Astrée Swiech1, Gaël de Rocquigny2, Thibault Martinez3, Gwion Loarer4, Sylvain Vico5, Jérôme Planchon6, Arnaud Le Goff7, Kilian Bertho8, Clément Derkenne9, Stéphane Travers10, Brice Malgras11, Christophe Martinaud12, Cyril Carfantan13, Stéphane Gaudry14, Mathieu Boutonnet15, Pierre Pasquier16. 1. Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France. Electronic address: astree.swiech@gmail.com. 2. Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France; École du Val-de-Grâce, 75005 Paris, France. Electronic address: gael.derocquigny@gmail.com. 3. Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France. Electronic address: thibault.martinez@hotmail.fr. 4. Direction centrale du service de santé des armées, Paris, France. Electronic address: gwion.loarerp@gmail.com. 5. Hôpital d'instruction des armées Sainte-Anne, Toulon, France. Electronic address: sylvain.vico@hotmail.fr. 6. Hôpital d'instruction des armées Bégin, Saint-Mandé, France. Electronic address: jerome.planchon@gmail.com. 7. Direction de la médecine des forces, Tours, France. Electronic address: as.legoff@yahoo.fr. 8. Brigade des sapeurs pompiers de Paris, Paris, France. Electronic address: kbertho@yahoo.fr. 9. Brigade des sapeurs pompiers de Paris, Paris, France. Electronic address: clement.derkenne@gmail.com. 10. École du Val-de-Grâce, 75005 Paris, France; 12°, antenne médicale, Villacoublay, France. Electronic address: travers.stephane@gmail.com. 11. École du Val-de-Grâce, 75005 Paris, France; Hôpital d'instruction des armées Bégin, Saint-Mandé, France. Electronic address: bricemalgras@hotmail.com. 12. École du Val-de-Grâce, 75005 Paris, France; Centre de transfusion sanguine des armées, Clamart, France. Electronic address: martinaudctsa@gmail.com. 13. État major opérationnel santé, Paris, France. Electronic address: cyril.carfantan@gmail.com. 14. Hôpital Avicenne, 93000 Bobigny, France. Electronic address: stephanegaudry@gmail.com. 15. Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France. Electronic address: mathieuboutonnet@hotmail.com. 16. Fédération d'anesthésie-réanimation-brûlés-bloc opératoire, hôpital d'instruction des armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France; École du Val-de-Grâce, 75005 Paris, France. Electronic address: pasquier9606@me.com.
Abstract
INTRODUCTION: The current terrorist threat challenges nations to train numerous non-trauma care providers with different backgrounds in damage control (DC) strategies. The purpose of this work was to propose a specific DC training program. METHODS: A Task Force of 16 civilian and military physicians met for a 24-hour session, to propose the construction of a DC training program for non-specialised caregivers. RESULTS: Existing DC training programs are heterogeneous, mainly theoretical and almost only for physicians. A program entitled Damage Control for Terrorist Attack Victims (DC-TAV) was then proposed. Identified training targets were care providers from prehospital and hospital staffs, with no experience in trauma care. The training objectives were the improvement of individual and collective skills in managing terrorist attacks casualties. The tools selected for training concerned e-learning on a dedicated digital teaching platform (including a core section of four modules with types and mechanisms of injury, basic DC techniques, triage, organisation of emergency medical response and two complementary modules for doctors with DC resuscitation including remote transfusion and DC surgery), hands-on workshops with procedural simulation and full-scale simulation exercises, technical (tourniquets, haemostatic gauzes, needle thoracostomy, chest tube drainage, management of airway, coniotomy) and non-technical (leadership, communication, coordination and triage, decision-making, appropriate use of resources) skills. Finally, an evaluation of the DC-TAV program was planned. CONCLUSIONS: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
INTRODUCTION: The current terrorist threat challenges nations to train numerous non-trauma care providers with different backgrounds in damage control (DC) strategies. The purpose of this work was to propose a specific DC training program. METHODS: A Task Force of 16 civilian and military physicians met for a 24-hour session, to propose the construction of a DC training program for non-specialised caregivers. RESULTS: Existing DC training programs are heterogeneous, mainly theoretical and almost only for physicians. A program entitled Damage Control for Terrorist Attack Victims (DC-TAV) was then proposed. Identified training targets were care providers from prehospital and hospital staffs, with no experience in trauma care. The training objectives were the improvement of individual and collective skills in managing terrorist attacks casualties. The tools selected for training concerned e-learning on a dedicated digital teaching platform (including a core section of four modules with types and mechanisms of injury, basic DC techniques, triage, organisation of emergency medical response and two complementary modules for doctors with DC resuscitation including remote transfusion and DC surgery), hands-on workshops with procedural simulation and full-scale simulation exercises, technical (tourniquets, haemostatic gauzes, needle thoracostomy, chest tube drainage, management of airway, coniotomy) and non-technical (leadership, communication, coordination and triage, decision-making, appropriate use of resources) skills. Finally, an evaluation of the DC-TAV program was planned. CONCLUSIONS: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.