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The French Armed Forces conduct asymmetric warfare in the Sahara-Sahel Strip. Casualties are treated with damage control resuscitation to the extent possible. Questions remain about the feasibility and sustainability of using blood for wider use in austere environments.We performed a retrospective analysis of all French military trauma patients transfused after injury in overseas military operations in Sahel-Saharan Strip, from the point of injury, until day 7, between January 11, 2013 to December 31, 2021.Forty-five patients were transfused. Twenty-three (51%) of them required four red blood cells units (RBC) or more in the first 24H defining a severe hemorrhage. The median blood product consumption within the first 48 h, was 8 (IQR [3; 18]) units of blood products (BP) for all study population but up to 17 units (IQR [10; 27.5]) for the trauma patients with severe hemorrhage. Transfusion started at prehospital stage for 20 patients (45%) and included several blood products: French lyophilized plasma, RBCs, and whole blood. Patients with severe hemorrhage required a median of 2 [IQR 0; 34] further units of BP from day 3 to day 7 after injury. Eight patients died in theater, 4 with severe hemorrhage and these 4 used an average of 12 products at Role 1 and 2.The transfusion needs were predominant in the first 48 h after the injury but also continued throughout the first week for the most severe trauma patients. Importantly, our study involved a low-intensity conflict, with a small number of injured combatants.

Hemorrhagic shock is the leading cause of preventable early death in trauma patients. Transfusion management is guided by international guidelines promoting early and aggressive transfusion strategies. This study aimed to describe transfusion timelines in a trauma center and to identify key points to performing early and efficient transfusions.This is a monocentric retrospective study of 108 severe trauma patients, transfused within the first 48 h and hospitalized in an intensive care unit between January 2017 and May 2019.One hundred and eight patients were transfused with 1250 labile blood products. Half of these labile blood products were transfused within 3 h of admission and consumed by 26 patients requiring massive transfusion (≥4 red blood cells [RBC] within 1 h). Among these, the median delay from patient's admission to labile blood products prescription was -11 min (-34 to -1); from admission to delivery of labile blood products was 1 min (-20 to 16); and from admission to first transfusion was 20 min (7-37) for RBC, 26 min (13-38) for plasma, and 72 min (51-103) for platelet concentrates. The anticipated prescription of labile blood products and the use of massive transfusion packs and lyophilized plasma units were associated with earlier achievement of high transfusion ratios.This study provides detailed data on the transfusion timelines and composition, from prescription to initial transfusion. Transfusion anticipation, use of preconditioned transfusion packs including platelets, and lyophilized plasma allow rapid and high-ratio transfusion practices in severe trauma patients.

Introduction Military anesthesiologists from the French Military Medical Service (FMMS) are part of the Forward Surgical Teams deployed in overseas military operations. The practice of anesthesia in combat zones requires specific skills that are not taught during the initial curriculum for French civilian anesthesiologist. The Pre-Deployment Advanced Course in Anesthesia and Resuscitation (DACAR) program was developed to prepare military anesthesiologist from the FMMS before their deployment in overseas military operations. Methods Created in 2013 by the French Military Medical Academy, the DACAR program is divided into two modules and carried out once a year. The DACAR program trains all military anesthesiologist residents at the end of their curricula. Since 2019, a number of Certified Registered Nurse Anesthetists have completed the DACAR program. The DACAR program is organized around the main axes of experience feedback from previous deployments in combat zones as well as didactic learning and practical training using high-fidelity simulation. Results Since 2013, a total of 99 trainees completed the DACAR program during six complete cycles of two modules. The DACAR program has gradually been enriched from 14 courses in 2013 to 28 in 2019. Participants’ reported satisfaction rates have increased steadily since 2016, when 88% of courses were rated as “interesting” or “very interesting,” and only 4% as “not very interesting.” By 2019, those figures had improved to 96% and 2%, respectively. Conclusion The DACAR program is a structured and adapted military medical course aimed at completing the curriculum of military anesthesiologists from the FMMS before deployment in overseas military operations. Regular audits and updates ensure that the DACAR training program maintains the highest standards of quality and rigor.

The k-Nearest Neighbors (k-NN) technique is a popular method for producing spatially contiguous predictions of forest attributes by combining field and remotely sensed data. In the framework of Working Group 2 of COST Action FP1001, we reviewed the scientific literature for forestry applications of k-NN. Information available in scientific publications on this topic was used to populate a database that was then used as the basis for a meta-analysis. We extracted qualitative and quantitative information from 260 experimental tests described in 148 scientific papers. The papers represented a geographic range of 26 countries and a temporal range from 1981 to 2013. Firstly, we describe the literature search and the information extracted and analyzed. Secondly, we report the results of the meta-analysis, especially with respect to estimation accuracies reported for k-NN applications for different configurations, different forest environments, and different input information. We also provide a summary of results that may reasonably be expected for those planning a k-NN application using remotely sensed data from different sensors and for different forest attributes. Finally, we identify some methodological publications that have advanced the state of the science with respect to k-NN.

National audience; La futaie de pin maritime du Massif des Landes de Gascogne fait l’objet d’une sylviculture dynamique ; les dommages occasionnés par les tempêtes Martin (1999) et Klaus (2009) puis par des ravageurs (scolytes) ont entrainé une forte diminution de la ressource en bois. Cela a accentué la demande de la filière forêt-bois aquitaine pour un suivi permanent, précis et spatialisé de celle-ci. L’étude Pinastéréo ouvre des perspectives nouvelles en la matière grâce au modèle numérique de surface (MNS) obtenu par corrélation d’images stéréoscopiques Pléiades. Sa combinaison avec le modèle numérique de terrain BD Alti® fournit le modèle de hauteur de canopée (MNHC). La précision des MNS et MNHC a été évaluée avec des mesures de référence (LiDAR aérien, placettes de levers dendrométriques) ; elle s'est avérée satisfaisante. Il est montré que la hauteur dominante des peuplements de pin maritime, leur volume aérien total et leur biomasse peuvent être modélisés à partir du MNHC. Une carte de la hauteur dominante a alors été produite sur un site de référence ; celle de la biomasse reste à faire. Les faibles incertitudes observées sur les estimations de hauteur et de volume sont très prometteurs pour une généralisation de la méthode au Massif landais ou même à d'autres futaies régulières résineuses.