Caring for the Wounded in the Future Supplément Sur Les Forces
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Vol. 58 (3 Suppl 3) June/juin 2015 canjsurg.ca The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future Supplément sur les Forces armées canadiennes et la médecine militaire : l’avenir des soins aux blessés Supplement canjsurg.ca Vol. 53 (3 Suppl 3) June/juin 2015 canjsurg.ca FOREWORD • AVANT-PROPOS S88 Technical innovations that may facilitate real- time telementoring of damage control surgery S80 Foreword in austere environments: a proof of concept Col H. Tien comparative evaluation of the importance of surgical experience, telepresence, gravity and S81 Avant-propos mentoring in the conduct of damage control Col H. Tien laparotomies Maj A.W. Kirkpatrick, A. LaPorta, S. Brien, T. Leslie, Col E. Glassberg, J. McKee, C.G. Ball, H.E. Wright Beatty, J. Keillor, INTRODUCTION • INTRODUCTION D.J. Roberts, Col H. Tien S82 Introduction BGen J.-R. Bernier REVIEW • REVUE S83 Introduction S91 Advances in damage control resuscitation and BGén J.-R. Bernier surgery: implications on the organization of future military field forces Col H. Tien, Maj A. Beckett, LCol N. Garraway, COMMENTARY • COMMENTAIRE LCol M. Talbot, Capt D. Pannell, T. Alabbasi S84 In memoriam — Erin Savage, MD, CCFP(EM), Lieutenant Colonel, Royal RESEARCH • RECHERCHE Canadian Medical Service LCol C. Forestier S98 Medical mentorship in Afghanistan: How are military mentors perceived by Afghan health S85 The need for a robust 24/7 subspecialty care providers? “clearing house” response for telementored Maj A. Beckett, R. Fowler, N.K.J. Adhikari, trauma care L. Hawryluck, T. Razek, Col H. Tien Maj A.W. Kirkpatrick, D. Hamilton, Maj A. Beckett, A. LaPorta, S. Brien, S104 Cervical spine injury in dismounted Col E. Glassberg, C.G. Ball, D.J. Roberts, improvised explosive device trauma Col H. Tien J. Taddeo, Maj M. Devine, LCol V.C. McAlister S78 J can chir, Vol. 58 (No 3 Suppl 3) juin 2015 ©2015 8872147 Canada Inc. S108 Blunt splenic injury and severe brain injury: S141 Factors affecting mortality of pediatric a decision analysis and implications for care trauma patients encountered in Kandahar, T. Alabbasi, A.B. Nathens, Col H. Tien Afghanistan Capt D. Pannell, J. Poynter, P.W. Wales, S118 Needle thoracostomy for tension Col H. Tien, A.B. Nathens, D. Shellington pneumothorax: the Israeli Defense Forces experience S146 The Canadian Armed Forces medical response LTC J. Chen, Capt R. Nadler, Maj D. Schwartz, to Typhoon Haiyan LCol E. Savage, Maj M.D. Christian, Col H. Tien, LTC A.P. Cap, Col E.Glassberg Maj S. Smith, Capt D. Pannell S125 Current use of live tissue training in trauma: a descriptive systematic review L.T. da Luz, B. Nascimento, Col H. Tien, DISCUSSIONS IN SURGERY M.J. Kim, A.B. Nathens, S. Vlachos, DISCUSSIONS EN CHIRURGIE Col E. Glassberg S153 Fresh whole blood transfusion capability for S135 Acute nontraumatic general surgical conditions Special Operations Forces on a combat deployment Maj A. Beckett, J. Callum, L.T. da Luz, Capt D. Pannell, A.B. Nathens, Col J. Ricard, J. Schmid, C. Funk, Col E. Glassberg, LCol E. Savage, Col H. Tien Col H. Tien Online manuscript submission and peer review AVAILABLE at http://mc.manuscriptcentral.com/cjs ©2015 8872147 Canada Inc. Can J Surg, Vol. 58 (Issue 3 Suppl 3) June 2015 S79 FOREWORD Foreword he Canadian Armed Forces protects Canada, defends national partners. The Canadian Institute for Military and North America and contributes to international peace Veteran Health Research is a unique consortium of more T and security in partnership with our allies. These part than 35 Canadian universities dedicated to researching the nerships are a key part of our national defence strategy, and health needs of military personnel, veterans and their fam are also important to how we provide medical care and how ilies. In addition, Canada has several formal and informal we innovate to improve care for our wounded. In the future, research relationships with our allies through the North different partner nations will contribute modules of medical Atlantic Treaty Organization and through the Technical and surgical capability that will be fastened together to form a Cooperation Program. We are also now developing solid network of care for our deployed soldiers. Likewise, net research partnerships with the Trauma Branch of the Israel works of national and international partners will come Defence Forces. Defence is now a multilateral and multi together to answer pressing questions to advance trauma national effort. Looking forward, the CFHS will continue medicine, and the care we deliver to our deployed soldiers. to partner with Canadian academic institutions and inter The Canadian Forces Health Services (CFHS) innovates national collaborators to