Retour d'expérience des six évacuations sanitaires aériennes collectives MoRPHEE durant la pandémie de Covid-19

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/FiO2 était 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.Alternate : Since its emergence in China in late 2019, the coronavirus disease 2019 (COVID-19) outbreak has rapidly posed the risk of critical care resources overload in every affected country. The distribution of the disease among the territories is heterogeneous. Long-range inter-hospital 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 article was to provide descriptive data about the six collective aeromedical evacuation of COVID- 19 patients performed within Europe and French national territory on March 18, 21, 24, 27, 31 and April 3, 2020. Thirty-six patients with acute respiratory distress syndrome (ARDS) were transported aboard six aeromedical evacuation missions. ARDS was moderate (PaO2/FiO2 ratio > 100 and ≤ 200) in 24 patients and mild (PaO2/FiO2 ratio > 200 and ≤ 300) in 12 patients. The median duration of mechanical ventilation in ICU before transportation was 4 days [Interquartile (IQ): 3–5]. The median PaO2/FiO2 ratio was 180 mmHg (IQ: 156–202). The median norepinephrine infusion rate was 0.08 μg/kg/min. No life-threatening event was reported. Collective aeromedical evacuation 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. Future works may evaluate the global safety and effectiveness of aeromedical evacuations in this context.

[2020, Mulhouse, Covid-19: a lesson in history, Europe and resilience]. / 2020, Mulhouse, Covid-19 : une leçon d'histoire, d'Europe, de résilience.

In March 2020, Covid-19, caused by the severe acute respiratory syndrome coronavirus 2, struck the Haut-Rhin region with extreme violence, overwhelming hospitals and requiring the massive opening of new resuscitation beds. The military resuscitation element of the French military health service was deployed for the first time in Mulhouse (68), in eastern France. Alsace-Lorraine, a European crossroads and the birthplace of European institutions, was once again at the heart of history. Perspectives.

[Operation Resilience, care at the crossroads of skills in civil-military cooperation]. / Opération Résilience, à la croisée des compétences dans la coopération civilo-militaire.

Launched on 25 March 2020, the operation Resilience is the armed forces' contribution to the interministerial commitment against the spread of COVID-19. The armed forces are committed in all sectors where they can provide support to the civil authorities, adapting their action to local contexts and as part of a permanent dialogue with the state authorities.

[The military intensive care field hospital, a unique experience in the fight against covid-19]. / L'élément militaire de réanimation, une expérience inédite face à la Covid-19.

The militaryintensive care field hospital is a new tool set up by the military medical service as part of Operation Resilience to provide medical support in the regions of France most affected by the SARS-Cov-2 pandemic. Deployed in Mulhouse and Mayotte, this hospital facility is a functional intensive care unit set up to support an existing hospital structure. The caregivers and logistics specialists are all from the military medical service, active personnel or reservists, predominantly nurses. The implementation of this intensive care field hospital in a constrained environment requires an efficient provision of care in accordance with medical guidelines, while protecting the healthcare staff and, notably, the frontline nursing staff.