Introduction: The current terrorist threat challenges nations to train numerous non-trauma care providers with different backgrounds in damage control (DC) strategies. The purpose of this work was to propose a specific DC training program. Methods: A Task Force of 16 civilian and military physicians met for a 24-hour session, to propose the construction of a DC training program for non-specialised caregivers. Results: Existing DC training programs are heterogeneous, mainly theoretical and almost only for physicians. A program entitled Damage Control for Terrorist Attack Victims (DC-TAV) was then proposed. Identified training targets were care providers from prehospital and hospital staffs, with no experience in trauma care. The training objectives were the improvement of individual and collective skills in managing terrorist attacks casualties. The tools selected for training concerned e-learning on a dedicated digital teaching platform (including a core section of four modules with types and mechanisms of injury, basic DC techniques, triage, organisation of emergency medical response and two complementary modules for doctors with DC resuscitation including remote transfusion and DC surgery), hands-on workshops with procedural simulation and full-scale simulation exercises, technical (tourniquets, haemostatic gauzes, needle thoracostomy, chest tube drainage, management of airway, coniotomy) and non-technical (leadership, communication, coordination and triage, decision-making, appropriate use of resources) skills. Finally, an evaluation of the DC-TAV program was planned. Conclusions: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy. (C) 2019 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Le damage control n’est pas une technique chirurgicale ou une solution dégradée mais un concept global de prise en charge du traumatisé sévère du lieu de l’accident à son traitement définitif. Le DC repose sur une chaine de survie visant à placer le bon geste au bon moment permettant au patient d’arriver vivant à l’échelon suivant sans perte de chance. Le temps est un facteur majeur de réussite du DC. Les indications de DC sont individuelles précoces (traumatisé sévère), individuelles tardives (traumatise sévère ne pouvant supporter un premier temps chirurgical trop long) et collectives (contexte d’afflux). Le DC resuscitation (DCR) doit nécessairement s’articuler avec le DC chirurgical. Ce dernier repose sur des gestes volontairement simples et partiels pour permettre un second temps sur un patient stabilisé. Le DCR repose sur l’hémostase précoce, la correction de la triade létale et l’hypotension permissive.

Tuberculosis disease, in its extra pulmonary form, remains a difficult diagnosis because of its atypical symptoms and evolution. We have observed a case of acute tuberculosis neuromeningitis, without being able to make a definite diagnosis prior to the patient's death because of the negativity of the initial bacteriological samples. We started the most probable appropriate treatment but in vain. This case allows us to challenge diagnostic methods and resulting treatments in emergency cases where tuberculosis is suspected. Moreover, it seems essential to do everything possible to find the bacterium when confronted with a patient with risk factors and clinical and radiological symptoms compatible with tubercular disease, before the disease becomes acute. (C) 2013 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.