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The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects
  1. Stéphane Bonnet1,2,
  2. F Gonzalez1,2,
  3. L Mathieu3,
  4. G Boddaert4,
  5. E Hornez1,
  6. A Bertani5,
  7. J-P Avaro2,6,
  8. X Durand2,7,
  9. F Rongieras2,5,
  10. P Balandraud2,8,
  11. S Rigal2,3 and
  12. F Pons2
  1. 1Department of Visceral and General Surgery, Percy Military Teaching Hospital, Clamart Cedex, France
  2. 2French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
  3. 3Department of Traumatology and Orthopedics, Percy Military Teaching Hospital, Clamart, France
  4. 4Department of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
  5. 5Department of Traumatology and Orthopedics, Desgenettes Military Teaching Hospital, Lyon, France
  6. 6Department of Thoracic and Vascular Surgery, Sainte-Anne Teaching Hospital, Toulon, France
  7. 7Department of Urology, Val-de-Grâce Military Teaching Hospital, Paris, France
  8. 8Department of Digestive Surgery, Sainte-Anne Military Teaching Hospital, Toulon, France
  1. Correspondence to Lt Col Stéphane Bonnet, Department of Visceral and General Surgery, Percy Military Teaching Hospital, 101 avenue Henri Barbusse, BP 406, Clamart Cedex 92141, France; bonnet.stephane2007{at}


Introduction The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)—called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)—has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed.

Methods Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops.

Results The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects.

Conclusion The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties.

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