Page 84 - JSOM Summer 2023

A Review of Medical Evacuations Related to
Dental Emergencies and Oral-Maxillofacial Injuries

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Iram Qureshi, MPH ; John Simecek, DDS, MPH *;
Timothy Mitchener, DMD, MPH 3

ABSTRACT
A literature review was performed to determine the frequency a 2011 study of French soldiers in Mali during Operation Ser-
of medical evacuations (MEDEVAC) that are required for den- val (Gunepin et al.) showed that nearly 16% of medical evac-
tal emergencies (DE) and oral-maxillofacial (OMF) injuries. uations of French soldiers were due to DEs. Afghanistan has
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Fourteen studies were reviewed altogether – eight which quan- a mountainous topography which makes having an advanced
tified evacuation of DEs or OMF injuries in military person- road system next to impossible. According to Mitchener, Dick-
nel (from 1982–2013) and six studies that discussed medical ens & Simecek, as of 2006, only 29% of the roadway system
evacuation of DEs occurring in civilians working in offshore there is paved. Therefore, it is difficult to set up remote mil-
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oil and gas rigs and wilderness expeditions (from 1976–2015). itary healthcare facilities or to easily use ground transporta-
Among military personnel, DE/OMF issues were frequently tion to travel to seek treatment. This made the reliance of air
among one of the top categories of medical evacuations, rang- evacuations in this type of rugged environment much more
ing from 2–16% of all evacuations. Among oil and gas indus- crucial for military personnel seeking treatment for DEs and
try workers, 5.3–14.6% of evacuations were dental-related, OMF trauma. A 2015 study by Gunepin et al. of French sol-
while one study of wilderness expeditions found that DEs diers deployed to Afghanistan (with no organic dental sup-
ranked as the third most frequent type of injury that required port) showed that 65% of troops that experienced oral-facial
evacuation. Previous studies have shown that dental and OMF problems required evacuation to the nearest dental treatment
problems often account for one of most frequently cited rea- facility. On the other hand, very few studies have looked at
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sons for evacuation. However, due to the limited study base medical evacuations in the civilian sector and simultaneously
of DE/OMF medical evacuations, further research is needed addressed dental issues as a cause for evacuation.
to determine their impact on the cost of health care delivery.
The objective of this study is to determine the percentage of
Keywords: medical evacuation; medevac; military personnel; MEDEVACs that are required for DE/OMF issues. This study
dental emergencies; oil and gas industry; emergencies; den- looks at such issues in US military personnel and in foreign
tal care; health care costs; stomatognathic diseases military personnel. Additionally, this study examines such is-
sues in the civilian population in both the US and abroad.

Methods
Introduction
A literature search was performed on pubmed.gov, a freely
Medical evacuations are extremely expensive, especially those searchable database provided by the US National Library of
that require an air ambulance. A 2019 civilian study by Bai et Medicine of the National Institutes of Health, and Google
al. reported that the median cost of an air evacuations within Scholar, a freely accessible web search engine used to search
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the US to be close to $40,000. One civilian study, led by Thi- for scholarly literature. The objective was to find studies which
bodaux et al., estimated the average cost of air evacuation off quantified DEs that required medical evacuation support in
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an oil rig to be almost $50,000. A military study by Griffith military members and the civilian population. Keywords such
described the US Department of Defense’s (DoD) cost of air as “Dental” AND “MEDEVAC” (medical evacuation), “Den-
evacuations of ill or injured US servicemembers deployed as tal Emergency” AND “Medical Evacuation” were used. From
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part of US Africa Command (AFRICOM). Depending on the these searches, we were able to identify 14 peer-reviewed arti-
location in Africa, the cost of a military air evacuation to mil- cles that span 39 years (1976–2015) that quantified the medical
itary medical care in Landstuhl, Germany ranges wildly. The evacuations and their reasoning. Eight studies quantified evac-
range goes from $17,000 from locations along the Mediter- uations of DEs or OMF injuries in military personnel (from
ranean Ocean to $265,000 from locations in countries such 1982–2013) and six studies discussed medical evacuation of
as Djibouti, Kenya, Mali and Nigeria. DE and more severe DEs occurring in civilians (from 1976–2015). Table 1 lists the
problems related to OMF trauma require a dentist and/or an 14 articles included in this review in chronological order by
oral-maxillofacial surgeon to provide proper treatment. DE study year, along with the full title, population in the study,
and OMF injuries affecting military personnel during opera- and years the study was conducted. The full citations for these
tions or civilians located in remote environments may require articles are listed in the references. Results were categorized as
evacuation for receiving medical/dental facilities. For example, military or civilian and summarized in chronological order.
*Correspondence to john.w.simecek2.civ@health.mil
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1 Iram Qureish, Dr John Simecek, and Dr Timothy Mitchener are all affiliated with the Naval Medical Research Unit San Antonio, JBSA San
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Antonio, TX.
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