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<br /> Vol. 58 (3 Suppl 3) June/juin 2015<br /> canjsurg.ca<br /> The Canadian Armed Forces Supplement<br /> on Military Medicine: Caring for the<br /> Wounded in the Future<br /> Supplément sur les Forces armées<br /> canadiennes et la médecine militaire :<br /> l’avenir des soins aux blessés<br /> Supplement<br /> canjsurg.ca<br /> Vol. 53 (3 Suppl 3) June/juin 2015<br /> canjsurg.ca<br /> FOREWORD • AVANT-PROPOS S88<br /> S80 Foreword<br /> Col H. Tien<br /> S81 Avant-propos<br /> Col H. Tien<br /> INTRODUCTION • INTRODUCTION<br /> Technical innovations that may facilitate real-<br /> time telementoring of damage control surgery<br /> in austere environments: a proof of concept<br /> comparative evaluation of the importance of<br /> surgical experience, telepresence, gravity and<br /> mentoring in the conduct of damage control<br /> laparotomies<br /> Maj A.W<a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 1" href="http://viewer.zmags.com/publication/25055a26?page=1"> Vol. 58 (3 Suppl 3) June/juin 2015 canjsurg.ca </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 2" href="http://viewer.zmags.com/publication/25055a26?page=2"> canjsurg.ca Vol. 53 (3 Suppl 3) June/juin 2015 </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 3" href="http://viewer.zmags.com/publication/25055a26?page=3"> S108 Blunt splenic injury and severe brain injur</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 4" href="http://viewer.zmags.com/publication/25055a26?page=4"> FOREWORD Foreword T he Canadian Arm</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 5" href="http://viewer.zmags.com/publication/25055a26?page=5"> Avant-propos L es Forces armées canadi</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 6" href="http://viewer.zmags.com/publication/25055a26?page=6"> INTRODUCTION Introduction I commend the C</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 7" href="http://viewer.zmags.com/publication/25055a26?page=7"> Introduction J e félicite le Journal can</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 8" href="http://viewer.zmags.com/publication/25055a26?page=8"> COMMENTARY • COMMENTAIRE In memoriam — Erin Sav</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 9" href="http://viewer.zmags.com/publication/25055a26?page=9"> COMMENTARY • COMMENTAIRE The need for a robust </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 10" href="http://viewer.zmags.com/publication/25055a26?page=10"> COMMENTAIRE Early experience has shown that the</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 11" href="http://viewer.zmags.com/publication/25055a26?page=11"> Affiliations: From the Regional Trauma Services, </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 12" href="http://viewer.zmags.com/publication/25055a26?page=12"> COMMENTARY • COMMENTAIRE Technical innovations </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 13" href="http://viewer.zmags.com/publication/25055a26?page=13"> Damage control Surgery for truncal hemorrhage con</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 14" href="http://viewer.zmags.com/publication/25055a26?page=14"> COMMENTAIRE real-time telementoring of Damage c</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 15" href="http://viewer.zmags.com/publication/25055a26?page=15"> REVIEW • REVUE Advances in damage control resus</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 16" href="http://viewer.zmags.com/publication/25055a26?page=16"> REVUE requirement for multinational medical sol</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 17" href="http://viewer.zmags.com/publication/25055a26?page=17"> • 1 hour — damage control resuscitation (DCR; re</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 18" href="http://viewer.zmags.com/publication/25055a26?page=18"> REVUE and worsening shock, which further perpet</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 19" href="http://viewer.zmags.com/publication/25055a26?page=19"> cricothyrotomy for definitive airway control, lap</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 20" href="http://viewer.zmags.com/publication/25055a26?page=20"> REVUE be included in the module. If damage cont</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 21" href="http://viewer.zmags.com/publication/25055a26?page=21"> 31. Baraniuk S, Tilley BC, del Junco DJ, et al.; </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 22" href="http://viewer.zmags.com/publication/25055a26?page=22"> RESEARCH • RECHERCHE Medical mentorship in Afgh</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 23" href="http://viewer.zmags.com/publication/25055a26?page=23"> P revious work has been conducted on th</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 24" href="http://viewer.zmags.com/publication/25055a26?page=24"> RECHERCHE were general surgery, orthopedic surg</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 25" href="http://viewer.zmags.com/publication/25055a26?page=25"> scores were slightly lower (mean score 4.04; Tabl</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 26" href="http://viewer.zmags.com/publication/25055a26?page=26"> RECHERCHE part of NATO, has had previous experi</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 27" href="http://viewer.zmags.com/publication/25055a26?page=27"> RESEARCH Appendix 1: suRvey questionnAiRe foR A</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 28" href="http://viewer.zmags.com/publication/25055a26?page=28"> RESEARCH • RECHERCHE Cervical spine injury in d</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 29" href="http://viewer.zmags.com/publication/25055a26?page=29"> I n recent conflicts, blast injuries from impr</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 30" href="http://viewer.zmags.com/publication/25055a26?page=30"> RECHERCHE The number of patients with traum</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 31" href="http://viewer.zmags.com/publication/25055a26?page=31"> Affiliations: From the Maine Veterans’ Affairs Me</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 32" href="http://viewer.zmags.com/publication/25055a26?page=32"> RESEARCH • RECHERCHE Blunt splenic injury and s</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 33" href="http://viewer.zmags.com/publication/25055a26?page=33"> T he spleen is the intra-abdominal organ </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 34" href="http://viewer.zmags.com/publication/25055a26?page=34"> RECHERCHE related mortality can be secondary to</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 35" href="http://viewer.zmags.com/publication/25055a26?page=35"> We also considered the probability of death </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 36" href="http://viewer.zmags.com/publication/25055a26?page=36"> RECHERCHE for whom NOM failed.12 We chose the r</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 37" href="http://viewer.zmags.com/publication/25055a26?page=37"> well-designed prospective study of 717 patients, </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 