title: Combat casualties from two current conflicts with the Seventh French Forward Surgical Team in Mali and Central African Republic in 2014.
abstract: OBJECTIVE
  The Seventh Airborne Forward Surgical Team (FST) has been deployed in Gao, Mali, and in Bangui, Central African Republic (CAR), for two 3-month periods in 2014. The initial role of the FST was to provide emergent care to French and coalition soldiers but it was expanded to include humanitarian assistance. The aim of the present study was to describe and compare injuries and surgical activity of the Seventh Airborne FST during these two conflicts.
  
  
  METHODS
  All surgical patients treated by the FST between January and December 2014 have been included. Patient demographics, mechanisms of injury, surgical management including triage categories and types of surgery performed and evacuation modalities were recorded.
  
  
  RESULTS
  During the 6-month deployment period in 2014, the FST performed 129 operations on 134 patients, 61 of which were trauma patients (45 battle injuries (BI)). The remaining 73 patients were treated as part of the humanitarian mission. Thirty of the BI were managed during the Malian conflict and 15 in CAR; 29 patients (64%) were military. The median Injury Severity Score (range) was 20 (10-34) in Mali and 8 (5-21) in CAR with median (range) evacuation time of 390 min (240-947) in Mali and 120 min (60-120) in CAR (p<0.0001). The most frequent mechanisms of injury were gunshot wounds in Mali (15/30) and road traffic accident in CAR (7/15). Extremity injuries were most common (58%) with head, face and neck injuries and thoracic injuries in 15% of cases each and 12% had suffered abdominopelvic injuries. Ten patients were categorised as T1 and underwent urgent surgery, five had damage control surgery and four received transfusion. The average length of stay was 2 days (1-2), with most patients being transferred to another hospital.
  
  
  CONCLUSIONS
  Casualties from Mali and CAR presented with a wide variety of injury patterns, and there were some instances where damage control surgery and whole blood transfusion were necessary. Surgical equipment scales must allow treatment of a large variety of injuries including all body regions and extreme emergency procedures. These two conflicts differ in terms of scope, one being an urban guerrilla and the other an open conflict in a large desertic area. Long distances in the Malian desert increase significantly the evacuation time. It has to be taken into account in the FST location when coalition forces are deployed in such places.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Begin Military Hospital, Saint-Mandé, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Dubost
authors.affiliation: Department of General Surgery, Laveran Military Hospital, Marseille, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Goudard
authors.affiliation: Department of Orthopedic Surgery, Laveran Military Hospital, Boulevard Laveran, Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Soucanye de Landevoisin
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Saint-Anne Military Hospital, Toulon, France.
authors.forename: C
authors.initials: C
authors.lastname: Contargyris
authors.affiliation: Queens Medical Centre, Royal Air Force, Nottingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: Evans
authors.affiliation: Department of General Surgery, Laveran Military Hospital, Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Pauleau
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D002488:Central African Republic / Q000453:epidemiology; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008302:Mali / Q000453:epidemiology; D008887:Military Medicine; D008889:Military Personnel; D008952:Mobile Health Units; D010348:Patient Care Team; D011446:Prospective Studies; D012066:Relief Work; D014857:Warfare; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000601:surgery
keywords: PUBLIC HEALTH; SURGERY; TRAUMA MANAGEMENT