Personal view BMJ Mil Health: first published as 10.1136/bmjmilitary-2020-001569 on 5 August 2020. Downloaded from How do we fight COVID-19? Military Key messages ► As part of the national effort, the medical actions in the war against the French Military Medical Service was committed to the fight COVID-19 pandemic in France against COVID-19, involving all its departments. 1,2 3 3 1,2 4 Pierre Pasquier, A Luft, J Gillard, M Boutonnet, C Vallet, ► Within a global medical system, J- M Pontier,5 S Duron- Martinaud,3 A Dia,6 L Puyeo,7 F Debrus,7 innovative, dedicated interventions 2,8 9 2,10 2,11 brought together adaptive solutions B Prunet, S Beaume, G de Saint Maurice, E Meaudre, to issues encountered in the C Ficko,2,12 A Merens,2,12 G Raharisson,3 B Conte,13 F Dorandeu,2,14 COVID-19 pandemic. F Canini,2,14 R Michel,2,15 S Ausset,2,15 J Escarment2,16 ► Unprecedented and unique actions were conducted, including the use of a military intensive care field hospital health management. The French Military Centre ABSTRACT and multiple collective aeromedical for Epidemiology and Public Health provided ’We are at war’, French President Emmanuel evacuations of patients with severe all information needed to guide the decision- Macron said in an address to the nation on acute respiratory distress syndrome. 16 March 2020. As part of this national effort, making process. Medical centres of the French ► Dedicated military strategies have the French Military Medical Service (FMMS) Armed Forces organised the primary care for been adopted for the management is committed to the fight against COVID-19. military patients, with the widespread use of of patients in France, as well as in This original report aimed to describe and telemedicine. The Paris Fire Brigade and the overseas military operations. detail actions that the FMMS has carried out Marseille Navy Fire Battalion emergency depart- in the nationwide fight against the COVID-19 ments ensured prehospital management of pandemic in France, as well as overseas. Experts patients with COVID-19. The eight French mili- 9–11 in the field reported major actions conducted by tary training hospitals cooperated with civilian cases were confirmed in France. As the FMMS during the COVID-19 pandemic in regional health agencies. The French military part of the national effort, the FMMS was France. In just few weeks, the FMMS developed medical supply chain supported all military committed to the fight against COVID-19, ad hoc medical capabilities to support national medical treatment facilities in France as well involving all its departments. This report describes (Figure 1) the actions carried health authorities. It additionally developed as overseas, coping with a growing shortage copyright. adaptive, collective en route care via aero- of medical equipment. The French Armed out by the FMMS in the fight against the COVID-19 pandemic in France, as well as medical and naval units and deployed a mili- Forces Biomedical Research Institute performed overseas. tary intensive care field hospital. A COVID-19 diagnostics, engaged in multiple research Experts in the field reported the crisis cell coordinated the French Armed Forces projects, updated the review of the scientific following major actions conducted by the literature on COVID-19 daily and provided 1 FMMS during the COVID-19 pandemic Percy Military Training Hospital, French Military Health expert recommendations on biosafety. Finally, Service, Clamart, France in France. 2 Ecole du Val- de- Grâce French Military Medical even students of the French military medical http://militaryhealth.bmj.com/ Academy, Paris, France academy volunteered to participate in the fight 3Direction Centrale du Service de Santé des Armées, against the COVID-19 pandemic. In conclusion, COVID-19 CRISIS RESPONSE CELL OF Paris, France in an unprecedented medical crisis, the FMMS THE FMMS SURGEON GENERAL OFFICE 4Service Médical de la Force d’Action Navale, French engaged multiple innovative and adaptive As early as February 6, 2020, the Military Health Service, Toulon, France FMMS Surgeon General Office initi- 5Cephismer, Centre d’Expertise Plongée pour la Marine actions, which are still ongoing, in the fight Nationale, French Military Health Service, Toulon, France against COVID-19. The collaboration between ated a COVID-19 crisis cell to coordi- 6 Centre d’épidémiologie et de Santé Publique des military and civilian healthcare systems rein- nate actions related to the COVID-19 Armées, French Military Health Service, Marseille, France pandemic.12 13 The purpose of this response 7 forced the shared objective to achieve the goal Direction de la Médecine des forces, French Military cell was to ensure continuity and ongoing Health Service, Tours, France of ’saving the greatest number’. 