Asistencia en cuidados críticos de una unidad de Sanidad Militar dentro del hospital de campaña en la Institución Ferial de Madrid durante la crisis SARS-CoV-2 / Assistance of a Military Health Unit deployed in «Institucion Ferial de Madrid» field hospital during SARS-CoV-2 crisis

INTRODUCCIÓN: Durante la pandemia por coronavirus SARS-CoV-2 que afectó a España durante la primavera del año 2020, muchos de los hospitales se colapsaron por la afluencia de estos pacientes. Por este motivo se desplegó en la Institución Ferial de Madrid (IFEMA) un hospital de campaña. La única unidad de críticos de este hospital fue militar. La unidad responsable de su montaje, mantenimiento y repliegue fue la Unidad Médica Aérea de Apoyo al Despliegue (UMAAD) de Madrid perteneciente al Ejército del Aire. OBJETIVO: Describir la asistencia médica prestada en la unidad de críticos de IFEMA. MATERIAL Y MÉTODOS: Estudio descriptivo prospectivo realizado del 19 de marzo al 30 de abril de 2020. Se consiguió la autorización militar de la Dirección de Sanidad del Ejército del Aire para la realización del estudio. RESULTADOS: Durante el periodo de estudio 25 pacientes ingresaron en la unidad durante la Operación «Balmis». La mayoría fueron varones y de raza hispana, el motivo de ingreso fue por neumonía por SARS-CoV-2. Se aisló la vía aérea en el 88% de los pacientes. Las principales complicaciones fueron trombosis, hemorragia e hipertensión, falleciendo tres pacientes durante la realización del estudio. CONCLUSIÓN: La experiencia adquirida en este despliegue, demuestra, una vez más, la importancia de los apoyos que la Sanidad Militar puede prestar a la Sanidad Civil en el que el componente sanitario de la gestión de crisis en territorio nacional

INTRODUCTION: During the coronavirus SARS-CoV-2 pandemic that affected Spain in spring of 2020, many of hospitals were collapsed by these patients. For this reason, a field hospital was deployed at the «Institución Ferial de Madrid» (IFEMA). The only critical unit of this field hospital was military. The unit responsible for its deployment, maintenance and withdrawal was UMAAD (Madrid Deployment Support Air Medical Unit belonging to the Air Force). OBJECTIVE: To describe medical assistance provided in the IFEMA critical unit. MATERIAL AND METHODS: Prospective descriptive study carried out from March 19 to April 30, 2020. The pertinent military authorization (Air Force Health Service Director) was obtained to carry out the study. RESULTS: During the study time, 25 critically ill patients were admitted. Most of them were male and Hispanic race. SARS-CoV-2 pneumonia was the reason for hospital admission. Airway was performed in 88% of patients. Principal complications were thrombosis, hemorrhage and hypertension. Three patients died during this research paper. CONCLUSION: The experience acquired in this deployment demonstrates, once again, the importance of the support that Military Health can provide to Civil Health in the component of crisis management in national territory

Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades.

OBJECTIVE: The Israeli Defense Force (IDF) Medical Corps developed a model of airborne field hospital. This model was structured to deal with disaster settings, requiring self-sufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions worldwide. METHODS: Interviews with physicians who actively participated in the missions from 1988 until 2015 as chief medical officers combined with literature review of principal medical and auxiliary publications in order to assess and integrate information about the assembly of these missions. RESULTS: A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal). This study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations (creativity and improvisation) to accommodate logistics barriers. CONCLUSION: The principals and operative function for deploying medical relief system, proposed over 20 years ago, were challenged and validated in the subsequent missions of IDF outlined in the current study. These principals, with the advantage of the military infrastructure and the expertise of drafted civilian medical professionals enable the rapid assembly and allocation of highly competent medical facilities in disaster settings. This structure model is to large extent self-sufficient with a substantial operative flexibility that permits early deployment upon request while the disaster assessment and definition of needs are preliminary.

