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Lord S, Lee J. Critical Care in the Austere Environment. Crit Care Clin 2024; 40:451-462. [PMID: 38796220 DOI: 10.1016/j.ccc.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Practice of critical care in austere settings involves navigating rapidly evolving environments, where physical resources, provider availability, and healthcare capacity are constrained. Austere Critical Care focuses on maintaining the highest standard of care possible for patients while also identifying resource limitations, responding to patient surges, and adhering to proper triage practices at the austere site. This includes transferring the patient when able and necessary. This article describes the current practice of critical care medicine in the austere environment, using recent natural disasters, pandemics, and conflicts as case studies.
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Affiliation(s)
- Spencer Lord
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
| | - Jarone Lee
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Martinez T, Simon K, Lely L, Nguyen Dac C, Lefevre M, Aloird P, Leschiera J, Strehaiano S, Nespoulous O, Boutonnet M, Raynaud L. Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study. BMJ Mil Health 2023; 169:443-447. [PMID: 34244377 DOI: 10.1136/bmjmilitary-2021-001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient's characteristics and the flight's challenges.
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Affiliation(s)
- Thibault Martinez
- Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - K Simon
- 160th Military Medical Unit, Istres, France
| | - L Lely
- 190th Military Medical Unit, Lanester, France
- French Military Health Service, Paris, France
| | | | - M Lefevre
- 100th Military Medical Unit, Bricy, France
| | - P Aloird
- 100th Military Medical Unit, Bricy, France
| | - J Leschiera
- 50th Military Medical Unit, TOUL CEDEX, France
| | | | - O Nespoulous
- Aeromedical Research Expertise Training Department, French Armed Forces Biomedical Research Institute, Bretigny sur Orge, France, France
| | - M Boutonnet
- Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - L Raynaud
- Federation of anesthesiology, intensive care unit, Military Training Hospital Begin, Saint Mande, Île-de-France, France
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3
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Combat Trauma-Related Acute Respiratory Distress Syndrome: A Scoping Review. Crit Care Explor 2022; 4:e0759. [DOI: 10.1097/cce.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Évacuations sanitaires aériennes collectives du service de santé des Armées français – MoRPHEE et MEROPE – au profit de patients en syndrome de détresse respiratoire aigu lié à la COVID-19. MÉDECINE DE CATASTROPHE - URGENCES COLLECTIVES 2022. [PMCID: PMC8536524 DOI: 10.1016/j.pxur.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Après son apparition en Chine à la fin de 2019, l’épidémie de SARS Cov2 (ou COVID-19) a rapidement provoqué le risque d’une saturation des ressources en soins intensifs dans les régions touchées. La répartition de la maladie entre les différents territoires étant hétérogène, le recours à la réalisation des transferts de patients depuis des régions saturées vers des régions non saturées s’est imposé. Des missions d’évacuations aéromédicales collectives de patients atteints de COVID-19 ont été réalisées par les équipes du service de santé des Armées et de l’Armée de l’air français. Deux dispositifs ont été déployés : les modules MoRPHEE sur le vecteur Airbus A330 PHENIX et les modules MEROPE sur le vecteur Airbus A400 M ATLAS. C’est un total de 59 patients en SDRA lié à la COVID-19 qui ont pu bénéficier de ces transferts entre mars et novembre 2020.
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Nguyen C, Montcriol A, Janvier F, Cungi PJ, Esnault P, Mathais Q, Vallet C, Boussen S, Cordier PY, Serpin L, Papazian L, Bordes J. Critical COVID-19 patient evacuation on an amphibious assault ship: feasibility and safety. A case series. BMJ Mil Health 2021; 167:224-228. [PMID: 32764134 PMCID: PMC7411308 DOI: 10.1136/bmjmilitary-2020-001520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION An amphibious assault ship was deployed on 22 March in Corsica to carry out medical evacuation of 12 critical patients infected with COVID-19. The ship has on-board hospital capacity and is the first time that an amphibious assault ship is engaged in this particular condition. The aim is to evaluate the feasibility and safety of prolonged medical evacuation of critical patients with COVID-19. METHODS We included 12 patients with confirmed COVID-19 infection: six ventilated patients with acute respiratory distress syndrome and six non-ventilated patients with hypoxaemia. Transfer on an amphibious assault ship lasted 20 hours. We collected patients' medical records: age, comorbidities, COVID-19 history and diagnosis, ventilation supply and ventilator settings, and blood gas results. We calculated oxygen consumption (OC). RESULTS All patients had a medical history. The median delay from onset of symptoms to hospitalisation was 8 (7-10) days. The median Sequential Organ Failure Assessment score on admission was 3 (2-5). There was no significant increase in oxygen during ship transport and no major respiratory complication. There was no significant increase in arterial oxygen pressure to fractional inspired oxygen ratio among ventilated patients during ship transport. Among ventilated patients, the median calculated OC was 255 L (222-281) by hours and 5270 L (4908-5616) during all ship transport. Among non-ventilated patients, the median calculated OC was 120 L (120-480) by hours and 2400 L (2400-9600) during all ship transport. CONCLUSION The present work contributes to assessing the feasibility and safety condition of critical COVID-19 evacuation on an amphibious assault ship during an extended transport. The ship needs to prepare a plan and a specialised intensive team and conduct patient screening for prolonged interhospital transfers.