8Emergency Department, Brigade de Sapeurs- Pompiers adaptation of military medical support de Paris, Paris, France while responding to the public health on September 24, 2021 by guest. Protected 9Bataillon des Marins- Pompiers de Marseille, French authorities’ requests for assistance.14–16 Military Health Service, Marseille, France Providing care as close to the front- 10 This twofold challenge involved main- Legouest Military Training Hospital, French Military line as possible is the ultimate mission taining the French Armed Forces opera- Health Service, Metz, France 11 of the French Military Medical Service tional capabilities at home and in overseas Sainte- Anne Military Training Hospital, French Military 1 2 Health Service, Toulon, France (FMMS). Beyond this primary mission, military operations while ensuring the 12Bégin Military Training Hospital, French Military Health the FMMS makes a significant contribution health of military personnel and limiting Service, Saint- Mandé, France to the field of public health and the design 13 the spread of severe acute respiratory Direction des approvisionnements en produits de of government risk-management plans santé des armées, French Military Health Service, syndrome coronavirus 2 (SARS- CoV-2). Orléans, France intended to deal with health crises and From 6 April, more than 20 000 virtual 3–8 14Institut de Recherche Biomédicale des Armées, French terrorist threats. In the spring of 2020, consultations were conducted.17 The Military Health Service, Brétigny- sur- Orge, France COVID-19 spread through France. ‘We 15 use of teleworking enabled military Écoles Militaires de Santé, French Military Health are at war’, French president Emmanuel and medical teams to preserve human Service, Lyon- Bron, France 16French Military Health Service, Paris, France Macron said in an address to the nation on resources and to conduct all core missions 16 March 2020. ‘The enemy is invisible, of the French Armed Forces, including Correspondence to Prof Pierre Pasquier, Percy and it requires our general mobilisation’. the new COVID-19 French population- military training hospital, French Military Health Service, 18 Clamart 92140, France; pasquier9606@ me. com By mid- April, over 100 000 COVID-19 supporting Operation RESILIENCE. In Pasquier P, et al. BMJ Mil Health Month 2020 Vol 0 No 0 1 Personal view BMJ Mil Health: first published as 10.1136/bmjmilitary-2020-001569 on 5 August 2020. Downloaded from Collective aeromedical evacuations of civilian critically ill patients with COVID-19 8 military training hospitals - 9,268 patients with COVID-19 The French Air Force and the FMMS - 2,419 hospitalisations Field military intensive care hospital deployed a collective aeromedical evac- - 472 ICU admissions - 47 patients with COVID-19 and ARDS uation (aero- MEDEVAC) system. This Telemedicine - > 1000 consultations / day system used a military A330 Airbus, equipped with a resuscitation module for high elongation evacuation (MoRPHEE Module de Réanimation pour Patient à Haute Elongation d’Évacuation) system > 12,000 patients with COVID-19 and ARDS in prehospital setting which transformed the plane into an - Paris fire brigade > 60 Medevac missions for patients with COVID-19 - Marseille navy fire battalion - fixed- rotary-wings, naval ship intensive care unit (ICU) for a long- distance aero- MEDEVAC of six critically 6 collective ICU aeromedevac 21 22 - patients with COVID-19 and ARDS ill patients (Figure 2). A total of six aero- MEDEVAC systems transferred 36 patients with COVID-19. The six aero- MEDEVAC flights lasted between 52 and 77 min, with distances ranging from 700 to 1080 km. All patients received protec- tive mechanical ventilation. Two patients experienced severe hypoxaemia episodes. No other serious respiratory adverse events occurred, and no life-threatening Figure 1 French Military Medical Service's responses to COVID-19. ARDS, acute respiratory event was reported. distress syndrome; ICU, intensive care unit. Conception and deployment of a 30-bed overseas military operations, the FMMS aeromedical evacuation of all patients military intensive care field hospital in doctrine is based on early damage control presenting with respiratory symptoms or Eastern France resuscitation and surgery, combined with low- risk factors.20 Furthermore, in just copyright. Following the order of the French presi- early strategic aeromedical evacuations.2 19 few weeks, the FMMS developed ad hoc dent, the FMMS designed a 30- bed mili- These principles were applied to patients medical capabilities to support national tary intensive care field hospital. In an with COVID-19, intending to limit the health authorities: adaptive en route care unprecedented manner, the Élément Mili- incidence of severe COVID-19