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      Capacidades sanitarias del buque de proyección estratégica L-61 Juan Carlos I. Lecciones médicas identificadas tras las maniobras FLOTEX-17 Translated title: Health capacity of the strategic projection warship Juan Carlos I. Medical lessons identified after the FLOTEX-17 maneouvers

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          Abstract

          RESUMEN El Buque de Proyección Estratégica L-61 Juan Carlos I (L-61 JC I) es el buque de mayores dimensiones que ha tenido la Armada española en toda su historia. Puede desarrollar cuatro perfiles de misión: anfibio, portaviones, transporte estratégico y ayuda humanitaria. En todos ellos su capacidad sanitaria Role 2 juega un papel determinante gracias a las importantes prestaciones médicas con las que cuenta el buque. Las maniobras FLOTEX-17 realizadas en el Mar Mediterráneo en junio de 2017 en las que participaron 29 buques y más de 3500 efectivos fue la primera vez que embarcó un Role 2 en el L-61 JC I. El objetivo de este artículo es describir las características técnicas y sanitarias del buque, las lecciones identificadas obtenidas tras las maniobras navales y analizar las semejanzas y diferencias de buques similares de marinas de guerra aliadas.

          Translated abstract

          SUMMARY Strategic Projection Ship L-61 Juan Carlos I (L-61 JC I) is the largest ship that the Spanish Navy has had in its history. This warship can develop four mission profiles: amphibian, aircraft carrier, strategic transport and humanitarian aid. In all of them, Role 2 medical capacity and capability plays a decisive role thanks to the important medical benefits available in the ship. FLOTEX-17 maneuvers carried out in the Mediterranean Sea in June 2017 with the participation of 29 warships and more than 3,500 navy members was the first time that a Role 2 was shipped in the L-61 JC I. The purpose of this article is to describe warship technical and medical characteristics, lessons identified after the naval maneuvers and analyze the similarities and differences of similar warships of allied navies.

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          Most cited references 42

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          The evolving role of lyophilized plasma in remote damage control resuscitation in the French Armed Forces Health Service.

          Freeze-dried plasma was developed by the US Army for the resuscitation of combat casualties during World War II. The French Military Blood Institute began producing French lyophilized plasma (FLYP) in 1949, in accordance with French blood product guidelines. Since 2010, a photochemical pathogen inactivation process has been implemented to reduce the remaining transfusion-related infectious risk. All quality controls for this procedure verify that the hemostatic properties of FLYP are conserved. FLYP is compatible with all blood types, can be stored at room temperature for 2 years, and its reconstitution requires less than 6 minutes. As a result, FLYP allows quick delivery of all the coagulation proteins and the application of a 1:1 ratio of FLYP and red blood cells in the context of a massive transfusion. Hemovigilance data collected in France since 1994 have included FLYP. Results indicate no reporting of infection related to the use of FLYP. Clinical monitoring with a focus on hemostasis was implemented in 2002 and expanded in 2010. The data, obtained from overseas operations, confirmed the indications, the safety and the clinical efficacy of FLYP. Further research is needed to determine specific indications for FLYP in the therapeutic management of civilian patients with severe hemorrhage.
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            Wounding patterns for U.S. Marines and sailors during Operation Iraqi Freedom, major combat phase.

            This investigation examined the wounds incurred by 279 U.S. Navy-Marine personnel (97% Marines and 3% sailors) identified as wounded in action during Operation Iraqi Freedom, from March 23 through April 30, 2003. The goal was to assess the potential impact of each causative agent by comparing the differences in anatomical locations, types of injuries caused, and medical specialists needed to treat the casualties. The overall average number of diagnoses per patient was 2.2, and the overall average number of anatomical locations was 1.6. The causative agents were classified into six major categories, i.e., small arms, explosive munitions, motor vehicle accidents, falls, weaponry accidents, and other/unknown. Explosive munitions and small arms accounted for approximately three of four combat-related injuries. Upper and lower extremities accounted for approximately 70% of all injuries, a percentage consistent for battlefield injuries since World War II.
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              Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care

              Introduction The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties. Materials and Methods Hemovigilance and combat casualties data from Afghanistan 2006–2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1–5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP. Results No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products. Conclusion This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas.
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                Author and article information

                Contributors
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                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                March 2019
                : 75
                : 1
                : 27-39
                Affiliations
                orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Cirugía Ortopédica y Traumatología España
                orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Anestesiología, Reanimación y Terapéutica del Dolor España
                orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Cirugía Ortopédica y Traumatología España
                orgnameBPE L-61 Juan Carlos I
                orgnameEscuela de Suboficiales de la Armada España
                orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Cardiología España
                orgnameJefatura de Sanidad Operativa España
                orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Cirugía General y del Aparato Digestivo España
                orgnameInspección General de Sanidad España
                orgnameHospital Central de la Defensa “Gómez Ulla” orgdiv1Servicio de Medicina Intensiva España
                Article
                S1887-85712019000100027
                10.4321/s1887-85712019000100005

                http://creativecommons.org/licenses/by/4.0/

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                Figures: 0, Tables: 0, Equations: 0, References: 58, Pages: 13
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