Photo 3: Wounded nest before and after an evacuation (personal collection).
Table 1: Organisation of the medical care implemented for each casualty brought to the wounded nest.
WHAT? HOW? ORIENTATION WIA area KIA area In the order of arrival Back against a military vehicle (solar and physical protection) WHO? Doctor Nurse POSITIONING WITHIN THE NEST In a spiral on the ground NUMBERING In the order of their positioning in the Wounded nest (order of arrival) Two numbering points at least on skin or clothes (face, shoulder +++) Nurse RECORDING Registration 5 items: * rank * name * unit * description of the wound and penetrating agent * categorisation Doctor + soldier for administrative data MEDICALISATION Precise directive / consequence of injury MARCHE RYAN protocol FOLLOW UP Rounds / 20 - 30 Minutes Supplementary actions if needed
By order of: Doctor Performed by : Nurse and French medic / Chadian nurse
The medicalisation plan was based on the “MARCHE RYAN” method. The acronym has been adopted by the SSA and is taught at the Operational Medicine Training and Simulation Centre (CESimMO) (figure 2). However, because of the difficult context and the limited and haphazard material, the method was adapted for certain wounded patients from the standard model taught at CESimMO.
The first aid performed during combat3 included: M: Tourniquets were applied on any accessible bleeding, even when very small, with French and Chadian material. A/R: Three-side bandages and/or Asherman® valves were used for every thoracic and/or open back wound.
International Review of the Armed Forces Medical Services
Revue Internationale des Services de Santé des Forces Armées