foster future health care innova to improve care for our wounded. With our partners, the tion that helps us sustain and shield our fighting forces CFHS innovates in how we deliver prehospital trauma care when they deploy on military missions. on the battlefield; we innovate in how we resuscitate and provide surgical care at the field hospital level; and we inno Col Homer Tien, OMM, CD, MD, MSc vate in how we transport and care for our wounded back in Canadian Forces Health Services Canada. We also innovate in how we educate and prepare National Practice Leader — Trauma our health care teams for deployment to provide the highest level of trauma care possible. Competing interests: None declared. Much of the research presented in this supplement has been conducted in cooperation with our national and inter DOI: 10.1503/cjs.006615 S80 J can chir, Vol. 58 (No 3 Suppl 3) juin 2015 ©2015 8872147 Canada Inc. AVANT-PROPOS Avant-propos es Forces armées canadiennes protègent le Canada, Une grande partie de la recherche présentée dans le défendent l’Amérique du Nord et contribuent à la présent supplément a été effectuée en collaboration avec L paix et à la sécurité internationales en partenariat nos partenaires nationaux et internationaux. L’Institut cana avec ses alliés. Ces partenariats sont un élément détermi dien de recherche sur la santé des militaires et des vétérans nant de notre stratégie de défense nationale, mais ils est un consortium unique composé de plus de 35 universités jouent aussi un rôle important dans la façon dont nous canadiennes qui se consacrent à la recherche sur les besoins offrons les soins médicaux et innovons afin d’améliorer de santé du personnel militaire, des anciens combattants et les soins aux blessés. À l’avenir, des nations partenaires de leurs familles. De plus, le Canada entretient des relations contribueront des modules de ressources médicales et formelles et informelles en matière de recherche avec ses chirurgicales interreliés formant un réseau de soins solide alliés à l’Organisation du traité de l’Atlantique nord et avec pour nos militaires sur le terrain. De même, des réseaux la direction générale de traumatologie des Forces de de partenaires nationaux et internationaux se mobilise défense israéliennes. La défense est maintenant un effort ront afin de répondre à des questions pressantes pour multilatéral et multinational. À l’avenir, le Groupe des Ser améliorer la traumatologie médicale et les soins aux sol vices de santé des Forces canadiennes continuera de colla dats en mission. borer avec les établissements universitaires canadiens et des Le Groupe des Services de santé des Forces cana collaborateurs internationaux pour favoriser des innova diennes fait preuve d’innovation pour améliorer les soins tions en soins de santé qui aident à soutenir et à protéger offerts à ses blessés. En collaboration avec ses partenaires, nos forces combattantes lorsqu’elles sont déployées dans le le Groupe innove dans sa façon d’offrir les soins de trau cadre de missions militaires. matologie préhospitaliers sur le champ de bataille, les soins chirurgicaux et de réanimation dans les hôpitaux de Col Homer Tien, OMM, CD, MD, MSc campagne, ainsi que le rapatriement et les soins offerts aux Groupe des Services de santé des Forces canadiennes blessés au Canada. Nous innovons également dans la Chef national de l’exercice de la profession — Traumatologie manière dont nous formons nos équipes de soins et les préparons en vue du déploiement afin d’offrir les meilleurs Intérêts concurrents : Aucun déclaré. soins de traumatologie possible. DOI: 10.1503/cjs.006715 ©2015 8872147 Canada Inc. Can J Surg, Vol. 58 (Issue 3 Suppl 3) June 2015 S81 INTRODUCTION Introduction commend the Canadian Journal of Surgery (CJS) for pub- and humanitarian operations in many troubled areas of the lishing its second military medicine supplement in recent world. Such research is pursued extensively within the Sur- I years. Military-specific research and knowledge translation geon General Health Research Program in partnership with are critical to Armed Forces, which must operate in a unique Defence Research and Development Canada, other govern- context of extreme environments; exceptional physiological ment departments and military allies, but collaborative part- and psychological stresses; and extraordinary operational, nerships with civilian academic and clinical partners are occupational and environmental hazards. most essential to achieving synergistic benefits to both mili- This context often complicates or precludes the applica- tary and civilian populations. The enthusiastic dedication tion of civilian research findings to military populations, such with which civilian academia supports the Armed Forces in that a need for the application of science to military