Tactical Aeromedical Evacuation in Mali: assessment of five years of use of a new aircraft.
Introduction: The medical support of armed conflicts covering nearly 5 million km2 has justified since 2013 the establishment of new medical transport aircraft. These make it possible to ensure the medical evacuation (MEDEVAC) of patients at once from the field to the forward surgical structures; then to tracks allowing the installation of aircraft dedicated to their repatriation to France. The objective of our study was to describe the activity of these new medicalized vectors in order to evaluate their relevance and to consider possible evolutions.
Material and method: Monocentric retrospective observational study including all flights made by these aircraft from January 2013 to December 2017. For each mission, their nature; the number of flight hours; the number, categorization and pathologies of patients in care were collated; and the difficulties encountered.
Outcomes: 3002.6 flight hours were achieved. The average flight time was 3.5 hours +/- 0.8. 424 MEDEVAC were performed for 898 patients, an average of 2.1 patients per procedure. Most of them were French soldiers (87.5%). 147 patients were excluded due to lack of medical data. 338 (45%) were transported lying down and 413 were sitting (55%). They were supported in 75% of cases in areas of surgical structures. Their categorization included 75 Alpha (10%), 173 Bravo (23%) and 503 (67%) Charlie. 4% of patients were intubated and ventilated. The proportion of medical-surgical pathologies (34.0%) and war wounded (33.7%) was equivalent before the traditional traumatology (19.7%). The battle injuries were mostly by explosion (60%), and by bullet (26.3%). Affections predominated in the members (29%). No major difficulties related to the aeronautical environment were reported by the teams.
Discussion: The development of tactical medicalized aircraft seems since five years an efficient solution for the realization of early medical evacuations of patients in a context of significant elongations and increasing dispersion of the numbers to support. The success of this complex and demanding mission is conditioned by a rigorous organization. The medical team provides in-flight intensive care adapted to the remote damage control resuscitation. The evacuation time is particularly used for early transfusion with French lyophilized plasma or red blood cells.
Conclusion: This new concept of medicalization, particularly adapted to the operational involvement in the Sahel, represents an essential link in the health support, allowing the prolonged field care provided to the soldiers. In view of these feedbacks, thinking are underway in order to change the employment doctrine, to optimize the medical package and to offer a training to the projected personnel in adequacy with this demanding mission, in particular with the contribution of medical simulation.
