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      Rescue medical activities in the mediterranean migrant crisis

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      Conflict and Health
      BioMed Central

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          Abstract

          The central Mediterranean route, between Libya and Italy, is considered the most dangerous of the migration pathways to Europe. In 2015, 3771 people died trying to reach Europe’s shores; and there were 4655 deaths or disappearances between January and November 2016 [1]. In response to this extreme situation, in early 2016, Medicines du Monde France (MdM), in partnership with SOS Mediterranee, launched an emergency project on board of the MV Aquarius, a ship adapted for search and rescue operations. We describe here the main clinical features observed during search and rescue activities in the central Mediterranean route. Existing studies present medical activities for migrants upon disembarkation, whereas there is far less information on the medical conditions during rescue operations [2, 3]. We set up a clinic on the Aquarius to provide emergency medical care. In addition, psychological first aid, emergency shelter and information services were also provided by the MdM team. The team included two physicians, two nurses, one logistician, one communication officer and one interpreter. SOS Mediterranee search and rescue members were also trained by the MdM medical team to identify severe conditions and provide first aid during rescue. A medical doctor was always available on standby during the approach and rescue manoeuvres. A visual assessment and triage based on the South African Triage Score (SATS) were conducted on the deck by a medical staff member immediately after people were secured on board [4]. Severely sick and injured patients remained in the clinic for observation and follow-up. Decisions regarding medical evacuation and referral upon disembarkation were based on case severity and vulnerability, using the physicians’ clinical assessments and resources available on board. Demographic and clinical data were collected during the intervention by MdM medical staff. During the operation between February and May 2016, out of the 919 people rescued, 212 medical consultations were provided by the medical team on board. All people were rescued from inflatable boats which departed from Libya and the main countries of origin reported by patients were Gambia (27.8%), Nigeria (24.1%) and Senegal (11.8%). Unaccompanied male minors were the main group in our medical consultations (43.6%), followed by both male (35.1%) and female (21.3%) adults. The most frequent medical conditions were accidental trauma (24.1%), medically unexplained physical symptoms (14.2%), intentional trauma (6.6%) and gastrointestinal problems (6.6%). These were often also accompanied by symptoms of mild and moderate hypothermia. The main causes of accidental trauma were chemical burns due to benzene (52.9%), contusions (25.6%) and wounds (21.5%).The main causes of intentional trauma were contusions (50%), bullet injuries (28.5%) and wounds (21.4%).Nearly a third (31%) of patients who attended the clinic had reported recent exposure to violent events. It was a challenge to properly screen mental health conditions and to fully identify severe psychological trauma cases due to time and space constraints on board. The lack of security and physical protection during the travel in overcrowded and unsafe inflatable boats magnifies the presence of accidental trauma, while gastrointestinal problems and symptoms of mild and moderate hypothermia can be associated with the changing weather conditions at sea. Medically unexplained physical symptoms are likely to be related to traumatic events during the travel, including witnessing people drowning, along with previous repeated exposure to violent events such as sexual violence, kidnapping and human trafficking, which all contribute to the burden of intentional trauma-related conditions and mental disorders among the rescued people [5]. This letter provides a snapshot of the clinical features of rescued people.It highlights the substantial health risks among migrants using the central Mediterranean route and the need for adequate health service responses, including during search and rescue operations. MdM continues addressing these urgent health needs and helps to ensure safe routes and access to universal health care for those fleeing conflict, war and poverty [6, 7].

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          Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study

          Background In resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool. Methods A cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (“high acuity” proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively). Results In 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS. Conclusion This is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0531-3) contains supplementary material, which is available to authorized users.
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            Initial assessment and treatment of refugees in the Mediterranean Sea (a secondary data analysis concerning the initial assessment and treatment of 2656 refugees rescued from distress at sea in support of the EUNAVFOR MED relief mission of the EU)

            Background As a part of the European Union Naval Force – Mediterranean Operation Sophia (EUNAVFOR Med), the Federal Republic of Germany is contributing to avoid further loss of lives at sea by supplying two naval vessels. In the study presented here we analyse the medical requirements of such rescue missions, as well as the potential benefits of various additional monitoring devices in identifying sick/injured refugees within the primary onboard medical assessment process. Methods Retrospective analysis of the data collected between May – September 2015 from a German Naval Force frigate. Initial data collection focused on the primary medical assessment and treatment process of refugees rescued from distress at sea. Descriptive statistics, uni- and multivariate analysis were performed. The study has received a positive vote from the Ethics Commission of the University of Ulm, Germany (request no. 284/15) and has been registered in the German Register of Clinical Studies (no. DRKS00009535). Results A total of 2656 refugees had been rescued. 16.9 % of them were classified as “medical treatment required” within the initial onboard medical assessment process. In addition to the clinical assessment by an emergency physician, pulse rate (PR), core body temperature (CBT) and oxygen saturation (SpO2) were evaluated. Sick/injured refugees displayed a statistically significant higher PR (114/min vs. 107/min; p < .001) and CBT (37.1 °C vs. 36.7 °C; p < .001). There was no statistically significant difference in SpO2-values. The same results were found for the subgroup of patients classified as “treatment at emergency hospital required”. However, a much larger difference of the mean PR and CBT (35/min resp. 1.8 °C) was found when examining the subgroups of the corresponding refugee boats. A cut-off value of clinical importance could not be found. Predominant diagnoses have been dermatological diseases (55.4), followed by internal diseases (27.7) and trauma (12.1 %). None of the refugees classified as “healthy” within the primary medical assessment process changed to “medical treatment required” during further observation. Conclusions The initial medical assessment by an emergency physician has proved successful. PR, CBT and SpO2 didn’t have any clinical impact to improve the identification of sick/injured refugees within the primary onboard assessment process. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0270-z) contains supplementary material, which is available to authorized users.
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              Author and article information

              Contributors
              p.favila@gmail.com
              homawe@hotmail.com
              stephspindola@gmail.com
              Journal
              Confl Health
              Confl Health
              Conflict and Health
              BioMed Central (London )
              1752-1505
              22 March 2017
              22 March 2017
              2017
              : 11
              Affiliations
              Medicines du Monde France, Mediterranean Search and Rescue Project, Rue Marcadet 62, Paris, 75018 France
              Article
              105
              10.1186/s13031-017-0105-1
              5361840
              487a7737-a1c2-483c-99b4-cbc4a22ed539
              © The Author(s). 2017

              Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

              Categories
              Letter to the Editor
              Custom metadata
              © The Author(s) 2017

              Health & Social care
              Health & Social care

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