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Affiliation(s)
- Cédric Nguyen
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - A Montcriol
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - F Janvier
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - P-J Cungi
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - P Esnault
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - Q Mathais
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | | | - S Boussen
- APHM, Marseille, Provence-Alpes-Côte d'Azur, France
| | - P-Y Cordier
- Anesthesiology and Intensive Care, HIA LAVERAN, Marseille, France
| | - L Serpin
- Emergency, Hospital Centre Ajaccio, Ajaccio, France
| | - L Papazian
- APHM, Marseille, Provence-Alpes-Côte d'Azur, France
| | - J Bordes
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
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Beaussac M, Boutonnet M, Koch L, Paris R, Di Filippo J, Distinguin B, Murris S, Dupre HL, Muller V, Turc J. Oxygen Management During Collective Aeromedical Evacuation of 36 COVID-19 Patients With ARDS. Mil Med 2021; 186:e667-e671. [PMID: 33211849 PMCID: PMC7717260 DOI: 10.1093/milmed/usaa512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The ongoing coronavirus disease-2019 pandemic leads to the saturation of critical care facilities worldwide. Collective aeromedical evacuations (MEDEVACS) might help rebalance the demand and supply of health care. If interhospital transport of patients suffering from ARDS is relatively common, little is known about the specific challenges of collective medevac. Oxygen management in such context is crucial. We describe our experience with a focus on this resource. METHODS We retrospectively analyzed the first six collective medevac performed during the coronavirus disease-2019 pandemic by the French Military Health Service from March 17 to April 3, 2020. Oxygen management was compliant with international guidelines as well as aeronautical constraints and monitored throughout the flights. Presumed high O2 consumers were scheduled to board the last and disembark the first. RESULTS Thirty-six mechanically ventilated patients were successfully transported within Europe. The duration of onboard ventilation was 185 minutes (145-198.5 minutes), including the flight, the boarding and disembarking periods. Oxygen intake was 1,650 L per patient per flight (1,350-1,950 L patient per flight) and 564 L per patient per hour (482-675 L per patient-1 per hour) and surpassed our anticipation. As anticipated, presumed high O2 consumers had a reduced ventilation duration onboard. The estimations of oxygen consumptions were frequently overshot, and only two hypoxemia episodes occurred. CONCLUSION Oxygen consumption was higher than expected, despite anticipation and predefined oxygen management measures, and encourages to a great caution in the processing of such collective medevac missions.
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Affiliation(s)
- Madeleine Beaussac
- 160th Military Medical Unit, 10th Military Medical Center, Istres 13800, France
| | - Mathieu Boutonnet
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Percy, Clamart 92140, France
| | - Lionel Koch
- Bacteriology Unit, French Armed Forces Biomedical Research Institute (IRBA), Bretigny sur Orge 91220, France
| | - Raphael Paris
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Laveran, Marseille 13000, France
| | - Julia Di Filippo
- 160th Military Medical Unit, 10th Military Medical Center, Istres 13800, France
| | - Berangère Distinguin
- 158th Military Medical Unit, 10th Military Medical Center, Salon de Provence 13661, France
| | - Sophie Murris
- 148th Military Medical Unit, 9th Military Medical Center, Hyeres 83400, France
| | - Henri-Louis Dupre
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Saint-Anne, Toulon 83000, France
| | - Violaine Muller
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Percy, Clamart 92140, France
| | - Jean Turc
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Desgenettes, Lyon 69003, France.,Intensive Care Unit and Anesthesiology Department, Edouard Herriot Hospital, Lyon 69437, France