La cooperación interdisciplinar en los campamentos de refugiados del Sahara / Interdisciplinary cooperation in refugee camps in the Sahara

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Escalón quirúrgico embarcado, experiencia en el buque de asalto anfibio L-51 «Galicia» en la operación Atalanta (julio-octubre de 2015) / Surgical Team onboard, experience from L-51 «Galicia» Landing Plataform Helicopter warship during «Atalanta Operation» from July to October 2015

INTRODUCCIÓN: La capacidad sanitaria de apoyo a un despliegue naval debe ser acorde con las características de la fuerza naval, la zona de actuación, el tipo de misión y la clase de amenaza. El objetivo de este artículo es describir el personal, material y fármacos del escalón quirúrgico embarcado en el Buque de Asalto Anfibio L-51 «Galicia» durante la Operación «Atalanta» desde julio a octubre de 2015. MATERIAL Y MÉTODOS: Descripción de personal, material y fármacos del escalón quirúrgico embarcado y revisión de la literatura relacionada. RESULTADOS: El equipo quirúrgico embarcado está compuesto por un cirujano general, un traumatólogo, un anestesiólogo, un farmacéutico (diplomado en análisis clínicos) y cuatro enfermeros. Este equipo apoya al primer escalón embarcado (un médico general, un odontólogo, dos enfermeros y dos sanitarios). La zona hospitalaria cuenta con sala de triaje, área prequirúrgica, 2 quirófanos, unidad de cuidados intensivos/reanimación con 8 camas, sala de radiología, sala de laboratorio, sala de esterilización, sala de consulta, gabinete odontológico, sala de infecciosos y varios pañoles de medicación. Se dispone de material y dispositivos sanitarios. Durante el periodo de estudio se ingresaron a 27 enfermos, se intervinieron quirúrgicamente a 2 pacientes y se realizaron 8 técnicas anestésicas. CONCLUSIÓN: Con el personal designado y con el material embarcado se puede cumplir con la misión encomendada

INTRODUCTION: Support medical capability in a maritime deployment would be according to naval forces, operation area, mission characteristics and type of damage. The objective is to describe personnel, material and drugs in the second naval echelon onboard in «Galicia» warship during «Atalanta Operation» from July to October 2015. MATERIAL AND METHODS: Description about personnel, material and drugs. RESULTS: Surgical Team onboard is composed by one general surgeon, one orthopedic surgeon, one anesthesiologist and critical care physician, one laboratory analyst, four nurses. This team helps to Role 1 (general physician, 1 dentist, 2 nurses and 2 medical assistances). The hospital zone in the warship has 1 triage room, 1 presurgical area, 2 operation rooms, 1 intensive care unit with 8 beds, 1 radiology area, 1 laboratory area, 1 sterilization area, 1 medical care room, 1 dental room, infectious area and 2 medicaments stores. Surgical team has material and medical devices. During the period of analysis 27 members were hospitalized, 2 surgical interven-tions and 8 anesthesia techniques were done. CONCLUSION: Medical mission can be accomplished with personnel and material onboard

El vapor de ruedas «Cid»: De pionero de la navegación comercial a vapor a primer vapor hospital / Paddle steamer «Cid»: pioneer of commercial steam navigation to first hospital steamship

La aparición de la máquina de vapor había hecho realidad el sueño de navegar sin depender de las fuerzas de la naturaleza. La carrera por lograr un vapor comercial eficiente había comenzado. Con retraso por la Guerra de la Independencia, España se incorporó a la carrera. Entre los primeros vapores comerciales estaba el vapor «Cid». En 1859, en la Guerra de África, ante la necesidad de una evacuación regular de bajas se designa al «Cid» como buque hospital, fue la primera vez en el mundo que se usó un vapor hospital. El Dr. Nicasio Landa fue el responsable de realizar la misión con una organización moderna, eficaz y ejemplar. Pronto los vapores de ruedas perdieron su batalla con los de hélice y el «Cid» quedó obsoleto. Sin embargo, a pesar de su corta vida operativa, poco más de quince años, escribió una importante página en la historia de la navegación en España

The advent of the steam engine had achieved to navigate without relying on the forces of nature. The race to get an efficient commercial had begun. With the delay caused by the Independence War, Spain joined the race. Among the first commercial steamboats was the «Cid». In 1859, in the African War, the need for regular casualties evacuations made the «Cid» to be designated as a hospital ship, the first hospital steamship in the world. Dr. Nicasio Landa was responsible for carrying out the mission with a modern, efficient and exemplary organization. Soon paddle steamers lost their battle against screw steamers and «Cid» became obsolete. However, despite its short operational life, little more than fifteen years, it wrote an important page in the History of sailing in Spain

Return to contingency: developing a coherent strategy for future R2E/R3 land medical capabilities.

