Modalities of Medical Assistance to Populations in French Role 1 Facilities From January 2020 to December 2021

Abstract

Introduction: Medical assistance to populations (MAP) is a rich and varied activity, but it is not well known, and its modalities are inconsistent and unclear, particularly in the pediatric field; they can confront the military doctor with difficult management issues. Today, a military doctor deployed in foreign operations (FOs) does not know if he will perform MAP. He does not know how it will be carried out, nor if it will include a pediatric component. Finally, he does not know what difficulties he will face and therefore cannot prepare himself effectively. The primary objective of this work is to describe the modalities of MAP in FO, with an emphasis on the pediatric activity. The secondary objective is to develop a template for a post-session MAP registry.

Materials and methods: This was a retrospective descriptive study. An electronic questionnaire was sent to all physicians in Forces Medicine. All military physicians deployed to a role 1 structure between January 1, 2020, and December 31, 2021, were included. The questionnaire reports the sociodemographic data of the responding physicians and their skills in pediatrics, the modalities of MAP, and the difficulties encountered, and questions the interest of setting up a "tactical health watch" and a tele-expertise with pediatricians in France. Analyses are descriptive (means, graphs, and percentages). This work was authorized by the Directorate of Forces Medicine and the Directorate of Training, Research, and Innovation of the French Defense Health Service.

Results: We obtained 140 analyzable responses, among which 102 deployments in a role 1 facility, and 44% of the physicians practiced MAP. The share of pediatrics during MAP sessions is estimated to be significant (i.e., >50% of patients) by 42% of physicians. Physicians felt that they were having difficulties in their MAP activity in 26% of the cases and in their pediatric activity in 38% of the cases. Difficulties encountered in pediatrics seemed to diminish with the level of experience in FO or when the practitioner had a pediatric activity back in metropolitan France. On the contrary, difficulties seemed to increase when the training in pediatrics was greater.

Conclusions: MAP in FO is an activity in which modalities are very variable depending on the theater. Practitioners must have a solid theoretical and practical preparation beforehand, particularly in pediatrics. Keeping a specific activity register is an essential basis for judiciously adapting human and material resources dedicated to this activity. Future studies should aim to investigate more precisely the difficulties encountered.