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study showed that most of the evacuations were because of the data capture is variable and not standardized. AFRICOM
disease (63%) and non-battle injury (33%), with battle inju- would benefit from a data capture method such as the DoD
ries accounting for only 4%. The Benghazi consulate attack Trauma Registry data collection mandate within US Central
16
falls within the timeframe of this retrospective review and can Command. Previous studies have highlighted the limitations
be used for comparison when examining the larger trend of of data collection prior to reaching a Role 2 or Role 3. 1,17,18
medical evacuations. Even though the injuries sustained in this Such a system, which previously was not used, now allows
singular kinetic operation were traumatic in nature, they are for data-driven solutions for the exceptionally large footprint
similar to the region’s trend over time in the decreased need for of AFRICOM. Despite these limitations, our small case series
evacuation resources for evacuations classified as battle inju- does focuses on a unique aspect of the military support re-
ries. The study also shows that during this time, most patients quired for diplomatic missions within unstable regions.
who were evacuated originated from Djibouti, which is ap-
proximately 4800 km from Benghazi, thus limiting the aircraft Conclusions
options for evacuation during the attack. Analyzing the larger
4
dataset in Carius et al. and the Benghazi causalities reinforces This case series focuses on the unique aspects of military sup-
the logistical strain of forces thinly spread within a very large port of diplomatic missions in countries lacking a stable gov-
area of operations, such as AFRICOM. Causalities rely on lo- ernment. Such events have implications as the US transitions
cal resources whenever available for both routine and emer- from military missions to diplomatic missions in several re-
gent medical care. With extended transport times, AFRICOM gions. The need for coordination of assets and planning for
faces a limited internal logistical supply chain for supply and medical evacuations between government agencies, as transi-
resupply as well as transport times for the transfer of patients. tions from in-mission types occur, will allow for better utili-
zation or creation of medical assets, aiding the transportation
The development of partnerships with regional allied nations, time variables faced in the AFRICOM area of operations.
such as the United Arab Emirates (UAE), can be seen as assisting
in the potential alleviation of transport times. The collaboration Acknowledgments
with a joint trauma team from the US DoD, which is embed- We would like to thank Mr Mark Barnes for providing us with
ded in a 750-bed facility (Mayo Clinic and Sheikh Shakhbout these data.
Medical City), and UAE Armed Forces Medical Professionals
hospital in Abu Dhabi, serves a military-military-civilian part- Ethics
nership and acts as a Landstuhl of the Middle East. Similarly, We submitted protocol FWH20180147N to the 59th Medical
such locations or partnerships in allied African nations could Wing regulatory office, which determined it was exempt from
serve as closer evacuation points in this large continent. institutional review board oversight. We obtained only deiden-
tified data.
Large distances in Africa and an increasing dispersion of com-
bat resources with the use of Expeditionary Resuscitation Conflicts/Disclosures
Surgical Teams (ERSTs) may offer a solution in providing nec- None.
essary medical care closer to casualties and possibly within the
golden hour timeframe beneficial in trauma resuscitation. 14,15 Disclaimer
ERSTs and similarly structured teams can perform damage The view(s) expressed herein are those of the author(s) and do
control resuscitation and surgery in austere locations of the not reflect the official policy or position of Brooke Army Med-
continent. The critical care capabilities of these units can be ical Center, the US Army Medical Department, the US Army
prolonged when held in garrison, but they quickly decrease Office of the Surgeon General, the Department of the Army,
in austere environments with acutely injured and complex pa- the Department of the Air Force, or the Department of Defense
tients. Evacuations from the AFRICOM theater do not follow or the US Government.
the injury pattern seen in Operation Iraqi Freedom/Operation
Enduring Freedom but rather are composed more of disease References
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