38" href="http://viewer.zmags.com/publication/25055a26?page=38"> RECHERCHE and to the effect of hypotension on T</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 39" href="http://viewer.zmags.com/publication/25055a26?page=39"> modelled as a Markov process, but as immediate ev</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 40" href="http://viewer.zmags.com/publication/25055a26?page=40"> RECHERCHE disease assumptions. Therefore, our s</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 41" href="http://viewer.zmags.com/publication/25055a26?page=41"> after surgical treatment: a multicenter pros</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 42" href="http://viewer.zmags.com/publication/25055a26?page=42"> RESEARCH • RECHERCHE Needle thoracostomy for te</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 43" href="http://viewer.zmags.com/publication/25055a26?page=43"> T ension pneumothorax (TPTX) is a life-t</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 44" href="http://viewer.zmags.com/publication/25055a26?page=44"> RECHERCHE chest wounds using a vented chest sea</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 45" href="http://viewer.zmags.com/publication/25055a26?page=45"> anterior chest wall at the second ICS in the midc</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 46" href="http://viewer.zmags.com/publication/25055a26?page=46"> RECHERCHE (9%) and tourniquet application (6%).</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 47" href="http://viewer.zmags.com/publication/25055a26?page=47"> more frequent than other symptoms indicating ches</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 48" href="http://viewer.zmags.com/publication/25055a26?page=48"> RECHERCHE suspected TPTX. Standard NT has many </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 49" href="http://viewer.zmags.com/publication/25055a26?page=49"> RESEARCH • RECHERCHE Current use of live tissue</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 50" href="http://viewer.zmags.com/publication/25055a26?page=50"> RECHERCHE I n both the military and civil</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 51" href="http://viewer.zmags.com/publication/25055a26?page=51"> Participant characteristics The 12 studies inclu</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 52" href="http://viewer.zmags.com/publication/25055a26?page=52"> RECHERCHE Outcome measurements Not all studies</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 53" href="http://viewer.zmags.com/publication/25055a26?page=53"> knowledge of expert surgeons and trauma fellows i</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 54" href="http://viewer.zmags.com/publication/25055a26?page=54"> RECHERCHE prior medical training, Hall18 conduc</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 55" href="http://viewer.zmags.com/publication/25055a26?page=55"> detect any differences was further diluted by dif</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 56" href="http://viewer.zmags.com/publication/25055a26?page=56"> RECHERCHE procedures and skills is erroneous. T</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 57" href="http://viewer.zmags.com/publication/25055a26?page=57"> hemostatic agent to current combat hemos</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 58" href="http://viewer.zmags.com/publication/25055a26?page=58"> RECHERCHE Appendix 1 (continued fRoM pRevious pA</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 59" href="http://viewer.zmags.com/publication/25055a26?page=59"> RESEARCH • RECHERCHE Acute nontraumatic general</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 60" href="http://viewer.zmags.com/publication/25055a26?page=60"> RECHERCHE T he Afghan war represented </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 61" href="http://viewer.zmags.com/publication/25055a26?page=61"> Statistical analysis The DHSO database was queri</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 62" href="http://viewer.zmags.com/publication/25055a26?page=62"> RECHERCHE exam. In the 1 patient with an umbili</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 63" href="http://viewer.zmags.com/publication/25055a26?page=63"> The most common acute surgical illness requiri</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 64" href="http://viewer.zmags.com/publication/25055a26?page=64"> RECHERCHE who are otherwise very healthy. The n</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 65" href="http://viewer.zmags.com/publication/25055a26?page=65"> RESEARCH • RECHERCHE Factors affecting mortalit</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 66" href="http://viewer.zmags.com/publication/25055a26?page=66"> RECHERCHE B etween August 2007 and J</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 67" href="http://viewer.zmags.com/publication/25055a26?page=67"> 42% of admissions being blast-related. (Table 2).</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 68" href="http://viewer.zmags.com/publication/25055a26?page=68"> RECHERCHE discussion The data presented in thi</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 69" href="http://viewer.zmags.com/publication/25055a26?page=69"> local hospital, where resources were more limited</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 70" href="http://viewer.zmags.com/publication/25055a26?page=70"> RESEARCH • RECHERCHE The Canadian Armed Forces </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 71" href="http://viewer.zmags.com/publication/25055a26?page=71"> I nternational disaster response is a complex</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 72" href="http://viewer.zmags.com/publication/25055a26?page=72"> RECHERCHE questions regarding patient classific</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 73" href="http://viewer.zmags.com/publication/25055a26?page=73"> RESEARCH 25 20 15 10 5 </a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 74" href="http://viewer.zmags.com/publication/25055a26?page=74"> RECHERCHE problems. For example, 50% of musculo</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 75" href="http://viewer.zmags.com/publication/25055a26?page=75"> the destruction caused by Typhoon Haiyan. The sta</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 76" href="http://viewer.zmags.com/publication/25055a26?page=76"> RECHERCHE had reached an area that was substant</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 77" href="http://viewer.zmags.com/publication/25055a26?page=77"> DISCUSSIONS IN SURGERY • DISCUSSIONS EN CHIRURGIE</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 78" href="http://viewer.zmags.com/publication/25055a26?page=78"> DISCUSSIONS EN CHIRURGIE circumstances where Sp</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 79" href="http://viewer.zmags.com/publication/25055a26?page=79"> Casualties should be triaged to avoid wasting FWB</a> <a title="The Canadian Armed Forces Supplement on Military Medicine: Caring for the Wounded in the Future page 80" href="http://viewer.zmags.com/publication/25055a26?page=80"> DISCUSSIONS EN CHIRURGIE References 1. Pinker</a>