The Damage Control Resuscitation and Surgical Team: The New French Paradigm for Management of Combat Casualties

Abstract

ABSTRACT Introduction The aim of this work was to introduce the new French forward resuscitation and surgical unit. It’s also to discuss the choices and waivers granted to fit the tactical context of modern conflicts and the current epidemiology of combat casualties. Materials and Methods A multidisciplinary task force of 11 people proceeded to the conception and the creation of a new military resuscitation and surgical unit. The preliminary work included a scoping review of the combat casualties’ epidemiology in modern conflicts and an analysis of the recent French medical–surgical treatment facilities lessons learned. In April 2019, a technical–operational evaluation was conducted to confirm all the technical, ergonomic, and organizational choices made during the design phase. Results The multidisciplinary task force resulted in the creation of the Damage Control Resuscitation and Surgical Team (DCRST). The DCRST focused on the resuscitation strategy, including transfusion of blood products, and the life-saving surgical procedures to be performed as close as possible to the point of injury. It was designed for the resuscitation of two patients: the life-saving surgery of two patients and the very short-term intensive care (<12 hours) of four patients at the same time. The DCRST provided sufficient autonomy to provide take care of four T1 and four T2 or T3 casualties per day for 48 hours. It was armed with 23 soldiers. The technical equipment represented 5,300 kg and 27 m3. All the technical medical equipment could be stored in two 20-foot containers. Conclusion The DCRST represents a new paradigm in medical support of French military operations. It offers the advantage of two combat casualties’ surgical management at the same time, as close as possible to the combat zone. It responds to a 2-fold epidemiological and logistical challenge.