The training of military rescuers of the Special Forces of Defense sector

(To Marina Militare)

The Special Forces operate mainly in scenarios characterized by high levels of physical risk, in which it is not always possible to ensure direct health care by medical and / or nursing staff. For this reason, since 2019, the COMSUBIN health service has been carrying out a training activity aimed at increasing the training level of the Special Forces personnel qualified as "Military Rescuer" and of the health personnel supporting the Special Forces of Defense sector.

In this regard, the "Nettuno Workshop" took place at the "Teseo Tesei" Underwater and Incursors Group from 22 to 26 March 2021 (in strict compliance with the anti-COVID protocols), organized by the Special Forces Operational Command (COFS) and assigned as lead to the Incursori Operational Group (GOI) and exclusive in the Combat Medicine panorama in support of Special Defense Operations, whose central theme was Prolonged Field Care (PFC), i.e. the stabilization of the seriously injured in an operational context, in waiting for advanced aid and definitive medical assistance.

The COFS has been contributing directly to the specialization of Special Forces operators of all the Armed Forces and the Carabinieri for some time, sending them to attend specific courses abroad and organizing in-depth activities of a few days in the permanent offices, as in the most recent at the GOI, both to share experiences and best practices, also emerging in real uses, and to make use of national health excellence. Experiences in the international field as well as operational activities are confirming the need for more and more specific skills of the medical operators of the Special Forces to be able to intervene to the rescue of colleagues even in the heart of operational contexts, with the timeliness essential to increase the chances of survival and preservation of vital functions. In this sense, the Defense has carried out an intense work of internal analysis to reach, in agreement with the national health authorities, the overcoming of the regulatory obstacles for the development of these capabilities.

To underline the significance and importance of the event, and to share perspectives, was attended by gen. Nicola Lanza de Cristoforis, commander of the COFS, Deputy Inspector General of Military Health Brigadier General (CC) Sebastiano Fallo, Admiral Inspector Riccardo Guarducci, Head of the Navy's Health Corps and Health Inspector and Colonel Di Liberato dell 'institute for further education and training in aeronautical and space medicine, as well as significant presences from the academic and scientific world in the fields of emergency medicine, anesthesia and resuscitation and orthopedics.

In the first two days, Dr. Cretella, manager of the emergency-urgency system of the Lazio Region, held a course on advanced airway management, even in the case of thermal and chemical burns.

On Wednesday, Dr. Battistella and Notari, operating in the Ligurian health emergency, dealt with the management of respiratory insufficiencies generated by traumatic events, such as pneumothorax, pulmonary overdistension and head trauma.

Much of the fourth day was dedicated to updating the blood transfusion procedures in the field and the pharmacological management of the injured person, according to the guidelines of the Tactical Combat Casualty Care (TCCC) by tv (San / Par) Degani, doctor of the GOI and scientific manager of the Workshop, of dr. Brambati, medical specialist in Anesthesia, Resuscitation and Pain Therapy, and a US Navy Seal Petty Officer SOCM (Special Operation Combat Medic). Dr. Mariani, orthopedic-traumatologist, illustrated the management of orthopedic and musculoskeletal trauma, with particular focus on the reduction of fractures and dislocations, and the use of fasciotomy in the management of compartment syndrome.

The final phase of the Workshop engaged the operators in a tactical act concerning the management of a mass casualty, organized by dr. Andreotti, resuscitator anesthetist of the Advanced Training and Medical Simulation Center of the Faculty of Medicine and Surgery of Modena (FASiM), also using the help of a latest generation simulator provided by the Accurate company, capable of reproducing extreme medical emergencies.

Many prominent personalities from the health academia were also present, such as Prof. Petrini, president of the Italian Society of Anesthesia, Analgesia, Intensive Care and Intensive Care (SIAARTI), prof. Mezzopera, of the scientific technical committee of the Italian model for risk management in health care and Dr. Simonetti, co-director of the Post-University Specialization Course in Clinical Risk Management of the LUISS Business School, prof. Beghi, scientific advisor to the Navy.