title: Initial assessment and treatment of refugees in the Mediterranean Sea (a secondary data analysis concerning the initial assessment and treatment of 2656 refugees rescued from distress at sea in support of the EUNAVFOR MED relief mission of the EU).
abstract: BACKGROUND
  As a part of the European Union Naval Force - Mediterranean Operation Sophia (EUNAVFOR Med), the Federal Republic of Germany is contributing to avoid further loss of lives at sea by supplying two naval vessels. In the study presented here we analyse the medical requirements of such rescue missions, as well as the potential benefits of various additional monitoring devices in identifying sick/injured refugees within the primary onboard medical assessment process.
  
  
  METHODS
  Retrospective analysis of the data collected between May - September 2015 from a German Naval Force frigate. Initial data collection focused on the primary medical assessment and treatment process of refugees rescued from distress at sea. Descriptive statistics, uni- and multivariate analysis were performed. The study has received a positive vote from the Ethics Commission of the University of Ulm, Germany (request no. 284/15) and has been registered in the German Register of Clinical Studies (no. DRKS00009535).
  
  
  RESULTS
  A total of 2656 refugees had been rescued. 16.9 % of them were classified as "medical treatment required" within the initial onboard medical assessment process. In addition to the clinical assessment by an emergency physician, pulse rate (PR), core body temperature (CBT) and oxygen saturation (SpO2) were evaluated. Sick/injured refugees displayed a statistically significant higher PR (114/min vs. 107/min; p < .001) and CBT (37.1 °C vs. 36.7 °C; p < .001). There was no statistically significant difference in SpO2-values. The same results were found for the subgroup of patients classified as "treatment at emergency hospital required". However, a much larger difference of the mean PR and CBT (35/min resp. 1.8 °C) was found when examining the subgroups of the corresponding refugee boats. A cut-off value of clinical importance could not be found. Predominant diagnoses have been dermatological diseases (55.4), followed by internal diseases (27.7) and trauma (12.1 %). None of the refugees classified as "healthy" within the primary medical assessment process changed to "medical treatment required" during further observation.
  
  
  CONCLUSIONS
  The initial medical assessment by an emergency physician has proved successful. PR, CBT and SpO2 didn't have any clinical impact to improve the identification of sick/injured refugees within the primary onboard assessment process.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany. mail@kulla.de.
authors.forename: M
authors.initials: M
authors.lastname: Kulla
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Josse
authors.affiliation: Frigate Schleswig-Holstein, Ship Medical Officer, Endraßstrasse, 26382, Wilhelmshaven, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stierholz
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hossfeld
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Lampl
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Helm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D008297:Male; D008522:Mediterranean Sea / Q000208:ethnology; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D012036:Refugees; D012042:Registries; D012066:Relief Work / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014218:Triage; D055815:Young Adult
keywords: Asylum seeker; German Armed Forces; Initial assessment; Initial treatment; Mediterranean Sea; Refugee; Triage