Position: A study protocol for the prevention of fall injuries in french special forces selection courses using a body-centered intervention.

INTRODUCTION: The Military Physical and Sports Training program was developed by the French Army in order to train, optimize, and maintain individual readiness. Although the health benefits of sport practice do not need to be demonstrated, such activities can cause acute musculoskeletal injuries that need to be addressed. The prevalence of lower limb injury is rather high in the French military population and, in particular, ranges from 15 to 45% during Special Forces selection courses. Thus, this project aims to investigate the efficiency of a body-centered program designed to enhance body awareness. The program seeks to train the mind to actively pay attention to body information, while the latter is viewed as a protective factor against fall injuries. We assume: (i) that postural control can be improved by enhancing the level of body awareness; and (ii) that greater postural awareness could be beneficial in reducing the risk of fall injuries. The body-centered prevention program is based on the Optimization of the Resources of the Armed Forces (ORAF) intervention, which focuses on mental preparation and recovery, and has been deployed in the French Army for many years. METHOD AND ANALYSES: The study focuses on five French Special Forces selection courses (400 soldiers/ participants). It is divided into two stages (year 1, year 2). The first year is dedicated to data collection from the control group (200 participants), while in the second year the ORAF intervention will be deployed. In both year, participants will be subjected to the same enrollment schedule (Fig 3). The main objective is to evaluate the effectiveness of the ORAF intervention in reducing the rate of fall injuries during military selection, based on a multidisciplinary method that captures demographic, biological, biometric, clinical, and para-clinical measures. TRIAL REGISTRATION: Registration number: IDRCB number 2021-A02108-33, Clinical Trial: NCT05451394.

Helicopter Rescue Missions for Emergency Medical Aid at Sea: A New Assignment for the French Military Medical Service?

Historically in charge of the search and rescue of aircraft in distress alongside military aeronautical crews, the doctors and nurses of the French Military Medical Service (FMMS) also participate in helicopter rescue missions for emergency medical aid at sea off the French metropolitan coast. This public service mission is placed at the heart of force medicine because it can be transposed to external theaters of operations (OPEX). Recent changes in the regulation of medical aid at sea, in particular the creation in 2013 of maritime emergency mobile resuscitation services, initially weakened the role of the teams of the FMMS. However, their 2018 and 2019 activity report reflects the persistence of strong involvement. The "FMMS 2020" model, especially through its "openness" aspect, allows the FMMS the optimal conditions to maintain its position as a key player in this field, particularly through the development of institutional partnerships with the public health service. Associated with their mastery of the air-maritime environment, strengthening the skills in emergency medicine of the military medical teams in charge of this mission appears to be 1 of the main measures ensuring the achievement of this objective and a high quality of care for patients.

An example of extreme cardiology: chest pain on the high seas and helicoptered medical evacuations: the French Navy experience.

Medicalized high sea rescue is very different from prehospital medical evacuation. It requires specifically trained medical teams because the difficulties are marine, aerial, and medically related. The French Navy provides medical evacuations by helicopter on the Atlantic coast, up to 320 km offshore and under all weather conditions. The epidemiology of acute chest pain in the high seas has been poorly described. Therefore, in this retrospective study, we aimed to assess the prevalence and constraints found in the management of these emergencies. From January 1, 2000, to April 30, 2009, 286 medical evacuations by helicopter were performed, 132 of which were due to traumatological emergencies, and 154 to medical emergencies. Acute chest pain, with 36 missions, was the leading cause of medical evacuation. All evacuated patients were men who were either professional sailors or ferry passengers. The median age was 48 years (range, 26-79). The most common prehospital diagnosis was coronary chest pain in 23 patients (64%), including 11 patients with acute coronary syndrome with ST-segment elevation. Thirty-two patients were airlifted by helicopter. All patients benefited from monitoring, electrocardiogram, peripheral venous catheter, and medical management as soon as the technical conditions allowed it.

Heart rate and autonomic balance during stand tests before and after fighter combat missions.

BACKGROUND: High workload during combat missions is a critical factor in the use of modern aircraft. Our objective was to evaluate the impact of piloting in war zones on the kinetics of the sympathovagal balance during recovery. METHODS: There were 40 military pilots who were monitored during operational flights in Afghanistan. Electrocardiographic activity was recorded during stand tests performed 1 h before takeoff (T-1), immediately after landing (L+0), 2 h after (L+2), and 4 h after (L+4) the flight. Missions were divided in two groups according to flight duration. RESULTS: The mean length of long flights was 4:31 +/- 0:53 h and of short flights 1:27 +/- 0:09 h. For long flights, at L+0, all indices related to parasympathetic modulation rose significantly in comparison to T-1, L+2, and L+4 (total power L+0: 2083 +/- 414 ms2 x Hz(-1),T-1: 1269 +/- 158 ms2 x Hz(-1), L+2: 1095 +/- 148 ms2 x Hz(-1), and L+4: 1238 +/- 124 ms2 x Hz(-1); high-frequency normalized units (HFnu) L+0: 16 +/- 2%, T-1: 11 +/- 1%, L+2: 10 +/- 1%, and L+4: 11 +/- 1%). At the same time the sympathetic frequency components significantly decreased (low-frequency normalized units (LFnu) L+0: 83 +/- 2%, T-1: 88 +/- 1%, L+2: 90 +/- 1%, and L+4: 89 +/- 1%; LF/HF L+0: 7 +/- 1, T-1: 11 +/- 1, L+2: 13 +/- 2, and L+4: 16 +/- 3). For short flights, the sympathetic components were higher at L+0 (LFnu: 77 +/- 2%; LF/HF: 14 +/- 3) than at T-1 (LFnu: 66 +/- 5%; LF/HF: 6 +/- 1). A concomitant reduction of vagal components was observed. CONCLUSIONS: Modulations of autonomic balance differed with the type of mission. A postflight sympathetic increase represents an autonomic adaptation due to stress and flight. A raise of parasympathetic modulation after flight may be related to the decrease of alertness.