.
to fully integrate with NATO doctrine. 3 Half of the war-wounded do not receive analgesics, and none
has pain monitored. Morphine is the main molecule used, then
The MCV22 brings to the French SOF community a versatile ketamine. This situation is because of the conditions of exer-
asset, bringing far forward its DCR/DCS capacity in support cise in overseas operations as well as French medical practice
of highly challenging operations. and its strict regulation. The analgesia of the war-wounded
represents a topic of improvement for our practices and of
innovation and clinical research. The intranasal route is an
interesting axis of research. Advances will also benefit count-
er-terrorist units in France, which are confronted with situ-
ations involving civilian massive casualties of firearms. The
analgesia of the war-wounded is a subject where the presence
of a physician or a nurse at the front is interesting. It allows
us to adapt care to the patient’s health status by taking into
account the undesirable effects of the analgesic molecules.

Dr Simon-Pierre Corcostegui is affiliated with the Paris Fire Brigade,
Emergency Medical Service.

References
1. Beckett A, Parker P, Naveed A, Williams P, Tien H. Effect of spe-
cial operational forces surgical resuscitation teams on combat ca-
sualty survival: a narrative review. Transfusion. 2022;62 Suppl 1:
S266–S273.
2. Malgras B, Aoun O, Pauleau G,et al. Deployment of the Surgical
Life-saving Module (SLM) in 2017: lessons learned in setting up and
training operational surgical units. Injury. 2019;50(5):1133–1137.
3. Parker PJ. The NATO Special Operations Surgical Team Develop-
ment Course: a program overview. J Spec Oper Med. 2019;19(3):
26–29.
2
3
1 Dr Jean Cotte, Dr Guillaume Boddaert, Dr Emmanuel Hornez,
4 William Menini, Marie Meriaux, Dr Pierre Mahé, and Dr Pierre
7
6
5
Pasquier are all affiliated with the SOF surgical teams, French Special
Operations Forces Medical Command, Villacoublay, France.

126 | JSOM Volume 23, Edition 1 / Spring 2023