Transposing intensive care innovation from modern warfare to other resource-limited settings.
Authors
Affiliations (7)
Affiliations (7)
- Department of Anesthesiology and Intensive Care Unit, Bégin Military Teaching Hospital, 69 avenue de Paris, Saint-Mandé, 94160, France. [email protected].
- Department of Anesthesiology and Intensive Care Unit, Bégin Military Teaching Hospital, 69 avenue de Paris, Saint-Mandé, 94160, France.
- Department of Surgery, Bégin Military Teaching Hospital, Saint Mandé, France.
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Clinical Acute and Emergency Medicine, Federal Armed Forces Hospital Ulm, Ulm, Germany.
- French Military Medical Service Academy - École du Val-de-Grâce, Paris, France.
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France.
- Department of Anesthesiology and Intensive Care, Sainte-Anne Military Teaching Hospital, Toulon, France.
Abstract
Delivering intensive care in conflict zones and other resource-limited settings presents unique clinical, logistical, and ethical challenges. These contexts, characterized by disrupted infrastructure, limited personnel, and prolonged field care, require adapted strategies to ensure critical care delivery under resource-limited settings. This scoping review aims to identify and characterize medical innovations developed or implemented in recent conflicts that may be relevant and transposable to intensive care units operating in other resource-limited settings. A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Five major databases were searched for English-language publications from 2014 to 2025. Studies describing innovations applicable to intensive care in modern warfare or resource-limited settings were included. While many studies relied on experimental or simulated models, a subset described real-world applications in resource-limited environments, including ultrasound-guided regional analgesia, resuscitative endovascular balloon occlusion of the aorta, portable blood transfusion platforms, and artificial intelligence-supported monitoring of traumatic brain injury. Training strategies such as teleconsultation/telementoring and low-cost simulation were also emphasized. Few of these intensive care innovations were validated in real-life wartime conditions. Innovations from modern warfare offer pragmatic and potentially transposable solutions for intensive care in resource-limited settings. Successfully adapting them requires validation and contextual adaptation, as well as the implementation of concrete collaborative strategies, including tailored training programs, joint simulation exercises, and structured knowledge translation initiatives, to ensure effective and sustainable integration.