Key to deploying forces in the future will be the provision of a rapidly deployable Deployed Hospital Capability. Developing this capability has been the focus of 34 Field Hospital and 2nd Medical Brigade over the last 18 months and this paper describes a personal account of this development work to date. Future contingent Deployed Hospital Capability must meet the requirements of Defence; that is to be rapidly deployable delivering a hospital standard of care. The excellence seen in clinical delivery on recent operations is intensive; in personnel, equipment, infrastructure and sustainment. The challenge in developing a coherent capability has been in balancing the clinical capability and capacity against strategic load in light of recent advances in battlefield medicine. This paper explores the issues encountered and solutions found to date in reconstituting a Very High Readiness Deployed Hospital Capability.

The 912th forward surgical team in Operation New Dawn: employment of the forward surgical team during troop withdrawal under combat conditions.

The Wars in Afghanistan and Iraq witnessed the first widespread use of U.S. Army Forward Surgical Teams (FSTs). Although doctrinally designed to support maneuver brigades in a linear front conflict, FSTs were quickly adapted to fulfill area support and special operation support missions as part of Operation Enduring Freedom and Operation Iraqi Freedom. FST's were also split to cover a greater area in both theaters. We now report further adaptation of the split FST role to meet the unique requirements encountered during the final phase of Operation New Dawn. Maintaining resuscitative surgical capabilities for U.S. Forces withdrawing under combat conditions required changes in techniques, tactics, and procedures. We describe our experience within three different scenarios in which elements of an FST were successfully employed and discuss operational planning considerations.

1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief.

The Canadian Forces' (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities.

Hospital Cristo Redentor S/A: influências internas e externas na sua formação identitária (1956-2006), Porto Alegre/RS

Este trabalho tem por objetivo identificar as marcas identitárias do Hospital CristoRedentor no contexto de sua criação e quando do seu cinquentenário, analisando e colocandoem comparação as suas diferenças e/ou semelhanças, indicando quais as razões das mudançasou permanências diante do seu projeto original. Pois, esta entidade de saúde localizada nazona norte da cidade de Porto Alegre, no tempo de seu cinquentenário, tem característicasinstitucionais identitárias distintas das características de seu tempo de criação, determinadaspor postura e conduta no âmbito do estado no tocante à política de saúde no plano nacional.Ou seja, são questões internas e externas à instituição que fazem esta ter, atualmente,características de existência diferentes daquelas de sua fundação. E essas questões refletemdiretamente no atendimento à população e seus objetivos como instituição.Assim, para realizar a tarefa optamos por organizar o estudo em quatro partes: umacaracterizando a cidade e região no início do século XX; outra, estabelecendo o porquê dafundação do hospital e caracterizando o que identificamos como sua primeira fase; umaterceira esclarecendo a grande ruptura ideológica que o HCR sofreu na década de 70 e comoseguiu a partir daí até seu cinquentenário; e um último momento analítico, aonde destacamosas principais semelhanças e diferenças entre os períodos.

Hard times call for creative solutions: medical improvisations at the Israel Defense Forces Field Hospital in Haiti.

Mass disaster medicine is characterized by the need to manage limited resources that are far inadequate to meet the population's demands. Under these hectic conditions, lack of specific medical equipment is expected and requires improvisation using available items. We describe the innovative use of medical improvisations at the Israel Defense Forces field hospital, working in the earthquake zone, Port-au-Prince, Haiti, on January 2010. Creative solutions were found to several problems in a variety of medical fields: blood transfusion, debridement and coverage of complex wounds, self-production of orthopedic hardware, surgical exposure, and managing maxillofacial injuries. We hope that the methods described will help to inspire medical teams working in disaster regions.

An academic center's delivery of care after the Haitian earthquake.

The Miller School of Medicine of the University of Miami and Project Medishare, an affiliated not-for-profit organization, provided a large-scale relief effort in Haiti after the earthquake of 12 January 2010. Their experience demonstrates that academic medical centers in proximity to natural disasters can help deliver effective medical care through a coordinated process involving mobilization of their own resources, establishment of focused management teams at home and on the ground with formal organizational oversight, and partnership with governmental and nongovernmental relief agencies. Proximity to the disaster area allows for prompt arrival of medical personnel and equipment. The recruitment and organized deployment of large numbers of local and national volunteers are indispensable parts of this effort. Multidisciplinary teams on short rotations can form the core of the medical response.

Early disaster response in Haiti: the Israeli field hospital experience.

