Forward medevac during Serval and Barkhane operations in Sahel: A registry study.
BACKGROUND
The French army has been deployed in Mali since January 2013 with the Serval Operation and since July 2014 in the Sahel-Saharan Strip (SSS) with the Barkhane Operation where the distances (up to 1100km) can be very long. French Military Medical Service deploys an inclusive chain from the point of injury (POI) to hospital in France. A patient evacuation coordination cell (PECC) has been deployed since February 2013 to organise forward medical evacuation (MEDEVAC) in the area between the POI and three forward surgical units. The purpose of this work was to study the medical evacuation length and duration between the call for Medevac location accidents and forward surgical units (role 2) throughout the five million square kilometers French joint operation area.


METHODS
Our retrospective study concerns the French patients evacuated by MEDEVAC from February 2013 to July 2016. The PECC register was analysed for patients' characteristics, NATO categorisation of gravity (Alpha, Bravo or Charlie who must be respectively at hospital facility within 90min, 4h or 24h), medical motive for MEDEVAC and the time line of each MEDEVAC (from operational commander request to entrance in role 2).


RESULTS
A total of 1273 French military were evacuated from February to 2013 to July 2016; 533 forward MEDEVAC were analysed. 12,4% were Alpha, 28,1% Bravo, 59,5% Charlie. War-related injury represented 18,2% of MEDEVAC. The median time for Alpha category MEDEVAC patients was 145min [100-251], for Bravo category patients 205min [125-273] and 310min [156-669] for Charlie. The median distance from the point of injury to role 2 was 126km [90-285] for Alpha patients, 290km [120-455] km for Bravo and 290km [105-455] for Charlie.


CONCLUSIONS
Patient evacuation in such a large area is a logistic and human challenge. Despite this, Bravo and Charlie patients were evacuated in NATO recommended time frame. However, due to distance, Alpha patients time frame was longer than this recommended by NATO organisation. That's where French doctrine with forward medical teams embedded in the platoons is relevant to mitigate this distance and time frame challenge.
French Military Medical Service, Medical Center of Solenzara air base, BA 126 RN 198 Cs 10001 Ventiseri 20223 Ghisonaccia Cedex, France. Electronic address: cma.carfantan@gmail.com.
Cyril
C
Carfantan
French Military Medical Service, 7th paratrooper forward surgical unit, Laveran Military teaching hospital, general surgery unit, Marseille France.
Yvain
Y
Goudard
French Military Medical Service, 7th paratrooper forward surgical unit, Sainte-Anne Military teaching hospital, orthopedic surgery unit, Toulon France.
Christophe
C
Butin
French Military Medical Service, French Military Center for Epidemiology and Public Health, France.
Sandrine
S
Duron-Martinaud
French Military Medical Service, Medical Center of Luxeuil air base, France.
Jean-Philippe
JP
Even
French Military Medical Service, Medical Center of Angers, France.
Anthony
A
Anselme
French Military Medical Service, Medical Center of Mont-de-Marsan air base, France.
Erwan
E
Dulaurent
French Military Medical Service, Medical Center of Solenzara air base, BA 126 RN 198 Cs 10001 Ventiseri 20223 Ghisonaccia Cedex, France.
Mélanie
M
Géhant
French Military Medical Service, Medical Center of Lyon, France.
Vicky
V
Vitalis
French Military Medical Service, French Military Medical Service Academy - École du Val-de-Grâce, France.
Christian
C
Bay
French Military Medical Service, Operational headquarters, M3 Current operations officer, France.
Jérôme
J
Bancarel
French Military Medical Service, 7th paratrooper forward surgical unit, Sainte-Anne Military teaching hospital, intensive care and anaesthesiology unit, Toulon, France.
Julien
J
Bordes
D000208:Acute Disease / Q000628:therapy*; D000328:Adult; D017732:Air Ambulances; D002908:Chronic Disease / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008887:Military Medicine / Q000379:methods / Q000458:organization & administration; D008889:Military Personnel; D012042:Registries; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000458:organization & administration / Q000592:standards; D000067398:War-Related Injuries / Q000628:therapy*; D014857:Warfare
Combat; FLYP; Forward MEDEVAC; French military; Joint trauma system; PECC; Trauma