Page 98 - JSOM Summer 2025

Recommended measures include increased isolation, improved can be characterized by physiological (heart rate variability
hygiene, and enhanced microbiological surveillance to limit [HRV]), electrodermal conductance (ECD), electroencepha-
cross-transmission. lography, breathing, and behavioral objective measures. These
measures can therefore be used to objectively detect subPTSD.
Integration of military and civilian health services is essential To study and characterize the ER, it must be triggered. To do
for effective trauma management. Adapting the NATO four- this, emotionally relevant stimuli in different sensory modali-
tier system has proved effective in Ukraine, with level 1 stabi- ties were presented in virtual reality (VR), a technique already
lization in mixed military-civilian facilities and level 2 care in validated in the treatment of PTSD. The developed virtual en-
nearby civilian hospitals. Consolidating levels 3 and 4 in special- vironment was divided into several scenarios characterizing
ized facilities optimizes resources. Training and simulation ex- daily life (apartment, street and supermarket). The objective
ercises are critical to preparing medical teams, as demonstrated measures characterizing the ER induced by stimuli presented
by the initiatives of the Global Surgical and Medical Support during navigation were recorded to develop a subPTSD de-
Group. These collaborations enhance readiness and ensure tection score (algorithm). The semi-structured interview Clin-
seamless cooperation between military and civilian personnel. ical Administration PTSD Scale (CAPS) was used to diagnose
subPTSD in a military population for characterizing subPTSD
In conclusion, while open-source technologies offer signifi- (i.e., before the onset of all symptoms; 1<CAPS<2). Logistic re-
cant potential for improving medical care in conflict zones, gression models were performed to characterize ER differences
challenges remain in terms of data security, sustainability and between the subPTSD and no PTSD groups. The algorithm
clinical validation. Lessons from the Russo-Ukrainian conflict was developed and validated using training data and cross-
highlight the need for continuous adaptation, international validation methods.
cooperation, and comprehensive protocols and training pro-
grams to improve trauma care, reduce preventable deaths, and Results: A total of 84 operational military participants were
improve outcomes in modern warfare. included. Only 35% had no PTSD. For the others, 42.8% had
possible subPTSD, 16.66 had subPTSD (1<CAPS<2), and.6%
Reference had PTSD. Eight variables were validated by logistic regression
Jarrassier A, Py N, de Rocquigny G, Raux M, Lasocki S, Dubost C, (7 for HRV and 1 for ECD) to objectively detect subPTSD. The
et al. Lessons learned from the war in Ukraine for the anesthesiolo- accuracy of the final algorythme ranged from 81% to 89%,
gist and intensivist: A scoping review. Anaesth Crit Care Pain Med. with a negative predictive value from 81% to 95% and a pos-
2024;43:101409. doi:10.1016/J.ACCPM.2024.101409.
itive predictive value from 71% to 100%, depending on the
virtual scenario.
D STRESS: A Virtual Reality Tool for Detecting
Sub-Posttraumatic Stress Disorder (PTSD) Conclusion: The determination of the scores underlines the
3
Fanny Lévy ; Damien Claverie ; Marion Trousselard 3,4 fact that simple physiological measures recorded during a daly
1,2
life navigation in VR provided information on the quality of
1. Hôpital Pitié-Salpétrière, APHP, Paris, France. ER that were sufficient to detect subPTSD. This study high-
2. MyReVe.3.Unité de Neurophysiologie du lights the need to develop and evaluate prevention measures
Stress, Département Neurosciences & Contraintes for subPTSD, with the main challenge of how to take into ac-
Opérationnelles, Institut de Recherche Biomédicale des count the subPTSD to avoid the PTSD.
Armées (IRBA), Brétigny-sur-Orge, France. 4.Université de
Lorraine, Inserm, INSPIIRE, F-54000, Nancy, France:
Disclaimer
Introduction: PTSD arises following a perceived life-threat- The opinions or assertions contained herein are the private
ening threat to self and/or others. It manifests by intrusions views of the authors and are not to be construed as official or
of the traumatic event, hyper-vigilance, avoidance of anything as reflecting the views of the French and/or German military
reminiscent of the traumatic event and negative thoughts. Mil- medical service.
itary personnel, such as Special Forces operators, are partic-
ularly affected, due to repeated confrontations in the course References
of their professional activities. The prevalence of complete 1. Pasquier P, Josse F, Mahe P. Review of the Paris Special Operations
PTSD is estimated at between 35% and 70% in this popula- Forces Combat Medical Care Conference, Fall 2022. J Spec Oper
tion. Incomplete PTSD (subPTSD), is more difficult to identify Med. 2023;23(1):117–126. doi:10.55460/3WQ1-Z1Z8
because it is less clinically obvious. The severity of subPTSD is 2. Pasquier P, David M, Petit L, et al. Irregular warfare must combine
good medicine, with both good tactics and good strategies: Posi-
two-fold: 1) medically, the risk of complications is high (e.g., tion paper by the French Special Operations Forces Medical Com-
suicide, addiction and early-onset dementia) and 2) operation- mand. J Trauma Acute Care Surg. 2024;97(2S Suppl 1):S67–S73.
ally, the behavior of soldiers with undiagnosed subPTSD can 3. Remondelli MH, Remick KN, Shackelford SA, et al. Casualty
disrupt mission conduct. While these individual and collective care implications of large-scale combat operations. J Trauma
issues call for early detection of subPTSD, the detection tech- Acute Care Surg. 2023;95(2S Suppl 1):S180–S184. doi:10.1097/
niques available (questionnaire or interview) are subjective, as TA.0000000000004063
they depend on the answers given by the soldier, who may fear 4. Patterson JL, Bryan RT, Turconi M, et al. Life over limb: Why not
both? Revisiting tourniquet practices based on lessons learned
being stigmatized. There is therefore a need to develop an ob- from the War in Ukraine. J Spec Oper Med. Published online
jective detection tool for subPTSD in the military that is both March 13, 2024. doi:10.55460/V057-2PCH
effective and widely deployable. 5. Gurney JM, Kotwal RS, Holcomb JB, et al. A trauma expert con-
sensus: Capabilities are required early to improve survivability
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Suppl 1):S82–S90. doi:10.1097/TA.0000000000004414
even though the threat has disappeared. According to the lit- 6. Jarrassier A, Py N, de Rocquigny G, et al. Lessons learned from the
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96 | JSOM Volume 25, Edition 2 / Summer 2025