The earthquake that struck Haiti in January 2010 caused an estimated 230,000 deaths and injured approximately 250,000 people. The Israel Defense Forces Medical Corps Field Hospital was fully operational on site only 89 hours after the earthquake struck and was capable of providing sophisticated medical care. During the 10 days the hospital was operational, its staff treated 1111 patients, hospitalized 737 patients, and performed 244 operations on 203 patients. The field hospital also served as a referral center for medical teams from other countries that were deployed in the surrounding areas. The key factor that enabled rapid response during the early phase of the disaster from a distance of 6000 miles was a well-prepared and trained medical unit maintained on continuous alert. The prompt deployment of advanced-capability field hospitals is essential in disaster relief, especially in countries with minimal medical infrastructure. The changing medical requirements of people in an earthquake zone dictate that field hospitals be designed to operate with maximum flexibility and versatility regarding triage, staff positioning, treatment priorities, and hospitalization policies. Early coordination with local administrative bodies is indispensable.

Complejidad de la asistencia urgente en la España del siglo XXI / Complexity of emergency care in XXI century Spain

Los autores desarrollan en este artículo los factoresque a su juicio explican actualmente la complejidadde la asistencia urgente y emergente en España. Desdeel inicio del siglo XXI, y a pesar de que la medicina deurgencias y emergencias en el mundo está viviendo unconsiderable progreso científico-técnico, la asistenciaurgente en España está inmersa en una vorágine asistencialque actúa sobre un terreno poco abonado paraque arraiguen y se desarrollen los avances tecnológicosque sucesivamente van emergiendo. Este problemaes debido a la persistencia de múltiples obstáculosque impiden el progreso incidiendo, principalmentey de manera directa, la ausencia de especialidad y elcorporativismo de las juntas directivas de algunas sociedadescientíficas. Por todo ello, los avances sonpropiciados frecuentemente más por la propia inerciao por el rebosamiento de información desde otras disciplinas,que por el propio empuje de los profesionalesde la medicina de urgencias y emergencias en España.Asimismo, estos profesionales presentan una progresivaincidencia de transfuguismo hacia otras disciplinaso ámbitos de la asistencia que ofrecen mejores condicioneslaborales o simplemente mayores expectativasprofesionales(AU)

In this article, the authors explore the factorsthat, in their opinion, currently explain the complexityof emergency care in Spain. Since the start of theXXI century, and in spite of the fact that accident andemergency medicine in the world is undergoing considerablescientific-technical progress, accident andemergency care in Spain is immersed in a care maelstromacting on a terrain that is ill-prepared for the successiveemergent technological advances to take rootand develop. This problem is due to the persistenceof numerous obstacles preventing progress, with thelack of specialisation and the corporative spirit of themanagement boards of some scientific societies playinga principal and direct role in this. Due to all ofthis, advances are frequently achieved more throughinertia, or through the overflow of information fromother disciplines, than due to the initiative of the professionalsof emergency medicine in Spain. Similarly,there is a growing tendency amongst these professionalsto move to other disciplines or fields of care thatoffer better working conditions or simply better professionalexpectations(AU)

Surgeons without borders: a brief history of surgery at Médecins Sans Frontières.

Médecins Sans Frontières (MSF) is a humanitarian organization that performs emergency and elective surgical services in both conflict and non-conflict settings in over 70 countries. In 2006 MSF surgeons departed on approximately 125 missions, and over 64,000 surgical interventions were carried out in some 20 countries worldwide. Historically, the majority of MSF surgical projects began in response to conflicts or natural disasters. During an emergency response, MSF has resources to set up major operating facilities within 48 h in remote areas. One of MSF strengths is its supply chain. Large pre-packaged surgical kits, veritable "operating theatres to go," can be readied in enormous crates and quickly loaded onto planes. In more stable contexts, MSF has also strengthened the delivery of surgical services within a country's public health system. The MSF surgeon is the generalist in the broadest sense and performs vascular, obstetrical, orthopaedic, and other specialized surgical procedures. The organization aims to provide surgical services only temporarily. When there is a decrease in acute needs a program will be closed, or more importantly, turned over to the Ministry of Health or another non-governmental organization. The long-term solution to alleviating the global burden of surgical disease lies in building up a domestic surgical workforce capable of responding to the major causes of surgery-related morbidity and mortality. However, given that even countries with the resources of the United States suffer from an insufficiency of surgeons, the need for international emergency organizations to provide surgical assistance during acute emergencies will remain for the foreseeable future.