Finger thoracostomies were performed if there was any risk of suffocating pneumothorax judging by the clinical presentation of the injured soldier (preventative medical procedure realised by a doctor). Nasopharyngeal injection tubes were inserted for head wounds with a 20% mannitol solution (500ml) in accordance with the Glasgow Coma Scale < 10 (prevention of cerebral oedema). Oxygen therapy was seldomly used and only for suffocating patients showing clinical signs of desaturation. C: Potentially unstable casualties, with a weak pulse or no pulse, were put on a drip of Voluven®, Ringer lactate® or NaCl isotonic 0.9%. The stable casualties were put on a drip depending on the evolution of their wounds following the MARCHE protocol. H: Thermal protection consisted in removing the casualties from the sun by using vehicles to give shelter during the day and giving them blankets during the night. Oral rehydration was proposed to all the casualties allowed. E: The casualties waiting to be evacuated (evacuations took place at the end of the day because of the fighting), were put in a specific position: lateral security position (PLS) for head injuries, in a half sitting position for thoracic injuries, with raised legs for abdominal injuries. The zone dedicated to dead soldiers was placed about fifty metres away from the wounded nest. The bodies were wrapped in sheets, makeshift blankets or parachute canvases and kept away from the sun, ready to be evacuated in due time. R: A medical team took charge of the medical monitoring, every thirty minutes, following the “RYAN” protocol. They checked tourniquets, controlled respiratory parameters (so as to eliminate suffocating pneumothorax) and managed intravenous solutions. Y: Eye wounds were cleaned and bandaged. A: Fractures (mainly femur and humerus) were immobilised with the means at hand: Sam splint®, Kramer splint®, cardboard splints and slings. Painkillers were rarely used (less than ten doses of morphine were consumed) because many wounded soldiers were helped with intravenous paracetamol. There was no local anaesthesia because there was not enough time and very little specialized material available.
N: The protection of all the wounds was ensured with betadine and bandages. The antibiotic therapy for all was a mix of gentamicin (160mg) and amoxicillin (2g). None of the casualties were intubated because it would have involved too much monitoring and a long chain of evacuation (only one respirator and very little oxygen resources). E: We operated directly in the combat zone in a hostile environment (improvised explosive devices, mines) where the enemies were spread out and equipped with antiaircraft weapons. The number of casualties was increasing, therefore we decided to opt for medical evacuation by night. So the time between the injury and the evacuation to a mobile army surgical unit was extremely long (more than ten hours for most patients). From 8.00pm to midnight, three norias with four helicopters were carried out as follows:
1ST NORIA 1 medicalised MH (1 doctor, A nurse) 6U1 2ND NORIA 6U1 / UD KIA 3RD NORIA
3 non medicalised 8 / 10 U2, U3 8 / 10 U1, U2, U3 MH
The next day, a last rotation of two MHs was done to extract the remaining casualties: lightly injured patients with multiple wounds and simple fractures.
RESULTS (table 2)
At the end of the fight there were ninety-three casualties, divided as follows: - Nineteen KIA (killed in action) who showed lesions which had caused haemorrhagic shock, cranial or cerebral wounds and thoracic wounds resulting from the lack of ballistic protection. - Seventy-four WIA: (wounded in action): seventy by penetrating agents (N°1 to 66) and eight victims (N°67 to 74) of an accident in a vehicle during combat, causing minor fractures and dislocations. The first casualties essentially showed head, neck or thorax wounds resulting from motorized combat and no protection to the lower limbs. Later, all the classic injuries were reported during close range or hand-tohand fights, as well as suicide bombers and mines near enem