Ultrasonography Performed by Military Nurses in Combat Operations: A Perspective for the Future?

INTRODUCTION: In current French military operations, it is not uncommon for military nurses (MNs) alone to be required to support soldiers in isolated areas. At a time when advanced practice nurses in the civilian sector develop extended skills, we asked MNs about their willingness to be trained in pointof- care ultrasound (POCUS). METHODS: We conducted a webbased survey from 1 November 2018 to 1 December 2018, including all MNs deployed in Operation Barkhane. The questionnaire, sent by e-mail, aimed to describe the willingness of MNs to be trained in POCUS. Their opinion on the usefulness of this training, the situations, and ultrasound (US) targets that seemed most useful to them were also studied. RESULTS: Thirty of 34 questionnaires were completed. On average, MNs had 7.4 years of practice and had been deployed three times for military operations. Five MNs reported having had informal training in clinical US by the military physicians (MPs) they work with and had performed POCUS in real-life situations; 24 (96%) of the untrained MNs wanted to be trained. Twenty- nine (96%) of the MNs felt that there was added value in knowing how to perform POCUS, especially in operations and in isolated posts without an MP. Focused assessment with sonography for trauma and pleural and renal US were the targets considered most useful to them, in that order. CONCLUSION: MNs are interested in learning POCUS and say it would be beneficial for the patient. Available scientific data tend to validate their ability after a brief training course to perform reliable, targeted US examinations in the field.

Evaluation of Two Junctional Tourniquets Used on the Battlefield: Combat Ready Clamp® versus SAM® Junctional Tourniquet.

BACKGROUND: Junctional hemorrhage (i.e., between the trunk and limbs) are too proximal for a tourniquet and difficult to compress. These hemorrhages are responsible for 20% of preventable deaths by bleeding on the battlefield. The majority of these involve the groin area. Devices allowing a proximal compression for arterial axes have been recently developed. OBJECTIVE: The purpose of this study was to compare the use of two junctional- tourniquet models, the Combat Ready Clamp (CRoC®) and the SAM® Junctional Tourniquet (SJT), in simulated out-of-hospital trauma care when tourniquets were ineffective to stop the arterial flow. METHODS: During our clinical study, 84 healthy volunteers wearing battle dress performed a physical exercise to come approximate the operational context. The volunteers were randomly divided into two groups according to the device (the CRoC or SJT) used as supplement to a tourniquet self-applied to the root of the thigh. The primary study end point was the complete interruption of popliteal arterial flow, measured with Doppler auscultation. Time to effectiveness and subjective questionnaire data to evaluate the devices' application were also collected. RESULTS: Junctional device effectiveness was almost 90% for both the CRoC and the SJT, and did not differ between them, either used with a tourniquet (ρ = .36) or alone (ρ = .71). The time to effectiveness of the SJT was significantly shorter than that of the CRoC (ρ = .029). CONCLUSION: The SJT and the CRoC were equally effective. The SJT was faster to apply and preferred by the users. Our study provides objective evidence to the French Tactical Casualty Care Committee for improving junctional hemorrhage treatment.