Impact of Minor Surgery Emergencies in Isolated Sea-Based Environment: The French Navy Experience.

Abstract

The aim of this article is to determine whether some of the urgent (<24 hours) medical evacuations (MEDEVACs) (from French Navy surface ships in isolated situations but with an embarked medical officer) of patients suffering from minor surgical emergencies could have been avoided, and if so, which ones. This was a retrospective descriptive study of all MEDEVAC's performed between 2009 and 2014. This was done by an analysis of the records held at the French Naval Medical Headquarters that included both MEDEVAC signals and anonymized files called "Patient Movement Request." 560 MEDEVACs were performed from French Navy surface ships which most had an embarked medical officer but which were in isolated situations. Only 34 (6.1%) of the total evacuations were suffering from minor surgical emergencies. The majority of these were nonurgent MEDEVAC's of whom 17 (50%) had no surgical procedure attempted on board. Seven (20%) underwent urgent MEDEVAC and only 2 of them had undergone the indicated therapeutic procedure on board. The most common pathology was displaced fracture of the fifth metacarpal (29.4%) before deep abscess (17.6%). Contrary to our initial expectation, the operational impact of minor surgical emergencies remains low, which might suggest that a French naval medical doctor's training is sufficient in this particular field. However, 50% of the overall evacuated patients and 71% of the "urgent" MEDEVACs (<24 hours) did not undergo the indicated, simple surgical procedure before evacuation. The idea of introducing a specific training program for these procedures may therefore still have value.