Infectious diseases related aeromedical evacuation of French soldiers in a level 4 military treatment facility: A ten year retrospective analysis

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Summary

Background

Infectious diseases are a frequent cause of morbidity in French troops deployed abroad. They are usually minor in severity and managed by field practitioners. We aimed to describe the etiological spectrum of travel-related infections in French soldiers evacuated to a level 4 military treatment facility.

Methods

We evaluated the diagnoses of all service members who were medically evacuated from abroad to our infectious diseases department from January 1, 2004 to October 30, 2013.

Results

One hundred and twenty five cases, median age 32 years were referred, 117 (94%) were male and 78 (62%) were from the Army. Main areas of deployment were Africa in 80 cases (64%), Afghanistan in 15 cases (12%), and French Guiana in 10 cases (8%). Median time between initial consultation and hospitalization in the reference center was 5 days (IQ 2–7 d). Thirty (24%) immediate aeromedical evacuations were carried out. The top five diagnoses were Plasmodium falciparum malaria (30), fever of unknown origin (15), cerebro-meningeal infections (10), invasive amebiasis (9), and HIV primary infections (9). Thirteen individuals were admitted in ICU. No death was recorded.

Conclusions

Infectious diseases were a rare of cause of medevac. Most of them were preventable. Lethal etiologies were represented by malaria and cerebro-meningeal infections.

Introduction

Infectious diseases are an important cause of morbidity in deployed soldiers [1], [2], [3], [4], [5], [6], [7], [8]. Most often benign, they are managed by deployed field physicians. There are few data available on severe or complex cases leading to air medevac to a level 4 military treatment facility (MTF) in France [9], [10], [11], [12].

Section snippets

Methods

A ten year retrospective study was conducted from January 1, 2004 to October 30, 2013. We included all military personnel admitted to our infectious diseases unit (hospital stay > 24 h) following an air medevac during deployment abroad.

Inclusion criteria: medically evacuated servicemen after authorization of the medical chain of command.

Exclusion criteria: military personnel staying abroad for leisure and civilian humanitarians workers were excluded.

Demographics, health itinerary, clinical data

Patient data

A total of 125 individuals (117 males, 8 females) were medically evacuated from abroad. Their main epidemiological characteristics are summarized in Table 1.

The majority of soldiers were deployed for short term missions (median duration was 62 days). Main destinations of deployment were: sub-Saharan Africa (80), Afghanistan (15), French Guiana (10). Details on geographic data of transport origin are shown in Table 2.

Military branches were Army (78), French foreign legion (15), Air force (10),

Discussion

Each year, more than 40 000 French soldiers deploy or travel abroad among which 15 000 permanently exposed to malaria. Among the several risks to which they are exposed, like other foreign troops, infections are a frequent cause of morbidity on the field [1], [2], [3], [4], [5], [6], [7], [8]. Dominated by diarrhea, respiratory and cutaneous infections, they are most often benign and successfully managed in the deployed medical MTF [3], [8], [9].

According to the doctrine of the French Joint

Conclusion

Infections represent a small proportion of air medical evacuations. Malaria and meningitis are the leading causes but remain rare. Severity of infection and difficulties in accessing good quality health care are the main determinants of evacuation. These data are useful to reinforce disease prevention strategies in French soldiers and other occupational groups deployed overseas.

Conflict of interest

The authors state no conflict of interest.

References (22)

  • J.S. Glennie et al.

    UK role 4 military infectious diseases at Birmingham Heartlands Hospital in 2005–2009

    JR Army Med Corps

    (2010)
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    Data from the manuscript has been presented at the 3rd North European Conference of Travel Medicine, May 26–29, 2010, Hamburg, Germany.

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