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Pre-hospital management of pediatric polytrauma during modern conflict: experience and limits of the French military health service

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Abstract

Background

French military physicians serving in deployment are confronted with pediatric polytrauma patients (PPP) during the provision of medical aid to civilian populations. The objectives of this study were to describe the current care of PPPs during these missions, to report difficulties encountered and to evaluate the training of doctors for management of PPPs in the field.

Methods

A descriptive epidemiological study based on a questionnaire sent to physicians who had been deployed overseas.

Results

91 doctors participated. Their mean age was 35 years. 86% of the doctors managed children whilst serving overseas, of which 54% were PPPs. The incidence of pediatric polytrauma varied according to the country, but overall from 1129 emergencies reported during overseas missions, 11% were PPPs. Penetrating traumas represented 37% of cases; 24% were circulatory distress and 19% were massive bleeding. 80% of the doctors reported a lack of pediatric trauma experience, less than 5% had received appropriate in-service training and only 9% had worked in pediatric emergency facilities in France. The equipment available for PPPs in the field was often poorly understood and frequently considered to be insufficient.

Conclusions

The occurrence of PPPs of war is rare and complex, but care of older children it is similar to that required for adults. Preparation for PPP management, it could be optimized by identifying risks which alter depending on the country of deployment, such as the logistical organization of the battlefield chain of care. Improvements in doctors’ pediatric trauma training should be individualized, based on their mission needs.

Level of evidence

III.

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Acknowledgements

The authors thank the physicians who participated in the study despite the severe constraints of current time and the short time available.

Author information

Authors and Affiliations

  1. 35e Régiment d’infanterie, CMA Belfort, quartier Maud’Huy, BP 529, 90016, Belfort Cedex, France

    Victor Laville

  2. 28e RĂ©giment de transmission, CMA Clermont-Ferrand, Quartier de Bange, avenue de Bange, 63500, Issoire, France

    Christophe Lebleu

  3. Unité INSERM 1193, 16 avenue Paul Vaillant-Couturier, 94800, Villejuif, France

    Christophe desterke

  4. Hôpital Necker, 149 rue de Sèvres, 75015, Paris, France

    Pierre Mornand

  5. CMA Marseille, BP 40026, 13568, Marseille Cedex 2, France

    Luc Aigle

  6. Service de chirurgie viscérale, Hôpital d’Instruction des Armées Percy, BP 406, 92141, Clamart Cedex, France

    Emmanuel Hornez

Authors
  1. Victor Laville
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  2. Christophe Lebleu
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  3. Christophe desterke
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  4. Pierre Mornand
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  5. Luc Aigle
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  6. Emmanuel Hornez
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Contributions

Literature search: Hornez, Laville. Study design: Hornez, Laville, Mornand. Data collection: Laville. Data analysis: Laville, Hornez, Desterke. Data interpretation: Hornez, Laville, Lebleu. Writing: Laville, Hornez. Critical revision: Lebleu, Aigle, Hornez.

Corresponding author

Correspondence to Emmanuel Hornez.

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Conflict of interest

All authors declared that they have no conflict of interest.

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Laville, V., Lebleu, C., desterke, C. et al. Pre-hospital management of pediatric polytrauma during modern conflict: experience and limits of the French military health service. Eur J Trauma Emerg Surg 45, 437–443 (2019). https://doi.org/10.1007/s00068-018-0915-x

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  • DOI: https://doi.org/10.1007/s00068-018-0915-x

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