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Collective aeromedical transport of COVID-19 critically ill patients in Europe: A retrospective study. Anaesth Crit Care Pain Med 2021; 40:100786. [PMID: 33232835 PMCID: PMC7680057 DOI: 10.1016/j.accpm.2020.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/10/2020] [Accepted: 11/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In early 2020, the coronavirus disease 2019 (COVID-19) pandemic outbreak has posed the risk of critical care resources overload in every affected country. Collective interhospital transport of critically ill COVID-19 patients as a way to mitigate the localised pressure from overloaded intensive care units at a national or international level has not been reported yet. The aim of this study was to provide descriptive data about the first six collective aeromedical evacuation (MEDEVAC) of COVID-19 patients performed within Europe. METHODS This retrospective study included all adult patients transported by the first six collective MEDEVAC missions for COVID-19 patients performed within Europe on the 18th, 21st, 24th, 27th, 31st of March and the 3rd of April 2020. RESULTS Thirty-six patients with acute respiratory distress syndrome (ARDS) were transported aboard six MEDEVAC missions. The median duration of mechanical ventilation in ICU before transportation was 4 days (3-5.25). The median PaO2/FiO2 ratio obtained before, during the flight and at day 1 after the transport was 180 mmHg (156-202,5), 143 mmHg (118,75-184,75) and 174 mmHg (129,5-205,5), respectively, with no significant difference. The median norepinephrine infusion rate observed before, during the flight and at day 1 after the transport was 0,08 µg/kg-1. min-1 (0,00-0,20), 0,08 (0,00-0,25), and 0,07 (0,03-0,18), respectively, with no significant difference. No life-threatening event was reported. CONCLUSION Collective aero-MEDEVAC of COVID-19 critically ill patients could provide a reliable solution to help control the burden of the disease at a national or international level.
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de Lesquen H, Bergez M, Vuong A, Boufime-Jonqheere A, de l'Escalopier N. Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel. Mil Med 2020; 186:e30-e33. [PMID: 33169148 PMCID: PMC7717289 DOI: 10.1093/milmed/usaa273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.
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Affiliation(s)
- Henri de Lesquen
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, 8300, Toulon, France
| | - Marie Bergez
- 4th Forward Surgical Team, French Military Health Service, France.,Département d'Anésthésie-Réanimation, Etablissement Hospitalier Civilo Militaire de Metz., 57070 Metz, France
| | - Antoine Vuong
- 183ème Antenne Medical de Mont de Marsan, 12ème Centre Médical des Armées de Bordeaux, 4000 Mont de Marsan, France
| | | | - Nicolas de l'Escalopier
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Orthopedic, Traumatology and Reconstructive Surgery, PERCY Military Teaching Hospital, 92140, Clamart, France
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Beaussac M, Distinguin B, Turc J, Boutonnet M. Retour d’expérience des six évacuations sanitaires aériennes collectives MoRPHEE durant la pandémie de Covid-19. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Après son apparition en Chine à la fin de 2019, l’épidémie de coronavirus 2019 (Covid-19) a rapidement provoqué le risque d’une saturation des ressources en soins intensifs dans chaque pays touché. La répartition de la maladie entre les différents territoires est hétérogène. Le transport interhospitalier sur longue distance de patients atteints de Covid-19 dans le but de limiter la pression sur les unités de soins intensifs au niveau national ou international n’a pas encore été décrit. L’objectif de cet article était de fournir des données descriptives des six missions d’évacuation aéromédicale collective (Evasan) de patients atteints de Covid-19 réalisées en Europe et sur le territoire national français les 18, 21, 24, 27, 31 mars et 3 avril 2020 grâce au dispositif MoRPHEE. Trente-six patients souffrant de syndrome de détresse respiratoire aiguë (SDRA) ont été évacués durant six missions d’évacuations sanitaires collectives. Le SDRA était modéré (rapport PaO2/FiO2> 100 et ≤ 200) chez 24 patients et léger (rapport PaO2/FiO2> 200 et ≤ 300) chez 12 patients. La durée médiane de la ventilation mécanique en soins intensifs avant le transport était de quatre jours (interquartile [IQ] : 3‒5). Le rapport médian PaO2/FiO2était de 180 mmHg (IQ : 156‒202). Le débit médian de perfusion de noradrénaline était de 0,08 μg/kg par min. Aucune complication mettant en jeu le pronostic vital n’a été signalée. En conclusion, l’évacuation sanitaire aérienne collective de patients gravement malades de Covid-19 est une solution contribuant à contrôler le niveau de saturation du système de soins au niveau national ou international.
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Pasquier P, Mathais Q, Déserts MDD, Favier JC, Escarment J. L’élément militaire de réanimation du service de santé des armées : un hôpital militaire de campagne dédié à la réanimation. ANESTHÉSIE & RÉANIMATION 2020. [PMCID: PMC7224165 DOI: 10.1016/j.anrea.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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