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Level of Onboard Care for Critical Patients: Analysis of the French Armed Forces Air Medical Evacuations From the Sahel Since 2013

      Highlights

      • Early STRATEVAC is a French military specificity. This political choice ensures that wounded French soldiers are repatriated to France 24 hours after their injury.
      • The French military health service easily deploys an anesthesiologist/intensive care physician to provide medical care during the flight, accepting the risk of overtriage.
      • The majority of severe patients evacuated from the Sahel do not require intensive care during the flight.
      • Greater use of emergency physicians, especially for transporting stabilized patients, would provide more personnel trained in long-distance air transport.

      Abstract

      Objective

      Since 2013, the French Armed Forces have been engaged in the Sahel. The aim of our work was to study the characteristics of severe patients evacuated according to the composition of the air medical staff (ie, an anesthesiologist/intensive care physician [AICP] or an emergency physician [EP]).

      Methods

      This was a retrospective cohort analysis including all French service members repatriated from the Sahel with a speedy evacuation priority between 2013 and 2019.

      Results

      A total of 191 patients were evacuated. The causes were trauma for 103 patients and disease for 88. Trauma patients included war injuries (n = 58) and nonbattle injuries (n = 44). For disease patients, the main pathologies were cardiovascular (n = 17), infectious (n = 17), neurologic (n = 15), and gastrointestinal (n = 12). Highly dependent patients were significantly (P < .001) more likely to be managed by an AICP (n = 41) than an EP (n = 5). Moderately dependent patients managed by an AICP (n = 51) were more frequently unstable hemodynamically (n = 5 vs. n = 0, P < .05) and referred to an intensive care unit (n = 24 vs. n = 2, P < .001) than those managed by an EP (n = 41). There were no deaths in flight.

      Conclusion

      Greater use of EPs, especially for transporting stabilized patients, would provide more personnel trained in long-distance air transport.
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